Photo credit: Dr Tiffany Parks
Dr. Tiffany Parks is an internist and menopause specialist, and the founder and medical director of Parks Wellness. She specializes in helping women navigate perimenopause and menopause with individualized, patient-centered care, and is a vocal advocate for closing the awareness gap around hormonal health, particularly for Black women.
Midlife brings real changes, but women should not have to navigate them without answers. Dr. Tiffany Parks, founder and medical director of Parks Wellness, joined this week to break down perimenopause and help women take control of their health.
Porsha: Many women enter perimenopause without realizing it because they’re still having regular cycles. What are the early signs that hormonal changes may already be underway?
Dr. Parks: You can have regular periods on your calendar, but your hormones have a different agenda. During perimenopause, your hormones are fluctuating and ovulation may not be as predictable, so you can feel like you’re on an emotional and physical rollercoaster. Your flow can become heavier or lighter, your period can last longer or shorter than usual, and your cycles may become more frequent or closer together. You can also experience hot flashes and night sweats, and for Black women, those symptoms are more likely and can last longer.
Porsha: When do these symptoms start, and how do we know this is something we need to pay attention to?
Dr. Parks: Those changes can typically begin in your early 40s, though in some cases they start in your late 30s. You may notice changes in your period flow and cycle, along with shifts in your mood and sleep. The main thing I ask women to do is note what’s going on in their bodies and when it changed. Write it down, bring it to your doctor, and continue to be persistent even if you don’t get an answer right away.
Porsha: If a woman suspects she’s in perimenopause, what information does she need to track before visiting her physician, and what questions should she bring to the appointment?
Dr. Parks: Note any changes in your period flow and cycle, whether your periods are lasting longer or shorter, and any hot flashes, night sweats or early morning awakenings. Write those down and bring them to your provider. Then ask four key questions: Could this be perimenopause? Could this be something else? What tests are available to help my provider? And what is our plan?
Porsha: What’s the simplest definition you can give us for perimenopause?
Dr. Parks: Menopause is the state where you no longer have periods after 12 consecutive months, and the day after that, you’re postmenopausal. Prior to that, you’re perimenopausal. During this phase, hormones like estrogen, progesterone and testosterone are steadily declining, though in a chaotic way, which is why it feels like an emotional and physical rollercoaster. Perimenopause is really your body preparing you to become postmenopausal.
Porsha: Why might standard testing fail to explain what women are experiencing, and what should happen next?
Dr. Parks: In perimenopause, your hormones are fluctuating, so a lab test only gives you a snapshot of that specific moment. A normal lab result does not rule out perimenopause. It’s important for clinicians to talk with you about your symptoms, and for you to continue advocating for yourself. If you don’t feel like yourself, ask your provider to refer you to a menopause specialist or an OB-GYN who can take a closer look.
Porsha: There’s no single treatment plan that works for every woman. How should someone evaluate options like lifestyle changes, hormone therapy and non-hormonal medication?
Dr. Parks: We always take an individualized, patient-centered approach at Parks Wellness, making decisions together. Hormone replacement therapy is appropriate for some individuals depending on their medical history, and non-hormonal options are helpful in other cases. It comes down to your comfort level and the risks and benefits of treatment. Always ask your provider what your risks are, what the benefits are, and what you should expect to feel.
Porsha: Perimenopause can affect intimacy, vaginal health and sexual wellbeing, but many women hesitate to discuss those changes. What symptoms should women know are common and treatable?
Dr. Parks: A lot of women are intimidated or afraid to ask these questions. During midlife, you can experience increased vaginal dryness, irritation, painful sex and urinary symptoms similar to a urinary tract infection, which can all be related to declining estrogen. If painful sex leads to a loss of desire, you shouldn’t have to suffer in silence or tolerate it. There are treatment options available, so it’s important to speak up with your provider.
Porsha: I want to follow up on vaginal dryness, since it’s a common but uncomfortable symptom to discuss. What other symptoms can accompany it, what treatment options are available, and when should a woman speak with her physician?
Dr. Parks: Other symptoms that can accompany vaginal dryness and irritation include vaginal yeast infections and symptoms consistent with a urinary tract infection, like urinary urgency and burning, along with painful sex. There are treatment options available, including vaginal estrogen inserts, vaginal estrogen creams and vaginal testosterone inserts, which can also help improve libido and sexual pleasure.
Porsha: For women who know something has changed but feel overwhelmed or unheard, what are the first three steps they can take this week to begin advocating for themselves?
Dr. Parks: First, validate yourself. The changes you’re feeling are true, and you’re not imagining them. Second, write down what’s going on, whether it’s a note in your phone, an app, or pen and paper. Third, bring that information to your provider and book an appointment this week. You do not have to tolerate this, and you do not have to suffer in silence.
Dr. Parks can be found on Instagram and Facebook @ParksWellnessMD, as well as on LinkedIn and @parkswellness.com, where she’ll be sharing upcoming content for International Menopause Day and a continued series on hair loss.
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