Read this first

Medical disclaimer

What this course is. The Perimenopause Guide is education. It was written by Dr Carolina Gonzalez, a Doctor of Chinese Medicine, to help you recognise patterns, prepare for appointments, and build daily foundations. Its worksheets are recognition and preparation tools, not diagnostic instruments.

What it is not. The course is not medical advice and it does not diagnose anything. It is not a substitute for the care of your doctor. It is preparation for it. Nothing here should delay you from seeking clinical care when you need it.

On supplements and diet changes. Where the course discusses supplementation, it means supplementation guided by a qualified practitioner or pharmacist, not guesswork. Before any trial of gluten-free eating, the course advises a coeliac screen first, because the screen only works while you are still eating gluten.

On hormone therapy. The course presents the current evidence alongside the older cautions. Whether hormone therapy is right for you is a decision for you and your prescriber.

When not to wait

Red flags. When to escalate.

Some findings or symptoms deserve prompt escalation. If you encounter any of the following, do not wait for a routine follow-up. Ask for an urgent appointment or go to an emergency department if warranted. This list is not a substitute for clinical judgment. The course keeps the same list as a printable reference sheet.

Bleeding concerns

  • Bleeding that soaks through protection every hour for several hours
  • Bleeding that lasts more than seven days
  • Large clots
  • Bleeding between periods (repeated)
  • Bleeding after sex
  • Any bleeding after twelve consecutive months of no periods (postmenopausal bleeding)

Pain

  • Severe pelvic pain, new or worsening
  • Pain with sex that is new or severe
  • Severe, unfamiliar headache

Cardiovascular

  • Chest pain, particularly with exertion
  • Sudden shortness of breath
  • Palpitations with dizziness or fainting

Other

  • Unexplained weight loss
  • Blood in stool or urine
  • New lumps, particularly in breasts
  • Sudden visual changes
  • Sudden severe confusion or cognitive change

Hold this in mind

Most of these will turn out to be benign. Some will not. The point of escalation is not to panic. It is to get the right eyes on it promptly. You are not being difficult by asking for the care you need.