Perimenopause, the transitional phase leading to menopause, is a significant yet often misunderstood stage in a woman’s life. For many women, it’s a challenging time that impacts quality of life, work productivity, and mental health. It can last for 2-8 years and is often symptomatic. During this time women may suffer with common perimenopause symptoms, such as heavy menses, mood swings, breast tenderness, brain fog, insomnia, and more. 

Unfortunately, there is a notable gap in both patient and provider education around perimenopause, which can make this time even more challenging. The lack of education on perimenopause can be attributed to many factors, including insufficient medical training, limited patient formal education, cultural stigmas around this stage of life, historical neglect of women's health issues, and variability of perimenopausal symptoms. On June 2, 2025, DUTCH released its “Perimenopause Management” course, free for all registered DUTCH providers, in order to help close this gap in education. 

The Education Gap: A Barrier to Care

Insufficient Medical Training and Limited Patient Formal Training

One of the barriers to effective perimenopause care is the lack of comprehensive training for providers and health education for patients. Many general practitioners have relatively little training on perimenopause and menopause, and patients themselves are uninformed. An online 2022 survey by Harper et al. found that more than 90% of women had never been taught about menopause in school, and more than 60% did not feel informed about menopause. Moreover, the majority of women started looking for information on perimenopause when their symptoms started (68.2%), with only 12.3% looking before they became symptomatic. This combination often results in years of silent suffering, as women struggle to understand their symptoms and find knowledgeable providers.

Cultural Stigma

Cultural attitudes also contribute to the lack of education around perimenopause. Perimenopause, like menopause, is often dismissed as a "natural" phase and a normal part of aging. This type of thinking minimizes the suffering of so many women during  this stage in their lives. It prevents providers from prioritizing perimenopause education and discourages women from seeking help. Moreover, some providers may tell women that their symptoms are “normal”. While well-intentioned, this message can leave women feeling invalidated and hopeless.

Historical Neglect of Women's Health 

Women’s health has long been neglected by the medical field. Before 1993, women were rarely included in clinical trials. In fact, in 1977 the Food and Drug Administration (FDA) put a policy in place to exclude reproductive age women from Phase 1 and Phase 2 clinical trials unless they had a life-threatening condition. This was understandable to some degree, as previous clinical trials (e.g., thalidomide) on pregnant women resulted in birth defects and in some cases fetal death. But this policy excluded all reproductive age women, including women who were not pregnant, women on birth control, and women who abstained from sex. Unfortunately, this gender bias has contributed to health care disparities, especially for women of color. The medical field still doesn’t know how well many drugs work for women, and women are more likely to have side effects from medications. Medical research on women’s health is far behind where it should be, and in effect, contributes to the lack of education and knowledge around perimenopause.

Perimenopausal Symptom Variability

The symptoms that women experience in perimenopause can vary dramatically, and symptoms can change as a woman progresses through this stage towards menopause. One woman may experience debilitating hot flashes, while another might suffer with mood swings or cognitive challenges. This variability and unpredictability makes perimenopause difficult to standardize, study, and treat uniformly. 

DUTCH’s Perimenopause Management Course: A Step Toward Change

Recognizing the need to bridge this education gap, DUTCH has developed a comprehensive Perimenopause Management course, available free to all registered DUTCH providers starting June 2, 2025. This self-paced, online program consists of five lessons designed to equip healthcare providers with the knowledge to support their perimenopause patient population effectively:

1. Lesson #1: Perimenopause Physiology: This lesson explores the physiological changes during perimenopause, focusing on the hypothalamic-pituitary-ovarian (HPO) axis. By comparing perimenopause physiology to reproductive physiology, providers gain insight into symptom origins, lab trends, and treatment considerations.

2. Lesson #2: Perimenopause Lab Testing: Lesson 2 delves into diagnostic tools, including serum and DUTCH urine testing. Providers learn to interpret lab findings to assess hormonal changes and stage perimenopause accurately.

3. Lesson #3: Perimenopause Lifestyle & Supplement Support: This lesson emphasizes non-hormonal interventions, such as dietary adjustments, exercise, stress management, and evidence-based supplements, to alleviate symptoms and improve quality of life.

4. Lesson #4: Hormone Therapy Risks & Benefits: Lesson 4 provides a brief overview of hormone therapy, exploring its potential benefits for symptom relief and long-term health, alongside risks and contraindications.

5. Lesson #5: Hormone Therapy in Perimenopause: The final lesson focuses on practical applications of hormone therapy, focusing on estrogen and progesterone, tailored to individual patient needs and stages of perimenopause.

By covering physiology, diagnostics, and treatment options, this course empowers providers to deliver personalized, evidence-based care. 

Why This Matters

Perimenopause is not just a biological transition; it’s a stage of life that can profoundly shape a woman’s well-being, relationships, and work life. Left unaddressed, symptoms like insomnia or brain fog can affect mental wellbeing, while heavy bleeding or hot flashes can disrupt daily routines. The lack of education and clinical support exacerbates these challenges, leaving healthcare providers and their perimenopausal patient population to navigate this phase with limited resources. DUTCH’s course aims to transform perimenopause care by equipping providers with specialized knowledge on perimenopause physiology, diagnostics, and treatment options.

Sign up for the DUTCH Perimenopause Management Course Today!

Consider taking a step towards improving the quality of care for your perimenopausal patients by signing up for the DUTCH “Perimenopause Management” course (and telling your colleagues about it also)! By investing time in this education, you can increase your knowledge of this misunderstood stage and get better results with more targeted and personalized patient treatment plans!

Registered DUTCH Providers can access this course through the homepage of the Provider Portal. Not a DUTCH Provider? Become one today!

References:

Balch, B. et al. (2024, March 26). Why we know so little about women’s health. AAMC.  

Harper JC et al. An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Womens Health (Lond). 2022 Jan-Dec;18:17455057221106890.