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By Dr. Gail King
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Women deserve clear information about how aging may affect their health before symptoms begin to disrupt daily life. Concerns about sleep, memory or sexual health should receive thoughtful attention, even when they may be associated with aging. Recognizing that a change is common should lead to a discussion about its possible causes and appropriate care.
In my practice, I have recently noticed more women in their early 40s asking about hormones and what lies ahead. That observation does not establish a national trend. It does, however, raise a practical question: How well are we preparing women who do not yet know what to ask?
I believe preparation for perimenopause and menopause should become a routine part of midlife care. Women should not have to arrive with their own research before receiving an explanation of what may change, which concerns warrant assessment and what options might help.
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The Office on Women’s Health outlines three stages of menopause. Perimenopause is the transition leading up to menopause. Menopause is a retrospective moment identified only after 12 consecutive months without a menstrual period. Postmenopause is the life stage that follows. Understanding these stages can help women prepare for changes in their health rather than simply waiting for symptoms to pass.
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Better Preparation
Even that basic conversation needs room. In my view, short appointments and competing clinical and administrative demands can make preparation difficult. An annual examination may leave questions unanswered. A patient may assume everything relevant has been considered, while her clinician may not know which changes are troubling her most.
This is where a more deliberate approach could help. Asking about disrupted sleep, difficulty concentrating or changes in sexual desire gives women permission to discuss concerns they might otherwise leave unspoken.
I have made a point of raising questions and concerns about libido directly rather than waiting for patients to mention it. Sensitive subjects belong in ordinary medical conversations.
Listening carefully also means avoiding assumptions about the cause. Menopause should not become a catch-all explanation for every midlife symptom. A useful assessment considers the patient's history, the nature of the change and whether other explanations need investigation. Reassurance should follow that consideration.
Testing and Treatment
The same care applies to testing. Women deserve to know what their bloodwork includes and what its results can establish. Yet more testing is not automatically more informative. The Royal College of Obstetricians and Gynaecologists advises that women over 45 with menopausal symptoms usually do not need hormone tests to diagnose menopause.
A thoughtful discussion should explain when testing would change care. The way I see it, what harm is it doing? If a patient wants to know more about their hormonal fluctuations, we should absolutely dig deeper into the specifics and get them the answers they are looking for.
Bone health offers another reason to look beyond immediate symptoms. The U.S. Preventive Services Task Force's 2025 recommendation supports osteoporosis screening for women aged 65 and older, and for younger postmenopausal women whose clinical assessment indicates increased fracture risk.
These are the suggested guidelines, but they are not individualized or prioritized for the patient. We should absolutely look early and often so that we can intervene at the osteopenia stage, rather than waiting for full-blown osteoporosis, when the risk of fracture drastically increases.
Treatment deserves the same individual attention. Hormonal and nonhormonal options should be discussed in relation to symptoms, medical history, preferences, and potential benefits and harms. Women should be able to understand why an option is offered or ruled out. Neither enthusiasm for hormones nor fear of them should replace that discussion.
Better Follow-Up
If we leave women to work through unanswered questions alone, some may continue tolerating symptoms they could have discussed or struggle to judge conflicting online advice. Earlier conversations could give them a clearer basis for decisions. That is a realistic improvement worth pursuing without promising to prevent every difficulty associated with aging.
Access matters, too. Time to ask questions should be part of ordinary care, including for women who cannot afford concierge services. A follow-up visit may help, but arranging another appointment can carry costs and practical burdens. Practices should make the next step clear and help patients find a workable way to continue the discussion.
Before leaving a routine visit, women should identify any unresolved concern and request a dedicated follow-up when needed. Bring a brief record of what has changed and how it affects daily life. Clinicians should explain what warrants investigation, discuss appropriate options and agree on when to review progress.
“Normal for your age” should begin a care conversation, not close it. If you’re not getting the answers that are aligned with what you are looking for, seek a second opinion.
Dr. Gail King is a physician and founder of Dr. Gail King Longevity Medicine in Aspen, Colorado. Her work includes women’s health, hormone therapy, and individualized care; all opinions are the author’s own.
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