Perimenopause
Perimenopause is the transitional period before menopause, during which the ovaries gradually reduce hormone production. It often begins in the late 30s or 40s and precedes the final menstrual period by several years. Hormone levels (especially estrogen and progesterone) become erratic — sometimes high, sometimes low — leading to fluctuating symptoms and unpredictable menstrual cycles.
Common symptoms
During perimenopause, people may experience:
Irregular menstrual cycles (shorter, longer, heavier or lighter)
Hot flashes, night sweats
Sleep disturbances, insomnia
Mood swings, irritability, anxiety or low mood
Decreased libido, sexual changes
Vaginal dryness, discomfort
Fatigue, brain fog / memory problems
Bone density changes (gradual bone loss)
Changes in metabolism / body composition
Hormone therapy prescriptions commonly used
Because hormone levels fluctuate unpredictably in perimenopause, hormone therapy is sometimes used to stabilize symptoms. Prescriptions may include:
Oral micronized progesterone (OMP) — your body recognizes this formulation as molecularly identical to natural progesterone produced by the body. OMP protects the uterine lining (endometrium), decreases heavy menstrual bleeding, has a calming effect on the body and helps improve sleep, and also has many anti-cancer benefits.
Estradiol (E2) — Estradiol is the bioidentical formulation of estrogen that may be therapeutic for some women. Treatment with estradiol is typically avoided in perimenopause as estrogen levels are usually fluctuating and can be quite high. In later stages of menopause, when estradiol levels are low, or you are experiencing symptoms, you may benefit from estrogen therapy. This can be given as a transdermal (cream, gel, or patch), or an oral pill.
Testosterone — Women experiencing low libido, low motivation or drive, or vaginal symptoms may benefit from low dose testosterone therapy. Testosterone can be prescribed as a cream, or injection.
DHEA — Women experiencing cognitive symptoms or vaginal symptoms may also benefit from DHEA supplementation.
Our Nurse Practitioner may recommend tailored hormone therapy to address your symptoms after a detailed assessment.
How hormones can improve symptoms
Appropriately delivered hormones during perimenopause may help:
Stabilize fluctuating estrogen/progesterone levels and associated mood, sleep, and vasomotor symptoms (hot flashes, night sweats).
Maintain bone density and reduce risk of early bone loss.
Preserve urogenital health (reduce vaginal dryness, maintain lubrication, reduce urinary symptoms).
Improve sleep, energy, mood, and overall quality of life during transition.
Reduce risk of certain types of cancer.
Because perimenopause is highly individual and hormone levels vary, therapy should be personalized — balancing potential benefits and risks, and re-evaluated often.