Perimenopause, Menopause, and Post-Menopause: The Phases of Menopause

 

 

As a woman approaches midlife, her body begins to undergo a series of natural and sometimes disruptive changes. These transitions, particularly perimenopause and menopause, can significantly impact a woman's physical, emotional, and mental well-being. While menopause is frequently discussed, perimenopause—the transitional period leading up to it—often receives far less attention. Dr. Steven R. Goldstein, MD, is a Certified Menopause Practitioner and a Menopause Specialist in NYC.

With decades of experience treating thousands of women through every stage of this transition, Dr Goldstein would like to help you better understand what’s happening in your body and what your options are for feeling like yourself again.

What Is Perimenopause?

Perimenopause is the stage leading up to menopause, marked by a gradual decline in the hormones estrogen and progesterone. Most women begin to notice perimenopausal symptoms in their early 40s, though for some, these changes may begin as early as their 30s. This transition period can last anywhere from 4 to 7 years, though the timeline varies widely among individuals.

Symptoms of perimenopause can be diverse and, at times, disruptive. They often include irregular periods, occasional hot flashes, difficulty sleeping, mood swings, vaginal dryness, reduced concentration, and even episodes of free-floating anxiety. These symptoms are caused by fluctuating and destabilizing hormone levels, as ovulation becomes less regular.

It’s important to understand that if you're experiencing any of these symptoms, you are not alone—and more importantly, you’re not imagining things. These changes are real and physiologically based. As a specialist in perimenopause and menopause care, Dr Goldstein works with women every day to evaluate these symptoms and develop individualized plans to help manage them effectively.

Menopause: A Natural Life Stage

Menopause itself is officially diagnosed when a woman has gone twelve consecutive months without a menstrual period. While some women transition through menopause with few complications, others may experience significant symptoms that interfere with daily life. These may include hot flashes, night sweats, mood changes, low libido, vaginal atrophy, and changes in weight.

Beyond these more noticeable symptoms, menopause can also have serious implications for long-term health. Estrogen plays a critical role in maintaining bone density and cardiovascular health. As estrogen levels drop, the risk for osteoporosis and heart disease increases.

It’s crucial to recognize that menopause is not a disease—it is a natural biological process. However, that does not mean women need to suffer through it without support or treatment. Each woman’s experience is unique, and there is no “one-size-fits-all” approach to managing symptoms. Which is why Dr Goldstein, a Menopause Specialist in NYC, practices individualized patient care where he personally sits with each patient to understand their medical history, symptoms and more in order to come up with an individualized treatment plan for their Menopause.

How Hormone Replacement Therapy (HRT) Can Help

One of the most effective ways to manage moderate to severe symptoms of menopause is hormone replacement therapy (HRT). HRT involves replenishing the estrogen—and in some cases, progesterone—that your body is no longer producing at the same levels.

As a HRT Specialist NYC, Dr Goldstein assesses each patient's unique medical history, symptoms, and lifestyle before recommending any treatment. This careful, individualized approach ensures that any therapy is tailored to the patient's specific needs and health goals. While HRT is highly effective for many women, it is not suitable for everyone, and part of his job is helping you weigh the benefits and risks in the context of your overall health.

Post-Menopause: Monitoring for Important Signs

The post-menopausal phase begins after a woman has fully transitioned through menopause. At this stage, many of the earlier symptoms may ease or resolve. However, there are still important health considerations.

One of the most concerning symptoms that can occur post-menopause is any form of vaginal bleeding. Even light spotting, short in duration or infrequent, must be taken seriously. In medical training, we emphasize a rule of thumb: “Postmenopausal bleeding is uterine cancer until proven otherwise.” While the cause may often be benign, it is essential to conduct a thorough evaluation to rule out serious conditions, including endometrial cancer.

If you are postmenopausal and experience any bleeding, do not ignore it. Prompt assessment is key to ensuring your continued health and peace of mind.

