You wake up at 3 AM for no reason. You’re snapping at people you love. Your periods are suddenly unpredictable, and your jeans fit differently even though nothing about your routine has changed. You mention it to a doctor and hear that it’s probably stress.
For many women in their forties, it isn’t stress. It’s perimenopause, the years of hormone change that lead up to menopause. Because the symptoms start while you’re still having periods, they often get blamed on work, kids, or getting older.
At Yunella Women’s Health in Los Angeles, Dr. David Seil Kim has cared for women through this transition for nearly 30 years. This article explains the difference between perimenopause and menopause, what symptoms to expect, whether hormone therapy is safe, what your other options are, and what a menopause visit with Dr. Kim looks like.
What Is the Difference Between Perimenopause and Menopause?
People use “menopause” to describe the whole experience, but it’s really three stages.
- Perimenopause is the transition. Your ovaries make less estrogen and progesterone, the two main female hormones, and the levels swing up and down from month to month. Periods become irregular. This stage usually begins in the early to mid forties and lasts several years.
- Menopause is a single point in time: 12 months in a row without a period. The National Institute on Aging puts the average age in the United States at about 52.
- Postmenopause is everything after that. Some symptoms fade. Others, like vaginal dryness, tend to start later and don’t go away on their own.
Most of what brings women to our office happens in perimenopause, not after menopause. That surprises a lot of patients.
What if my periods stop early?
Periods that stop before age 45, and especially before 40, are not treated as ordinary menopause. There can be other causes, and going without estrogen at a younger age affects your bones and heart. If this sounds like you, tell us when you call. Early menopause changes what the first visit needs to cover.
What Are the Symptoms?
Hot flashes get the attention, but they’re often not the first sign. For many women, sleep changes first. Menopause symptoms can include:
- Hot flashes and night sweats. A sudden wave of heat, usually in the face, neck and chest, sometimes followed by chills. Doctors call these vasomotor symptoms.
- Trouble sleeping. Waking in the middle of the night, with or without sweating.
- Mood changes. Irritability, anxiety, or feeling low in a way that’s new for you.
- Brain fog. Trouble concentrating or finding words.
- Irregular periods. Closer together, further apart, heavier, or lighter.
- Vaginal dryness and pain with intercourse.
- Urinary changes. Needing to go more often, or getting more bladder infections.
- Weight changes. Especially more weight around the middle.
- Joint aches, heart palpitations, and lower libido.
You don’t need all of these to be in perimenopause, and no two women have the same mix.
One symptom needs a prompt visit. Bleeding after menopause is never normal. If you’ve gone a year without a period and then bleed, even lightly, call us. Most causes are harmless, but abnormal bleeding always needs to be checked, usually starting with an in-office ultrasound. Very heavy periods during perimenopause deserve a look too, because fibroids and polyps are common at this age.
How Do I Know If I’m in Perimenopause?
Mostly from your story. There is no single blood test that confirms it. Hormone levels in perimenopause can be high one week and low the next, so one lab result often doesn’t settle the question.
Dr. Kim makes the diagnosis from the pattern: your age, how your cycles have changed, and which symptoms you have and when they started. Blood tests are still useful, but for a different reason. They rule out conditions that can look like perimenopause, especially thyroid problems. When bloodwork is needed, it’s drawn at the lab in the building next door.
Can I still get pregnant?
Yes. Until you’ve gone a full 12 months without a period, you can still ovulate, which means you can still get pregnant. If you don’t want a pregnancy, you still need birth control during perimenopause. Some methods also help with heavy or irregular periods, so it’s worth talking through the options.
What Is Hormone Therapy?
Hormone therapy, also called HRT or menopausal hormone therapy, replaces the estrogen your body is no longer making. It comes in two main forms:
- Systemic hormone therapy travels through your whole body. It comes as a pill, a skin patch, a gel or a spray. This is the form that treats hot flashes, night sweats and sleep problems.
