Perimenopause is the transitional phase leading up to menopause, and for many women, it is when symptoms first appear—often years before periods stop completely. Hormonal shifts during this time can affect energy, sleep, mood, weight, focus, and overall well-being. Because hormone levels fluctuate rather than decline in a predictable pattern, perimenopause is frequently misunderstood and misdiagnosed, leaving many women frustrated and without clear answers.
Thoughtful perimenopause care depends on experience, ongoing assessment, and flexibility as hormones shift. Dr. Corey Howard is board-certified, has specialized training in hormone management, and has spent decades helping women navigate perimenopause as a central focus of his practice. Under his concierge care model, he makes himself available to patients when they need him, which is a major departure from the impersonal traditional healthcare system.
Stages of Perimenopause
Perimenopause typically begins in a woman’s 30s or 40s and can last several years. Early perimenopause is often marked by subtle changes in cycle length or flow, while later stages may include skipped periods and more noticeable symptoms. Because timing and progression vary widely, recognizing perimenopause early can help women address symptoms before they intensify.
Common Symptoms of Perimenopause
Symptoms during perimenopause may include:
- Irregular or changing menstrual cycles
- Fatigue and low energy
- Sleep disturbances or night sweats
- Mood changes, anxiety, or irritability
- Brain fog or difficulty concentrating
- Weight changes, especially around the midsection
- Changes in libido or sexual comfort
Symptoms can fluctuate from month to month, which is why ongoing assessment is so important.
Hormonal Changes During Perimenopause
Perimenopause is characterized by fluctuating estrogen and progesterone levels rather than a steady decline. Progesterone often decreases first, which can affect sleep and mood, while estrogen levels may spike and crash unpredictably. Testosterone levels may also shift, contributing to changes in energy, muscle mass, and motivation.
Understanding these patterns—and how they interact with stress, metabolism, and lifestyle—is essential for choosing appropriate treatment.
Diagnosing Perimenopause
Diagnosing perimenopause involves more than a single lab test. Dr. Howard evaluates symptoms, menstrual history, hormone levels, and overall health together. Because hormone levels can vary daily during this phase, diagnosis often relies on clinical judgment supported by targeted testing and follow-up rather than isolated numbers.
Hormone Therapy for Perimenopause
Hormone therapy during perimenopause focuses on stabilizing hormonal fluctuations and relieving symptoms while supporting long-term health. Treatment may include estrogen, progesterone, and in some cases testosterone, depending on symptoms and lab findings.
Choosing the right therapy, delivery method, and dosing requires experience and regular monitoring. Dr. Howard adjusts treatment over time as hormone patterns change, rather than relying on fixed protocols.
Additional Treatment Options and Lifestyle Support
Hormone therapy works best when paired with lifestyle strategies that support hormonal balance and metabolic health. This may include:
- Nutrition guidance to support blood sugar and inflammation
- Strength training and movement plans to protect muscle and bone
- Sleep optimization strategies
- Stress management to reduce cortisol-related hormone disruption
Dr. Howard integrates these elements into care when appropriate, recognizing that hormones do not function in isolation.
Why Choose Dr. Howard for Perimenopause Care?
Dr. Corey Howard offers perimenopause care through a concierge model designed for access, continuity, and thoughtful medical guidance. Patients pay one flat fee that covers all appointments, calls, and texts, allowing for ongoing communication without rushed visits or fragmented care. You get access to someone who will listen when you need them.
The Comprehensive Health Partnership provides advanced diagnostics, hormone and metabolic analysis, and a personalized plan addressing all aspects of wellness, longevity, and performance. It can help you optimize your health during and after perimenopause. Building a long-term relationship with a dedicated provider is key to feeling your best.
Perimenopause care at our clinic is proactive, data-driven, and centered on the individual—not on outdated assumptions or one-size approaches.
Perimenopause FAQs
What is perimenopause?
Perimenopause is the transitional phase before menopause when hormone levels begin to fluctuate. It can start years before periods stop completely and often brings symptoms that feel unpredictable because hormones are rising and falling rather than steadily declining.
At what age does perimenopause usually begin?
Many women enter perimenopause in their late 30s or 40s, though timing varies. Symptoms may appear even when cycles are still regular, which is why perimenopause is often overlooked or mistaken for stress or burnout.
What are the most common symptoms of perimenopause?
Symptoms may include irregular cycles, fatigue, sleep disturbances, mood changes, anxiety, brain fog, weight changes, and shifts in libido. Symptoms often come and go, which can make them frustrating and difficult to explain.
Can perimenopause be diagnosed with a blood test?
There is no single test that definitively diagnoses perimenopause. Hormone levels fluctuate frequently during this stage. Diagnosis is based on symptoms, cycle patterns, health history, and lab work interpreted in context.
Is hormone therapy an option during perimenopause?
Yes. Hormone therapy can be appropriate during perimenopause for many women, particularly when symptoms affect daily life. Treatment focuses on stabilizing hormonal fluctuations and requires careful dosing and regular follow-up.
Do I need to wait until menopause to get help?
No. Waiting often means living with unnecessary symptoms. Addressing perimenopause early can improve quality of life and help women feel more supported as they move toward menopause.
What is the best thing to do during perimenopause?
The most important step during perimenopause is to take symptoms seriously. Paying attention to changes in sleep, mood, energy, and cycles, supporting the body through nutrition and movement, and seeking medical guidance when symptoms begin to interfere with daily life can make a meaningful difference. Early care often leads to more options and better long-term outcomes.
Schedule a Perimenopause Consultation in Naples
If you’re experiencing symptoms that don’t feel like “your normal” and want clear answers and thoughtful care, perimenopause treatment may be the missing piece.
Dr. Howard offers in-person and telehealth consultations for perimenopause care. Call Howard Health and Wellness in Naples, FL at 239-331-2285 to get started.