Personalized Care from a Menopause Expert

In his practice, Dr Goldstein, an HRT Specialist in NYC, treats women at every stage of this journey—whether you're beginning to notice early signs of perimenopause, going through the height of menopausal symptoms, or are well into post-menopause. The goal is always the same: to provide compassionate, evidence-based care that helps you understand your body and make informed decisions about your health.

As a Certified Menopause Practitioner and a Past President of the International Menopause Society, Dr Goldstein brings both experience and a global perspective to his practice. He also co-authored The Estrogen Alternative, a book focused on empowering women to navigate hormone therapy options safely and effectively and textbooks on Menopause and Perimenopausal gynecology.

If you're experiencing symptoms of perimenopause, menopause, or post-menopause—or simply want a trusted medical professional to talk to about your concerns, schedule a consultation. Together, we can create a plan to support your health and well-being through this important stage of life.

 

YOUR CYCLES DURING PERIMENOPAUSE

 

Perimenopause is a natural yet often misunderstood phase in a woman’s reproductive journey. It represents the transitional period leading up to menopause, marked by hormonal shifts that can significantly impact both physical and emotional well-being.

Menopause itself is defined as the point at which ovarian function ceases entirely. At this stage, the ovaries no longer produce estrogen, and ovulation stops. However, the period leading up to this transition—known as perimenopause—is more nuanced and often challenging to navigate.

 

What Happens During Perimenopause?

 

Dr Steven R. Goldstein, a Perimenopause Specialist in NYC says that Pre-menopause (not Perimenopause) refers to the time when women are still producing estrogen and may be ovulating regularly. In contrast, perimenopause begins with the first signs of irregularity in the menstrual cycle. While most women associate any vaginal bleeding with menstruation, not all bleeding during this phase is a true menstrual period.

 

Clinically, a menses is defined as bleeding that occurs approximately two weeks after ovulation. During perimenopause, many cycles become anovulatory—meaning ovulation does not occur—even though estrogen is still being produced. In these cases, progesterone, which typically follows ovulation, is absent.

 

This hormonal imbalance—characterized by fluctuating estrogen without the stabilizing presence of progesterone—can lead to irregular bleeding patterns. Beyond physical changes, it can also result in a range of psychosocial symptoms. These may include increased premenstrual syndrome (PMS), anxiety, mood swings, difficulty concentrating, sleep disturbances, and the commonly reported “brain fog.” Unlike menopause, where estrogen is largely absent, perimenopause is dominated by erratic levels of unopposed estrogen.

 

Symptoms and Misunderstandings

Vasomotor symptoms such as hot flashes and night sweats are often thought to occur only in menopause, but they can also emerge during perimenopause. However, during this phase, they are typically caused by a rapid drop in estrogen rather than a complete lack of it.

 

Despite its prevalence, perimenopause remains underrecognized. Many women in their thirties or forties begin experiencing symptoms but are unaware of the hormonal shifts taking place. The irregular cycles and emotional symptoms often lead to confusion, and in some cases, their concerns may be dismissed as psychological rather than physiological. This misunderstanding can delay proper care and support.

 

Advancing Awareness and Education

The topic of perimenopause has gradually gained attention thanks to the contributions of leading gynecologists and menopause specialists like Dr Steven R. Goldstein, co-author of Could it be…Perimenopause?, one of the pioneering books addressing this transitional stage.

 

As a past president of both the International Menopause Society and the North American Menopause Society, and a Certified Menopause Practitioner, his efforts have significantly advanced public and medical understanding of the condition.

Increased awareness, education, and medical recognition are essential to ensure that women receive appropriate guidance and care during this complex stage of life.

 

Perimenopause is not “all in the head.” It is a real, hormonally driven experience that deserves to be addressed with knowledge, compassion, and clinical insight. If you are a woman experiencing these symptoms, then schedule a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist in NYC

 

Understanding PCOS: What You Need to Know Before You Worry

 

 

If you’ve recently been told you might have Polycystic Ovarian Syndrome (PCOS), it’s completely understandable to feel concerned. You may have gone online and read about the risks of infertility, insulin resistance, or even diabetes later in life. For many young women, hearing “PCOS” can feel like a life-changing diagnosis. But the truth is, sometimes this label is applied too quickly—or even incorrectly.