- Vaginal estrogen is a cream, tablet or ring placed in the vagina. Very little reaches the rest of your body. It treats dryness, pain with intercourse and urinary symptoms, but not hot flashes.
If you still have your uterus, systemic estrogen is always given together with a second hormone, progesterone. Estrogen by itself can cause the lining of the uterus to overgrow, and progesterone protects it. If you’ve had a hysterectomy, estrogen alone is enough.
Dr. Kim prescribes FDA-approved hormone therapy. Which type and which form is decided with you at your visit.
Is Hormone Therapy Safe?
This is the first question in most of these appointments, and the honest answer is that it depends on who is asking.
Here is why so many women were told to avoid it. In 2002, a large study called the Women’s Health Initiative reported that hormone therapy raised the risk of breast cancer, heart disease, stroke and blood clots. Prescriptions dropped almost overnight, and a strong warning was added to every estrogen product.
Since then, researchers have looked much more closely at that data. Many of the women in the study were in their sixties and seventies and had started hormones many years after menopause. For younger women closer to menopause, the picture looks different.
Two things reflect where the science stands today:
- The Menopause Society, the leading professional group in this field, says hormone therapy is the most effective treatment for hot flashes and night sweats. It says the benefits outweigh the risks for most healthy women who are under 60 or within 10 years of menopause and have symptoms.
- In November 2025, the FDA announced it was removing the broad boxed warning about heart disease, stroke and other risks from menopause hormone products. The labels now tell doctors and patients to weigh age, health history and timing.
That doesn’t mean hormone therapy is right for everyone. The risks are higher if you start it after 60 or more than 10 years past menopause. It may not be appropriate if you’ve had breast cancer, a blood clot, a stroke, or certain other conditions.
Dr. Kim has been in practice long enough to have prescribed hormones before the 2002 study, after it, and after the reappraisal. His approach is to look at your age, how long it’s been since your last period, your own health history and your family’s, and then tell you what applies to you.
What about “bioidentical” hormones and pellets?
“Bioidentical” means the hormone has the same structure as the one your body makes. Many FDA-approved products are bioidentical, including most estrogen patches and gels. What’s different are custom-mixed (compounded) hormones and pellets sold by some clinics. Those aren’t reviewed by the FDA for safety, dose or quality. At Yunella, Dr. Kim prescribes FDA-approved hormone therapy.
What If I Can’t or Don’t Want to Take Hormones?
You still have real options. Some women can’t take hormones for medical reasons, and others would simply rather not.
- Newer non-hormonal medications for hot flashes. Two daily pills work on the part of the brain that controls body temperature. Veozah (fezolinetant) was approved in 2023, and Lynkuet (elinzanetant) was approved in October 2025. Both require blood tests to check your liver.
- Other prescription medications. A low dose of certain antidepressants can reduce hot flashes, even in women who aren’t depressed.
- Treating sleep and mood directly. These often improve with their own treatment, with or without hormones.
- Everyday changes. Dressing in layers, keeping the bedroom cool, cutting back on alcohol, and regular exercise help some women, though usually not enough for severe symptoms.
Vaginal Dryness, Painful Sex and Bladder Changes
These symptoms have a name: genitourinary syndrome of menopause, or GSM. Estrogen keeps the tissue of the vagina and bladder thick, stretchy and moist. When estrogen drops, the tissue gets thinner and drier. That can cause burning, pain with sex, a frequent need to urinate, and repeat bladder infections.
Unlike hot flashes, GSM doesn’t get better with time. Left alone, it slowly gets worse. Many women never mention it because they assume it’s just part of aging or feel awkward bringing it up.
It’s also one of the most treatable parts of menopause. Low-dose vaginal estrogen works well, and very little is absorbed into the rest of the body, so the safety conversation is different from the one about systemic hormones. Non-hormonal moisturizers and lubricants help too. Pain with sex is something Dr. Kim examines and treats. You don’t have to work up to asking.
Weight, Bones and Heart: The Changes You Can’t Feel
Some effects of menopause don’t cause symptoms, which is why they’re easy to miss.
