Navigating Perimenopause with Dr. Kacy Stille
What Every Woman Needs to Hear About Perimenopause
For many women, perimenopause doesn't announce itself with a flashing sign.
Instead, it might look like restless nights, brain fog during an important meeting, increased anxiety, unexplained weight gain, or the nagging feeling that something just feels “off.” You may not even realize all of those changes could be connected.
During a recent UNC Health Appalachian Health Talk, Dr. Kacy Stille, a gynecologist at Women's Health in Boone, shared something she hears from women all the time, “Patients just come and say, ‘I just don't feel like myself anymore. I feel like I'm not living my best life. I don't feel like I was six months ago.’” For many women, that feeling can be one of the earliest signs of perimenopause.
The life stage nobody prepared us for
The challenge is that most of us were never really taught what perimenopause looks like. We spend years preparing girls for puberty and we talk about periods, hormones, mood swings, and all the changes that happen as our bodies mature. But when our hormones begin changing again later in life, many women are left to figure it out on their own.
As Dr. Stille explained, “When our hormones start to fall, there's really not been a parallel path for women to understand these physiologic changes that are happening in their body.” Instead, women often find themselves searching for answers online, listening to podcasts, scrolling through social media, or talking with friends who may be experiencing the same thing. And while those conversations can be incredibly helpful, they can also leave women wondering what information is actually accurate and what they should do next.
Dr. Stille acknowledged that social media has helped bring these conversations into the open. Women are talking more, sharing experiences, and realizing they aren't alone. But she also emphasized the importance of talking with a trusted healthcare provider who can help sort through the noise and provide individualized guidance.
It's about more than hot flashes
When most people think about perimenopause or menopause, they think about hot flashes. But according to Dr. Stille, that's often not what bothers women most. In fact, many women find brain fog and sleep disturbances to be far more disruptive than hot flashes. She explained that women frequently tell her they wake up between three and five in the morning and can't get back to sleep. Others describe increased anxiety, irritability, depression, tearfulness, difficulty concentrating, changes in libido, vaginal dryness, or unexplained weight gain.
For some women, these symptoms begin years before their periods actually stop. And while every woman's experience is unique, one thing is consistent: these changes can have a profound impact on daily life, relationships, work performance, and overall well-being.
You don't have to just tough it out
The biggest take away from the Health Talk was women should not have to suffer in silence. Too often, women are told that feeling exhausted, irritable, foggy, or unlike themselves is simply part of getting older. But Dr. Stille wants women to know there are options – and that they deserve to feel better.
One of the most effective treatment options available is hormone replacement therapy (HRT). While every woman's situation is different, HRT can help address many of the symptoms associated with perimenopause and menopause, including hot flashes, sleep disturbances, brain fog, mood changes, and vaginal dryness. Dr. Stille explained that hormone replacement therapy typically involves replacing some of the estrogen and progesterone that naturally decline during this stage of life. Depending on a woman's needs, that may include estrogen patches, gels, creams, oral progesterone, or vaginal estrogen therapy.
She also noted that recommendations around HRT have evolved significantly in recent years. Rather than simply helping women “get through” hot flashes, healthcare providers are increasingly recognizing the broader quality-of-life benefits hormone therapy may provide for some women, including support for sleep, mood, bone health, and even cardiovascular health.
For women who are not candidates for hormone replacement therapy, or who simply prefer a different approach, other treatment options are available as well. Certain medications can help manage hot flashes and mood symptoms, and lifestyle factors such as strength training, nutrition, sleep, and stress management can also play an important role in overall health during this transition. The right approach is different for every woman, which is why having a conversation with a healthcare provider is so important.
You don't have to navigate this alone
Perimenopause is a normal phase of life, yet many women enter this chapter feeling confused, unprepared, or alone. Dr. Stille hopes conversations like these help change that. The more we talk openly about perimenopause and menopause, the more women can recognize what's happening in their bodies, understand that their experiences are valid, and know when it's time to seek support.
If you're experiencing symptoms of perimenopause or menopause and wondering whether what you're feeling is normal, don't hesitate to talk with your healthcare provider. Dr. Stille and the teams at Women's Health and Women's Health Blowing Rock are available to answer questions, discuss treatment options, and help women navigate this stage of life. You're not imagining it. You're not overreacting. And you don't have to figure it out by yourself.
To watch Dr. Stille's Health Talk, click the video link below.
