Hormone Health 101
Menopause is a natural part of aging, but it’s often surrounded by silence, confusion, or misinformation. If women live long enough, 100% of them will go through it. Unfortunately, there are not nearly enough educated and informed providers to care for them. Not only that, but the time restraints of office visits also make it difficult to really educate patients properly. Social media has become a powerful platform for encouraging women to educate themselves about their health, and menopause is one of the most talked-about topics. For many, the journey doesn’t begin with menopause itself, but with perimenopause, which is a transitional phase that can start years earlier. Understanding what’s happening in the body during this time can empower women to take charge of their health, seek support, and make informed decisions. Here's what everyone should know about perimenopause and menopause.
What Is Perimenopause?
Perimenopause refers to the time leading up to menopause, typically beginning in a woman’s 40s, though it can start as early as the mid-30s. During this phase, estrogen and progesterone levels fluctuate, leading to a variety of physical and emotional symptoms.
Common symptoms of perimenopause include:
Irregular or skipped periods
Hot flashes and night sweats (vasomotor symptoms)
Mood swings, irritability, or anxiety
Trouble sleeping
Brain fog or forgetfulness
Decreased libido
Vaginal dryness or discomfort
Weight gain, especially around the midsection
Perimenopause can last anywhere from a few months to 8–10 years, with symptoms varying widely from person to person.
What Is Menopause?
Menopause is officially diagnosed after 12 consecutive months without a menstrual period, marking the end of reproductive years. The average age of menopause is around 51, but it can happen earlier or later. By this point, estrogen levels have declined significantly, and ovulation has stopped. Some symptoms from perimenopause may ease, while others may continue or change. In fact, some symptoms of perimenopause, such as vasomotor symptoms (VMS), brain fog, poor sleep and decreased libido often continue into post-menopause for over 7 years. There are multiple studies that indicate increased risks for women with premature ovarian insufficiency (POI), which is menopause prior to age 40, and early menopause, which is menopause between age 40 and 45. These risks can include cardiovascular disease (CVD), osteoporosis (bone thinning), and cognitive function or dementia. A Canadian study of ~900 postmenopausal women found that more severe menopausal symptoms (like vasomotor issues) correlated with greater cognitive decline and early dementia risk, while estrogen-based menopausal hormone therapy (MHT) appeared to reduce behavioral impairment.
Post-menopause, women may face increased risk for:
Osteoporosis (bone thinning)
Cardiovascular issues
Changes in metabolism or body composition
Ongoing sexual health concerns
The changes that women experience in menopause not only affect quality of life and potentially increase health risks, but they can also have a financial impact on both a personal and a societal level. About 85% of women experience menopausal symptoms that can reduce productivity, leading to absenteeism, reduced hours, or job exit. In Sweden and Norway, women who consulted for menopause issues saw a drop in earnings of approximately 10% by four years later. In the U.S., it's estimated that menopause symptoms cause $1.8 billion annually in lost work time. These statistics are significant and should be seen as a wake-up call to take menopause, and the years leading up to it seriously.
How to Manage Symptoms and Support Well-Being
Though menopause is a natural transition, its symptoms can affect quality of life. Fortunately, there are many strategies (both medical and lifestyle-based) to manage this phase effectively.
1. Talk to a healthcare provider who specializes in menopause management:
Menopause experts can offer guidance on managing symptoms, explore testing options, and discuss treatments such as menopausal hormone therapy (MHT) or non-hormonal alternatives. Find a provider who listens to you and takes your concerns seriously. If you don’t feel heard, find someone else. The easiest way to find a menopause expert in your area is to search the online directory through The Menopause Society’s webpage at menopause.org.
2. Focus on healthy habits:
Get regular exercise (especially strength training and cardiovascular movement)
Prioritize sleep and stress management
Eat a balanced diet rich in calcium, magnesium, vitamin D, and Omega 3 fatty acids
Limit alcohol and caffeine, which may trigger symptoms
3. Mental health matters:
Mood swings, anxiety, and brain fog are real and valid symptoms. Therapy, support groups, mindfulness, and self-care can all help manage emotional changes. Additionally, MHT may be appropriate even if you are not technically “menopausal”. These are nuanced conversations and MHT is not a one-size-fits-all approach, which is why it’s important to have a conversation with your health care provider or menopause specialist.
4. Don’t ignore sexual health:
Vaginal estrogen is the first line recommended treatment for genitourinary syndrome of menopause (GSM), which presents with symptoms such as vaginal dryness, increased urinary tract infections, or pain with sex. Other options like vaginal moisturizers or lubricants can also address vaginal dryness and discomfort but will not change the integrity of the vulvar/vaginal tissue. Our sexuality and intimate relationships are a significant part of our general health, so it’s important to find ways to help maintain intimacy and confidence during and after the menopause transition.
Why This Conversation Matters
Despite affecting every woman eventually, menopause is still a taboo topic in many communities and workplaces. Breaking the silence can lead to better healthcare, greater support, and less isolation. It’s important to get past the vernacular from the past 25 years that menopause symptoms must simply be tolerated or that MHT isn’t safe. While there are certainly situations where MHT is contraindicated, many women can get significant preventive benefit if MHT is initiated early in the menopause journey. Meta-analyses & clinical trials report:
Symptom relief: MHT dramatically reduces hot flashes (up to 90%), improves sleep & mood, and enhances vaginal health (normalizing pH, cell health).
Bone density & fractures: Estrogen-containing MHT improves lumbar/hip bone density and cuts fracture risk significantly.
Metabolic benefits: MHT boosts insulin sensitivity, reduces diabetes risk by ~30%, and improves lipid profiles.
Cardiovascular impact: Starting MHT within 10 years of menopause lowers coronary disease risk and overall mortality; however starting later can increase stroke and thrombosis risks.
Neurocognitive timing window: Initiating estrogen therapy in midlife is linked to a ~32% reduction in Alzheimer's/dementia risk, while delaying it eliminates or reverses the benefit.
Adverse effects: Depending on the route of administration and type of MHT (synthetic vs bio-identical) there can be an increased risk of breast cancer (with synthetic progestins), blood clots, strokes, and gallbladder issues (with oral estrogens), and uterine cancer (with unopposed estrogen). These adverse effects can vary by dose, formulation, route of administration, and when therapy starts. Because MHT isn’t for everyone, it’s important to discuss this with your own healthcare provider. The information provided here is for educational purposes only and is not meant to be individual medical advice.
Final thoughts:
Understanding perimenopause and menopause isn’t just about symptoms, it’s about empowering women to navigate midlife with confidence and clarity. Whether you're approaching this stage yourself or supporting someone who is, knowledge truly is power. If you would like to learn more about MHT and how it can benefit you, book an appointment with me. I can order and review lab studies, provide education, and offer personalized MHT based on your needs and desires.