 

Dr. Steven R. Goldstein, MD, a leading gynecologist in NYC, has seen this all too often. Young women, usually in their teens or early twenties, come into his office deeply worried after being told they have PCOS. But after a full evaluation, Dr. Goldstein finds that many of these patients do not actually meet the medical criteria for this diagnosis.

 

Let’s break down what’s really going on—and why you may not need to worry.

 

What Is PCOS?

 

Polycystic Ovarian Syndrome is a hormonal condition that affects how a woman's ovaries work. True PCOS is typically characterized by three key features:

 

1.    Irregular or absent menstrual periods

2.    High levels of androgens (male hormones such as testosterone), either in blood tests or seen as symptoms like facial hair growth (especially on the chin), severe acne, or hair thinning

3.    Ovaries that appear “polycystic” on ultrasound, meaning they contain 12 or more small follicles

 

According to the Rotterdam Criteria, a widely accepted guideline, a woman must have at least two of these three characteristics to be diagnosed with PCOS.

  

What’s Actually Happening in Many Young Women

 

Dr. Goldstein points out that many young women who have been labeled with PCOS don’t actually meet these criteria. Here’s what he’s seeing:

 

• Their periods are a little irregular—but that’s common and even expected during late adolescence and early adulthood. Your menstrual cycle is governed by a complex interaction between your brain (hypothalamus and pituitary gland) and your ovaries, and it often takes time—sometimes until your mid-twenties—for this system to fully mature.
  
  
• An ultrasound may show “multiple small follicles” in the ovaries. This can sound alarming if you're told it looks “polycystic.” But here’s the key insight: this appearance is completely normal in many healthy young women. In fact, with today’s high-resolution ultrasound machines, up to 50% of women may show more than 12 follicles per ovary—making this finding far less meaningful than it used to be.
  
  
• These patients are usually not obese, do not have elevated testosterone or DHEA-S levels, and do not have symptoms like excess facial hair or acne. In short, they are healthy.
  
  

Dr. Goldstein prefers to use the term “multicystic ovaries” to describe what he sees in these cases. It simply refers to the presence of multiple follicles, which is often a normal part of the menstrual cycle in younger women and not a disease. It’s not the same thing as PCOS—and it doesn’t mean you’ll have trouble with fertility or develop diabetes later in life.

The Importance of a Proper Diagnosis

Getting a PCOS diagnosis can have real implications—not just emotionally, but also in terms of how your health is managed. If you’re told you have PCOS when you actually don’t, you might be started on treatments you don’t need, or live in fear of problems that may never arise.

 

That’s why Dr. Goldstein gynecologist in NYC stresses the importance of taking a careful, individualized approach. Instead of rushing to label every irregular period or follicle-rich ovary as PCOS, it’s important to look at the whole picture—your symptoms, hormone levels, body composition, and overall health.

 

There’s Good News

If you’re a young woman with slightly irregular periods and an ultrasound that shows multiple follicles—but you don’t have elevated androgens or other symptoms—you’re most likely just going through a natural phase of reproductive development. According to Dr. Goldstein’s experience, the overwhelming majority of women in this situation go on to have normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes.

 

When to Seek a Second Opinion

If you’ve been told you have PCOS and you’re unsure if the diagnosis is accurate, consider seeking a second opinion. A thoughtful, experienced gynecologist like Dr. Steven R. Goldstein can help you understand what’s truly going on in your body and whether any treatment is actually necessary.

 

You deserve clarity, reassurance, and care based on the latest medical understanding—not outdated criteria or hasty conclusions.

 

Ready to Feel Confident About Your Health?

Dr. Steven R. Goldstein, MD, is a top NYC Gyn with decades of experience helping women understand and manage their reproductive health. If you're unsure about a PCOS diagnosis or simply want to learn more about your body, Dr. Goldstein can provide the insight and support you need.

 

Schedule your consultation today and get the answers—and peace of mind—you deserve.