Wen Shen, MD, on screening red flags during perimenopause care

Perimenopause often begins well before a patient’s final menstrual period, and recognizing that window gives clinicians a chance to treat symptoms and screen for long-term risk, according to Wen Shen, MD, Assistant Professor, Clinical Gynecology, Obstetrics, Johns Hopkins University School of Medicine; Director, Center of Menopause and Midlife Health.

Shen delivered the opening keynote, “Perimenopause is Every Clinician’s Patient,” at Perry Academy’s The Perimenopause Symposium, held September 25, 2026, in Baltimore, Maryland, during Perimenopause Awareness Month.

Continuing a discussion of pregnancy and comorbidity history in perimenopause care, Shen said menstrual changes are a simple entry point for identifying patients in transition.

“It’s not unusual for a woman’s menstrual cycles to change 1-to-2 or more years before she has that last menstrual period,” Shen said. In the interim, patients may be highly symptomatic even while still menstruating, and dismissing them until their periods stop can delay beneficial care.

“The data is beginning to show that by treating these women who are having menopause symptoms already, it can go a long way toward healthy aging,” Shen said.

She distinguished symptomatic patients from those seeking hormones for concerns that menopausal therapy does not address.

“I’m definitely not in favor of putting a woman on systemic menopausal hormones who is not having menopause symptoms and whose periods are still regular, but she is worried about hair loss and crepey skin,” Shen said, adding that such patients are better referred to dermatology. Vasomotor symptoms and disturbed sleep, by contrast, warrant attention—particularly given sleep’s links to heart disease and weight gain.

Screening red flags during the annual exam

Shen urged clinicians to use the perimenopausal visit to identify candidates for earlier bone and cardiovascular screening, noting that many patients already have osteoporosis by the time insurers cover a baseline scan.

“Right now, insurance companies say the baseline is 65, but by 65, a lot of women already have osteoporosis,” Shen said. “You’ve already left the gates open and the horses have left.”

A family history of osteoporosis should prompt a bone density scan before 65, she said, alongside routine questions about family histories of breast, ovarian, and colon cancer. Shen also flagged early-onset cardiovascular disease, an obstetric history of eclampsia or preeclampsia, an abnormally calcified placenta, and conditions such as PCOS or premature ovarian insufficiency as markers of elevated cardiovascular, brain, and bone risk.

Referring when time is short

Acknowledging the constraints of a 15-minute visit, Shen recommended scheduling dedicated follow-up when red flags surface.

“These are important factors that I would like to discuss with you further,” she suggested telling patients. “I would like you to make another appointment to follow up, so we can discuss this.” Most patients, she said, “appreciate that they’ve been heard and that the provider is taking a closer look.”

For clinicians who prefer not to manage these issues themselves, Shen advised keeping a referral to a certified menopause practitioner readily available, pointing to the Menopause Society’s certification program and menopause providers at university hospitals.

Reference:

Perry Academy Unveils Full Program for First-of-Its-Kind Multidisciplinary Perimenopause Symposium. Perry Academy. News release. September 1, 2026. Accessed September 30, 2026.