Perimenopause and Menopause Symptoms: Answers From 8 Leading Experts

Perimenopause and menopause can bring questions about brain fog, belly fat, sleep, sexual changes and hormone therapy. Even when you know your body well, it can be hard to understand what’s changing or decide which question to ask first.

I know that feeling. When I started going through menopause, I was struggling to read the teleprompter at work. I would lose words and my train of thought. I started leaving notes on my computer because I was afraid I would forget something.

I was still getting my period, so menopause wasn’t even on my radar.

Those experiences are a big reason I keep asking questions on The Tamsen Show. Sometimes I’m asking your question. Sometimes I’m asking mine. And even after writing How to Menopause, I still learn something every time I sit across from an expert.

For World Menopause Month, I brought selections from eight expert interviews into one episode. Here are the main takeaways, along with questions you can bring to your next appointment.

Listen to The Menopause Episode

1. Can you be in perimenopause if you still have periods?

Yes. Having periods does not rule out perimenopause.

In my conversation with OB-GYN Dr. Sharon Malone, we discuss why this part of the menopause transition can be confusing. Women may notice changes in how they feel while they are still menstruating, and they may never consider perimenopause as a possible explanation.

That was me. I thought having a period meant menopause couldn’t be part of what was happening.

Dr. Malone also explains why a single hormone blood test can be misleading during the transition. One result does not necessarily capture the changes happening over time.

Another misconception we address is that you must wait until you have gone a full year without a period before discussing treatment. That milestone helps identify menopause, but it does not mean you need to postpone a conversation about symptoms.

Treatment and contraception are separate considerations. If you still need pregnancy prevention, bring that into the conversation with your clinician.

A question to ask: Could my symptoms fit perimenopause, even though I’m still having periods?

2. Can menopause brain fog get better?

Menopause brain fog does not necessarily remain the same forever. Cognition can improve or stabilize through the transition, although women’s experiences vary.

When I sat down with neuroscientist Dr. Lisa Mosconi, I had noticed something encouraging. I was feeling sharper again. My memory seemed better, and I wasn’t reaching for my notes as often.

I wanted to know whether that improvement could be real.

Dr. Mosconi explains different patterns of cognitive recovery and why the answer is not identical for everyone. Her explanation helped me understand what I had been noticing in myself.

This conversation offers hope without promising that everyone’s brain fog will disappear. Some findings discussed were unpublished at the time of recording, and persistent cognitive problems deserve individual assessment.

A question to ask: What should we evaluate if my memory or concentration problems persist or affect my daily life?

3. Why might spending more time in bed make insomnia worse?

When you’re exhausted, going to bed earlier or staying in bed longer can seem like the obvious solution. But spending more time in bed does not necessarily mean getting more sleep.

Sleep psychologist Dr. Shelby Harris explains cognitive behavioral therapy for insomnia, often called CBT-I. The conversation covers time spent in bed, consistent wake times, what happens when you’re awake during the night and the dread that can build around bedtime.

I needed her to explain this. I remembered so many nights of lying there, trying to force myself to sleep.

One important part of the discussion is guidance. Adjusting time in bed is a treatment strategy to work through with a qualified professional or an appropriate guided program. It is not a suggestion to start depriving yourself of sleep.

A question to ask: Would CBT-I be appropriate for my sleep problems, and where can I get guidance?

4. What should you know about menopause belly fat?

The fat you can see is not the whole story.

Endocrinologist Dr. Rocio Salas-Whalen explains the difference between subcutaneous fat, which sits beneath the skin, and visceral fat around internal organs.

That distinction matters because a conversation about belly fat should include metabolic health, not only appearance.

In the episode, we discuss why liposuction does not address visceral fat around the organs. Dr. Salas-Whalen also discusses the role of strength training and protein.

I know how frustrating it can feel when your jeans fit differently even though you’re eating the same and still working out. Understanding these distinctions gives you more useful questions than simply asking how to make your stomach look different.

This section does not offer a specific protein target or a personalized weight-loss plan. It explains why the type of fat matters.

A question to ask: How should we assess my metabolic health alongside the changes I’m noticing around my waist?

5. Why does bone health matter around menopause?

Bone health deserves attention before a fracture brings it to your attention.

Orthopedic surgeon Dr. Vonda Wright discusses peak bone mass, bone loss around menopause and details that can help inform a conversation about your own risk.

These include family history, height loss and a fracture after a relatively minor fall.