Weight. Falling estrogen shifts where your body stores fat, and muscle mass drops with age. Many women gain weight around the middle without changing how they eat or move. It isn’t a lack of effort. Dr. Kim evaluates this as part of medical weight management, which can include medication when it’s appropriate.
Bones. Bone loss speeds up in the years around menopause. The U.S. Preventive Services Task Force recommends a bone density scan for all women at 65, and earlier for women past menopause who have risk factors such as a parent who broke a hip, low body weight, or smoking. Dr. Kim talks with you about when yours should be.
Heart. Blood pressure, cholesterol and blood sugar often rise after menopause. Your forties and fifties are a good time to know your numbers, when there’s still plenty you can do about them.
This is why menopause care at Yunella isn’t only about hot flashes. It connects with your regular well-woman care, including your Pap test, breast health and screening.
What Happens at a Menopause Visit at Yunella?
These appointments are scheduled longer than a standard visit, so there’s time to go through everything. Here is what to expect:
- A full history. Dr. Kim asks about your cycles, each symptom and when it started, what you’ve already tried, and your personal and family health history. Your history largely decides which treatments are safe for you.
- Testing where it helps. Thyroid and other bloodwork can rule out conditions that mimic perimenopause. Hormone levels are ordered when they’d change the answer.
- Your options, laid out clearly. Dr. Kim explains what hormone therapy could and couldn’t do for your symptoms, what the risks are for you specifically, and what the non-hormonal choices are.
- A plan you can start. Treatment usually begins with whatever bothers you most, so it’s clear what’s working.
- Follow-up. You come back on a set timeline to adjust the dose, change the plan, or stop. Prescriptions aren’t left to renew themselves for years.
Bring a list of everything you’ve been blaming on stress. It usually takes one conversation to sort out what is what.
Frequently Asked Questions
At what age does perimenopause start? Usually in the early to mid forties, though it can begin in the late thirties. It lasts several years.
How long do hot flashes last? It varies widely. For many women they continue for several years, and for some they last a decade or more. You don’t have to wait them out.
Can a blood test tell me if I’m in menopause? Usually not by itself. Hormone levels swing too much during perimenopause. Dr. Kim relies on your symptoms and history, and uses blood tests mainly to rule out other causes.
Does hormone therapy cause breast cancer? The answer depends on the type of hormone therapy, how long you take it, and your own risk. For most healthy women who start near menopause, the added risk is small. Dr. Kim goes over your personal risk before you decide on hormone therapy.
How long can I stay on hormone therapy? There’s no fixed time limit. Dr. Kim reviews it with you regularly and continues it as long as the benefits outweigh the risks for you.
Do I still need birth control? Yes. You need birth control until you’ve gone 12 months without a period.
Is weight gain in menopause inevitable? No. Your body does change, and what worked at 30 often stops working. That’s a reason to look at what has changed, and Dr. Kim can help through medical weight management.
I’m bleeding after menopause. Should I worry? Call us. It’s usually something minor, but bleeding after menopause always needs to be checked.
Will my insurance cover menopause care? Coverage depends on your plan. See Insurance & Payment or call our office.
Why see a gynecologist and not a hormone clinic? Los Angeles has many places that sell hormones. At Yunella, a board-certified OB/GYN examines you, reviews your history, and remains your doctor afterward for everything else. More answers are on our FAQ page.
Menopause Care at Yunella Women’s Health in Los Angeles
If you haven’t felt like yourself and no one has given you a clear answer, you don’t have to push through it. Dr. Kim listens to the whole picture, explains what’s happening in your body, and gives you a plan built around your history and what you want.
Call 424-404-8832 or request an appointment. Learn more about menopause and hormonal health and well-woman care at Yunella, or see what our patients say in their reviews and testimonial films.
Medically reviewed by David Seil Kim, MD, PhD · Last reviewed: October 15th, 2026
This article is for education and does not replace individualized medical advice.