Most of us, regardless of gender, have heard whispers about “the change.” It’s the time of life when a woman’s reproductive years end, her ovaries stop releasing eggs, and she can no longer get pregnant. For many years it was a taboo topic, even though it impacts 51% of the population. Despite being both natural and inevitable, it was considered shameful. Fortunately, there are new pathways for conversation about menopause, its effects on women, and possible methods to alleviate symptoms.

However, part of the reproductive cycle remains somewhat of an enigma to many people today: perimenopause. This transitional phase that precedes menopause usually begins in a woman’s 40s, but can start even earlier. The fluctuating hormone levels of perimenopause can cause a variety of symptoms including irregular periods, which can be particularly daunting to women who are trying to conceive. The perimenopause stage can last several years before a woman reaches menopause, which is defined by the 12 consecutive months without a period.

Medical experts like Dr. Leslie Saltzman, chief medical officer at Ovia Health, are working to remove the mystery around perimenopause to ensure more women are informed, prepared, and supported during this transitional phase. “While this is a natural and normal process, some of the symptoms can be disruptive or uncomfortable,” Dr. Saltzman said in a recent interview. On the employer side, engaging with a vendor like Ovia Health can help leaders provide crucial access to information and services for those who need it.

Identifying the Symptoms of Perimenopause

Because there is little conversation about perimenopause, many women are blindsided by its arrival. It begins as a woman’s reproductive stage starts to conclude but before it fully comes to a close. Women can still get pregnant during perimenopause, though it can be more challenging, as estrogen and progesterone begin to fluctuate wildly and periods, and therefore ovulation, may become irregular. “What used to be a predictable, EKG-like ebb and flow becomes chaotic,” Dr. Mary Claire Haver, an OB-GYN who specializes in menopause care recently told TIME.

A recent study suggested a genetic component to the onset and symptoms of reproductive aging, so women may want to consult female relatives for insight and guidance. A study by the University of Michigan also suggested race may be a factor, with Black women tending to experience the shift earlier and with more severe symptoms.

Unfortunately, there is no single test for perimenopause, so doctors will usually do blood work to rule out other causes like autoimmune disease or thyroid issues, then arrive at perimenopause by process of elimination. While the transitional phase can appear differently in each person, there are a few key symptoms to look out for:

• Irregular periods – Previously regular cycles may start to vary by as many as seven days, making it harder to get pregnant. Periods may be shorter or longer and flow can be lighter or heavier. 
• Hot flashes – While strongly associated with menopause, about 75% of women experience night sweats and hot flashes during perimenopause too.
• Vaginal dryness – Sex may become painful due to changing hormone levels. 
• Joint pain – Recent research found that more than 70% of perimenopausal women experienced joint pain, and of those, 25% of them found it debilitating . 
• Weight gain – Unexplained belly fat may be the result of lower levels of estrogen, which causes body fat in the midsection, rather than in the hips or thighs.
• Mood changes – PMS symptoms can become extreme. Those who experienced postpartum depression may be at greater risk for anxiety and depression during this period as well.  
• Warped sense of identity – For many women, due to societal pressures their sense of self is linked to their reproductive ability or simply their youth. The onset of perimenopause may bring on a grieving process for some. 
• Smaller changes like itchy skin, dry mouth, itchy ears, leaky bladder, frozen shoulder, and breast tenderness have also been reported, proving how perimenopause can show up in a wide variety of ways. 
• Brain fog – Recall of names and words may become trickier, due either to hormonal changes or the fatigue caused by hot flashes, which disrupt the sleep cycle.

Brain fog shows why a holistic approach to treating perimenopause is key. “We know that estrogen withdrawal can clearly have a cognitive impact,” Dr. Mindy Goldman, chief clinical officer at Midi Health, told TIME. “There’s data that says when you’re tired, you don’t exercise as much, and you don’t make healthy food choices,” she said, which can affect cognitive health. “It’s all tied together.”

Treating Perimenopause

Treatment options for perimenopause vary from person to person, just as the symptoms do, though there are some mainstays. “Treatment is typically aimed at managing symptoms,” Dr. Saltzman said. “Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy can be given in different formats including pills, patches, creams, and vaginal inserts. Antidepressants can help with night sweats, mood swings, and emotional issues. It’s best to speak with your provider and track your symptoms carefully to figure out the best management plan.”

Dr. Saltzman says that cholesterol changes that occur as a result of the menopausal transition are linked to a higher risk of cardiovascular disease, which is the leading cause of death for women in the United States. For women who are looking to get pregnant and have started to notice perimenopausal symptoms, Dr. Saltzman suggests consulting with a reproductive endocrinologist about options.

Employer Healthcare Solutions

Providing support for perimenopausal women is an investment in your workforce. “Women constitute about half of the workforce, and many are grappling with health conditions like perimenopause and menopause,” Saltzman said. “A recent study found that three out of five women have faced challenging symptoms while at work, with one in three actively hiding these symptoms from colleagues and managers. Additionally, another study revealed that nearly 20% of those experiencing menopause in the U.S. have either quit or considered leaving their jobs due to their symptoms.”

Employers can explore a variety of digital options to supplement their standard healthcare plan with additional support geared toward women’s health. One of these is Ovia Health. “We offer a perimenopause program within the Ovia app. Members can choose ‘Menopause preparation’ from the available programs listed under the Health tab. This provides them with access to relevant perimenopause articles and educational resources. They can use this information as a guide when tracking their health and monitoring day-to-day symptoms. Additionally, they can connect with a member of our Care Team, to assist in managing symptoms and finding the appropriate care and treatments,” Dr. Saltzman said.

Ovia also offers an even more expanded resource for women when they hit menopause, which includes tracking medications, mental health, and recognizing risk factors and patterns.  “With a personalized, proactive approach, we want to help members understand their bodies and find relief across all life stages.” Offering these types of benefits can lead to a happier, healthier, and more productive workforce. In turn, this can help control medical costs, boost overall satisfaction, and improve productivity,” Dr. Saltzman said.

Reframing the Conversation

By being open and flexible with healthcare solutions, employers can help reframe the conversation around perimenopause and start to eliminate some of the stigma. “Data shows that the long-standing silence around women’s health has had serious consequences. Many individuals have been forced to manage overwhelming stress due to shame or fear of discrimination, with some even leaving their jobs when the burden became too great,” Dr. Saltzman said. “However, organizations have the opportunity to create a significant positive change – normalize conversations about menopause, provide accessible education so people understand what to expect and how to seek treatment, and build workplaces that support individuals through these major life transitions.”

Editor’s note: From Day One thanks our partner, Ovia Health, for supporting this sponsor spotlight.

Katie Chambers is a freelance writer and award-winning communications executive with a lifelong commitment to supporting artists and advocating for inclusion. Her work has been seen in HuffPost and several printed essay collections, among others, and she has appeared on Cheddar News, iWomanTV, On New Jersey, and CBS New York.