At Three Rivers Medicine in St. Louis, Missouri, our physician-led primary care perimenopause care provides comprehensive evaluation and management for women experiencing symptoms related to the transitional phase before menopause. This stage, known as perimenopause, involves hormonal fluctuations that can affect menstrual patterns, mood, sleep, and overall well-being. Perimenopause care within a primary care context means your symptoms are evaluated in the full context of your health, not dismissed as “just hormones.” Concierge medicine at Three Rivers extends this model with extended visit time, preventive focus, and deep coordination with specialists when needed.
Perimenopause is a natural biological transition that can begin years before menopause, typically in the late 30s to mid-40s. During this time, estrogen and other hormone levels fluctuate significantly, leading to symptoms that overlap with other health conditions. Primary care physicians are uniquely positioned to assess these changes, integrate lab results, and coordinate care for coexisting issues like thyroid dysfunction, sleep disorders, metabolic transitions, and cardiovascular risk.
Recent clinical observations suggest anywhere from 40–80% of women experience perimenopausal symptoms significant enough to seek medical care, including vasomotor changes (hot flashes), mood disturbances, sleep disruption, and menstrual irregularities. Personalized, physician-supervised care helps distinguish perimenopause from other conditions and tailor treatment plans accordingly.
What Is Perimenopause?
Perimenopause refers to the period leading up to menopause when the ovaries begin to produce less estrogen and progesterone. This hormonal transition can last several years and may begin in the late 30s or early 40s, though the timing varies by individual. Symptoms arise from fluctuating hormone levels and may include irregular periods, hot flashes, night sweats, sleep disturbances, mood swings, decreased libido, and changes in menstrual flow.
Not everyone experiences every symptom, and severity can vary widely. Because symptoms overlap with other health conditions — such as thyroid disorders, sleep apnea, anxiety, or metabolic changes — a thorough medical assessment is essential to avoid misdiagnosis.
Common Perimenopausal Symptoms We Assess
- Irregular menstrual cycles and changes in bleeding patterns
- Hot flashes and night sweats
- Mood swings, anxiety, or depression
- Sleep disturbances or insomnia
- Decreased libido or vaginal dryness
- Weight changes or altered metabolism
- Memory or concentration issues (“brain fog”)
Why Physician-Led Care Matters
Perimenopause care that is physician-led and integrated into primary care provides continuity and coordination. Unlike symptom-specific clinics or oversimplified online interventions, primary care contextualizes symptoms within your broader health — including cardiovascular, metabolic, and mental health. This approach helps avoid misdiagnosis or ineffective treatment plans.
Women’s health transitional phases often require careful interpretation of symptoms because hormonal changes may mimic or mask conditions like thyroid disease, depression, or sleep disorders. Evidence supports comprehensive assessment over isolated symptom treatment.
How Primary Care-Based Perimenopause Care Works
Step 1: Detailed Medical Evaluation
Your clinician conducts an in-depth review of symptoms, medical history, and lifestyle. This includes documenting menstrual cycle changes, sleep patterns, mood concerns, and other health indicators that may influence your transition. Primary care evaluation ensures symptom context is not overlooked.
Step 2: Targeted Diagnostic Testing
While hormone levels fluctuate and single tests may not definitively diagnose perimenopause alone, lab work can be helpful in ruling out other causes such as thyroid dysfunction, anemia, or metabolic imbalances. Testing is ordered thoughtfully to guide medical decisions rather than as routine screening in every case.
Step 3: Personalized Care Plan
If perimenopause is contributing to your symptoms, your clinician creates a personalized plan. This may include hormone therapy when indicated, non-hormonal treatment options, lifestyle support strategies, and coordination with specialists such as cardiology or endocrinology when complex needs arise.
Step 4: Monitoring and Follow-Up
Perimenopause is a dynamic state; symptoms and health priorities change over time. Regular follow-up visits allow your physician to monitor symptom progression, adjust treatment plans, and manage related health factors such as bone health or cardiovascular risk.
Schedule a Complimentary Consultation You will speak with a clinician, clarify your symptoms, and outline next steps for ongoing evaluation or care planning.
Explore Related Services
For comprehensive women’s health across life stages, you may also be interested in our Internal Medicine offerings and broader preventive care strategies. To learn more about holistic hormone and midlife health support, visit our News & Insights section.
