At Princeton Integrative Health, we see it every day: women walking through our doors experiencing physical symptoms, emotional confusion, and a profound sense of being unheard. For many, the root cause is perimenopause—a phase of life that can span anywhere from 2 to 8 years and is often symptomatic, yet rarely discussed in meaningful ways.
Heavy periods, insomnia, mood swings, brain fog, breast tenderness, and anxiety aren’t just “normal signs of getting older”—they’re signs your body is asking for support. And unfortunately, too many women are left to navigate these years without it.
The truth? There is a massive educational gap—one that affects patients and providers alike. That’s why we’re thrilled to see the release of DUTCH’s new “Perimenopause Management” course, made free to all registered DUTCH providers as of June 2, 2025. This is the kind of progress women deserve.
Why the Education Gap Still Exists
We’ve long understood that perimenopause is both under-researched and under-treated, but the reasons behind that reality run deep:
Lack of Medical Training & Patient Awareness
Most general practitioners receive minimal formal training on perimenopause and menopause care. And on the patient side, there’s a glaring absence of education—especially early in life. A 2022 online survey conducted by Harper et al. revealed that over 90% of women were never taught about menopause in school, and more than 60% reported feeling uninformed about it altogether. (Harper JC et al., 2022)
By the time women begin to experience symptoms, most are scrambling to self-educate. According to the same survey, 68.2% of women only began searching for answers after symptoms began, while just 12.3% had sought out information beforehand. This leads to years—sometimes decades—of misdiagnosis, dismissal, or suffering in silence.
Cultural Stigma
At Princeton Integrative Health, we work to dismantle the cultural stigma that treats perimenopause as a silent rite of passage. When symptoms are brushed off as “just a part of aging,” women are told—directly or indirectly—that their suffering is inevitable. Even well-meaning clinicians may say “this is normal,” but that doesn’t mean it’s tolerable or should be left untreated.
A History of Neglect in Women’s Health
Women’s health research has been historically marginalized. In fact, before 1993, women were rarely included in clinical trials. A 1977 FDA policy excluded reproductive-age women from early-phase drug studies unless they had life-threatening conditions, leaving vast gaps in knowledge about how medications affect female physiology (Balch et al., 2024). As a result, much of modern medicine is built on data that may not fully apply to women—particularly during hormone-sensitive phases like perimenopause.
This lack of data continues to impact our understanding of perimenopause today, especially for women of color and those with complex medical histories.
The Variability of Perimenopausal Symptoms
Perimenopause doesn’t follow a script. Some women experience intense hot flashes and sleep disruption. Others may struggle with depression, weight gain, or irregular bleeding. Because these symptoms differ so dramatically between individuals—and can even shift within a single person’s journey—perimenopause is notoriously hard to standardize and therefore easy to dismiss. But at PIH, we recognize that individualized care is the only effective path forward.
What’s Changing: DUTCH Launches Free Provider Education
DUTCH’s “Perimenopause Management” course is a meaningful step toward closing the knowledge gap for providers—something we at PIH fully support and applaud. This five-part, self-paced online course equips practitioners with a deeper understanding of perimenopause and provides tools to treat it with accuracy, compassion, and confidence.
Here’s what the course covers:
1. Perimenopause Physiology
Understanding the HPO (hypothalamic-pituitary-ovarian) axis is essential to recognizing the root cause of symptoms. By contrasting reproductive vs. perimenopausal physiology, providers learn to interpret lab trends and tailor treatment strategies.
2. Perimenopause Lab Testing
From serum labs to DUTCH testing, this lesson provides a roadmap for evaluating hormone levels and staging perimenopause accurately.
3. Lifestyle & Supplement Support
DUTCH emphasizes holistic, non-hormonal approaches including nutrition, movement, stress reduction, and supplement protocols backed by science.
4. Hormone Therapy Risks & Benefits
This balanced discussion offers critical information about the pros and cons of hormone therapy, preparing providers to help patients make empowered decisions.
5. Hormone Therapy in Practice
Finally, the course explores real-life clinical application, including tailored use of estrogen and progesterone based on a woman’s unique hormonal status and symptom picture.
Why This Matters—To Us and To You
At Princeton Integrative Health, our mission is rooted in root-cause resolution and truly personalized care. Perimenopause is not a footnote in a woman’s life—it’s a phase that can shape her energy, productivity, relationships, mental clarity, and more.
When symptoms like brain fog or insomnia go unaddressed, they ripple into every area of life. When bleeding is so heavy it causes anemia, or when hormonal shifts trigger depression or anxiety, it isn’t enough to say “that’s just part of getting older.” These symptoms deserve the same urgency and expertise as any other medical concern.
We believe that every woman deserves to understand her body, have her symptoms taken seriously, and receive care rooted in the latest science—not outdated assumptions.
What You Can Do
If you’re a patient:
Ask your provider if they’ve taken DUTCH’s perimenopause training—or better yet, schedule a consultation with a team like ours at Princeton Integrative Health, where we take women’s hormonal health seriously and treat the whole person, not just the symptoms.
The bottom line? You’re not crazy. You’re not alone. And you don’t have to go through this without support.
We’re here to help you navigate perimenopause with clarity, compassion, and care that’s rooted in science and centered on you.
References:
-
Balch, B. et al. (2024, March 26). Why we know so little about women’s health. AAMC.
-
Harper JC et al. (2022). An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Womens Health (Lond). Jan-Dec;18:17455057221106890.