We notice when our clothes fit differently. Bone changes can be much easier to miss.

Dr. Wright also shares her clinical opinion about earlier baseline bone-density testing. That should not be interpreted as a universal screening recommendation. Whether and when you need a scan depends on your age, risk factors and clinical assessment.

A question to ask: Based on my history and risk factors, when should I have a bone-density test?

6. How can menopause affect sex and sexual anatomy?

Menopause-related sexual changes can involve more than desire.

Urologist Dr. Kelly Casperson discusses gaps in sex education and how changes in hormones can affect sexual tissues, arousal and orgasm.

When she described changes that can happen to the labia and clitoral tissues, I stopped her. I wanted her to explain what could change and why.

These changes do not happen identically to everyone. But knowing they are possible can help you describe an experience you might otherwise struggle to explain.

The conversation also addresses why women deserve more than dismissive advice when something feels different. A concern about pain, arousal or orgasm is worth bringing up.

This selected clip focuses on understanding the changes. It does not cover the full discussion of who can use vaginal estrogen.

A question to ask: Could tissue or hormonal changes be contributing to how sex feels, and what should we evaluate?

7. Does the type of hormone therapy matter when discussing breast cancer risk?

Yes. A meaningful discussion needs to identify which treatment and which evidence you are talking about.

Oncologist Dr. Avrum Bluming distinguishes estrogen-only therapy from combined hormone therapy and discusses findings from the estrogen-alone arm of the Women’s Health Initiative.

That study context matters. The estrogen-alone findings concern a particular trial population of women who had undergone hysterectomy. They cannot be generalized to every hormone regimen, every woman or treatment after breast cancer.

This was personal for me. I lost my mother to breast cancer, and I brought those fears into the conversation.

The takeaway is to ask for precision. “Hormone therapy” is a broad phrase, and your medical history belongs in the discussion of potential benefits and risks.

A question to ask: Which hormone treatment are we considering, and how does the evidence apply to my personal history?

8. What does “hormone balance” mean on a menopause supplement label?

A phrase on the front of a bottle does not tell you everything you need to know about the product.

OB-GYN Dr. Suzanne Gilberg-Lenz helps us look more closely at menopause supplements, including ingredient information, proprietary blends, medication interactions and third-party testing.

When you want to feel better, it is easy to buy something and hope it will help. This conversation gives you questions to ask before spending your money.

Third-party testing may help verify aspects of product quality. It does not establish that a supplement will improve your symptoms or be safe for everyone.

Herbal ingredients can also cause harm or interact with medications. “Natural” does not remove the need to discuss what you’re taking with your clinician.

Questions to ask: What are the ingredients and doses? What evidence supports this product? Could it interact with anything I take?

What to bring to your next appointment

You do not need to remember every term from this episode. Start with the part that sounds like your own experience.

Write down what has changed, when you noticed it and how it affects your day. Then choose the questions you most want answered.

You might want to discuss:

• Whether your symptoms could fit perimenopause
• Memory or concentration changes that need assessment
• Support for ongoing insomnia
• Belly-fat changes and metabolic health
• Your bone-health risk
• Sexual discomfort or changes in arousal
• The benefits and risks of a specific hormone treatment
• Supplements and possible medication interactions

Knowing more can help you describe what you’re experiencing and ask for an explanation that makes sense to you.

Listen to the full menopause episode

This episode brings together Dr. Sharon Malone, Dr. Lisa Mosconi, Dr. Shelby Harris, Dr. Rocio Salas-Whalen, Dr. Vonda Wright, Dr. Kelly Casperson, Dr. Avrum Bluming and Dr. Suzanne Gilberg-Lenz.

These are the conversations I wanted in one place because I know you don’t always have time for eight full interviews.

Listen to The Menopause Episode

For more context, explore the full interviews:

Is Hormone Therapy Safe? The Menopause Debate Explained

Exclusive: Top Neuroscientist Dr. Lisa Mosconi Unveils New Data On HRT And Alzheimer’s Risk

The #1 Sleep Expert Reveals What’s Ruining Your Sleep

Why Your Belly Fat Isn't Moving (And What To Actually Do)

The #1 Longevity Doctor: How Women Can Burn Fat, Build Muscle & Age Strong

Testosterone and Menopause: Every Women Should Know This

You can also learn more in my book, How to Menopause

This article summarizes conversations on The Tamsen Show for general education. Symptoms can have other causes. Discuss your concerns and treatment options with a qualified healthcare professional.

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