If you have noticed irregular periods, hot flashes, sleep changes, mood shifts, or brain fog — and you are somewhere between your late 30s and early 50s — perimenopause may be part of the picture.
Many women are not told what to expect, how long the transition can last, or that treatment is a conversation they can have with a gynecologist. This article explains the basics in plain language. It is education, not a personal treatment plan.
What is perimenopause?
Perimenopause is the transition leading up to menopause. Menopause is usually defined as 12 months in a row without a period. During perimenopause, estrogen, progesterone, and testosterone levels fluctuate and generally decline. That shift is behind many of the symptoms people notice.
The average age of menopause in the United States is 51.5 years. Menopause is not considered early unless it happens before age 40. About 80% of women experience some perimenopausal symptoms. Those symptoms can start 7–10 years before bleeding stops.
Symptoms vary. Some people have several of these; some have few:
- Irregular or heavier periods
- Hot flashes and night sweats
- Sleep disruption
- Mood changes, irritability, or anxiety
- Brain fog or trouble concentrating
- Vaginal dryness or discomfort
- Changes in libido
- Joint aches or changes in body composition
What is HRT — and why do people still worry about it?
Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), means using estrogen alone or estrogen plus a progestogen to replace hormones that decline in the menopausal transition.
HRT was widely used for years. In 2002, findings from the Women’s Health Initiative (WHI) raised concern about breast cancer and heart risk, and many people stopped therapy. Research and guidelines have been updated since then.
Who might consider HRT?
HRT is not right for everyone. A personal or family history that includes some hormone-sensitive cancers, clotting disorders, or uncontrolled cardiovascular disease may mean standard HRT is not appropriate, or that a different approach is needed. Unexplained uterine bleeding and liver disease are also reasons standard HRT may not be appropriate until they are evaluated.
You and your OGS doctor will need to balance your individual benefits and risks based on your medical history.
For others, HRT is one option among several for bothersome symptoms. The only way to know what fits you is a visit that covers symptoms, history, and goals.
Types of HRT (overview)
Today’s options include different doses and routes:
- Systemic estrogen (for example patches, gels, sprays, pills, or rings) when whole-body symptoms are the issue
- Local vaginal estrogen (cream, ring, or tablet) when dryness or some urinary symptoms are the main problem
- A progestogen for people who still have a uterus, to protect the lining — and also to help with sleep and anxiety
- Combined estrogen-progestogen products
- Testosterone, which is sometimes added for low libido, lowering muscle mass, and fatigue
“Bioidentical” — The Menopause Society
The HRT options we discuss are bioidentical in the sense The Menopause Society describes. The Society notes that “bioidentical hormone therapy” began as a marketing term for custom-compounded hormones, but most people use it to mean hormones that have the same chemical and molecular structure as the body’s natural hormones. Bioidentical hormones do not have to be custom compounded. There are many well-tested, FDA-approved hormone therapy products that meet this definition and are available from retail pharmacies in a variety of doses, which lets you and your doctor customize therapy. Custom-compounded hormones are not safer or more effective than approved bioidentical hormones and are not tested the same way for safety, effectiveness, or predictable absorption.
Risks — keep it individual
Risk depends on the product, how it is taken, age at start, and your health history. Headlines are a poor substitute for that conversation. You and your OGS doctor will need to balance your individual benefits and risks based on your medical history. At OGS Tulsa we walk through options in the exam room, not as a one-line internet rule.
You do not have to “just push through”
Perimenopause and menopause are normal. Disabling symptoms are still worth treating if you want help. Non-hormonal options exist when HRT is not a fit.
Talk with an OGS Tulsa gynecologist
Our gynecology team evaluates perimenopause and menopause, including whether HRT is appropriate and how it would be monitored.
OB/GYN Specialists of Tulsa is accepting new patients. Request an appointment online or call the office.
Frequently Asked Questions
What does perimenopause feel like? Hot flashes, night sweats, sleep and mood changes, brain fog, irregular bleeding, vaginal dryness, and libido changes are common. Severity varies.
