What to ask your doctor at your next perimenstrual check-up
At 56 in 2025, actress Naomi Watts released a book entitled, Dare I Say it: Everything I Wish I'd Known About Menopause. In it, she described menopause as "the adult version of puberty—this is puberty in reverse."
Among other symptoms, puberty is characterized by hormonal changes, which perimenopausal women also go through. This is normal, according to naturopathic doctor and wellness educator Dr. Debra Rouse.
At a talk organized by Healthy Options, entitled What Every Woman Should Know About Hormones, Rouse discussed how hormones affect women's health, including when they're going through perimenopause and menopause. Perimenopause is the transition period before menopause, while menopause is the biological process that marks the permanent end of a woman's menstrual cycle and her ability to bear babies.
Questions for the doctor
According to Rouse, current research says perimenopause begins 15 years before menopause, not five to seven years, as experts initially said. That period of over a decade can be marked with multiple symptoms, including hot flashes, irregular periods, migraines, sleep problems, brain fog, joint pain, and mood changes.
While you may ask your doctor how to address these specific symptoms, Rouse suggests also asking them to check for the following.
Baseline blood levels
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If you haven't had any blood tests done to address your perimenopausal symptoms, Rouse recommended you get some basic blood work so you can see where your baseline levels are.
To give the doctor a better understanding of where you're at, Rouse suggested you say, "I feel like I'm going through some changes and I wanna make sure that I don't have any deficiencies that I need to address before I move through any midlife transition."
Testosterone levels
"It depends on what stage of life you're in. But if you have unwanted hair growth or acne, you're going to want to look at [your] testosterone levels," Rouse said.
Both men and women produce testosterone, the hormone usually associated with high levels of acne and excess facial and body hair in women.
According to a study published on ScienceDirect, women's testosterone production normally shifts throughout the menstrual cycle. However, perimenopause doesn't typically cause elevated testosterone levels. That's why unusual acne or hair growth warrants a visit to the doctor for a check on testosterone levels.
Blood sugar
"Check your blood sugar [level] now. Check your fasting insulin levels now," said Rouse.
She added that higher levels of blood sugar can cause shakiness, a lack of energy, and even increase the frequency of sugar cravings.
Thyroid
"Rule out your thyroid first before assuming it's perimenopause," said Rouse.
"Subtle brain fog, too-high or too-low cortisol levels, raised blood sugar levels—all those can mimic symptoms or dysfunction in other areas," she added.
If all the tests turn out normal, said Rouse, it could be a sign that the changes are hormone-related.
Keeping hormones in check
Whether or not women are approaching menopause, they need to balance their hormones because these play a major role in bone and heart protection, sexual health, blood sugar management, moods, and stress response.
Rouse, who has over 30 years of clinical experience in women's health, recommended a list of habits women can start today to regulate their hormones.
Make fiber the hero
While protein is important, Rouse said fiber is a woman's "best friend." Add to your diet dark green leafy vegetables, malunggay, broccoli, cauliflower, kale, and cabbage, among other cruciferous vegetables.
For blood sugar and insulin management, eat more beans, legumes, nuts, and seeds.
Walk
"I know we're all busy, but one very important lifestyle change is a 10-minute post-meal walk," said Rouse. "Movement is medicine."
That brief walk after meals, added Rouse, can "help lower blood pressure, drive energy into the muscles, and burn blood sugar."
Build strength
"The other thing that's really important with all of this is going to be strength training and some weightlifting," recommended Rouse.
The workout doesn't have to be intense, especially if you are going through physical challenges, such as endometriosis or Polyendocrine metabolic ovarian syndrome. Rouse suggested focusing on more nurturing exercises than extreme weightlifting.
Get exposed to early morning sunlight
Rouse suggested even a five-to-10-minute exposure can do wonders.
Doing so will stimulate melatonin production in the brain. "So that when you lay down at night, that melatonin will be like, 'Great, now I can release'," said Rouse.
When the body releases melatonin at night, it signals the brain that it's time to wind down and sleep.
Meditate and do breathwork
If you can meditate in the morning light, that would be even better. It doesn't have to be 30 minutes with eyes shut. Rouse said it can even be just "five minutes here and there or one minute when you have a moment to yourself."
This supports the mitochondria, which boosts energy production, among other things.
End your showers in cold water
A 15-second splash of cold water on the thyroid, which is located in the lower front part of the neck, and the adrenal gland, found in the upper abdomen, helps calm and balance the nervous system, said Rouse.
Be consistent with sleep and wake times
Healthy patterns for bedtime and waking time are also beneficial for the nervous system, Rouse added.
"It's really just owning your power and saying, 'Hey, something doesn't feel right'," Rouse said.
"If you're just noticing something's shifted, bring it up. Don't let it go on," she said. "Because it's what we tend to do as women; we're carrying the weight of our families, our kids, our parents, that we put ourselves last."
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