Perimenopause and menopause mark significant transitions in a woman's life, that can also cause a wide array of symptoms. While these symptoms are common, you don’t have to suffer in silence! In fact, these hormone imbalances don’t just mess with the quality of your everyday life, they can have serious long term health effects.
Are you dreading your monthly cycle because you experience gut-wrenching cramps, mood swings, and bloating all the while you are told to “just grin and bear” and get on with your work and responsibilities?
Are you experiencing other annoying symptoms like losing lots of hair, noticing that there is more and more hair coming out in your hair brush, making your nervous about styling or even washing your hair regularly?
Is sex the last thing on your mind (honestly all you want to do is go to sleep) but your lack of interest is starting to cause stress in your relationship?
Have you gained weight seemingly out of nowhere and have gained weight in “new places” like your belly, arms or thighs, where you never had weight gain before?
Are you also feeling tired on a regular basis and using caffeine as a crutch to wake up and get through your day?
If you identify with any of these it could be you are going through hormonal changes of perimenopause or menopause.
As women age, they go through several changes that are induced by declining levels of reproductive hormones, they can deal with a wide range of life-disrupting symptoms. The first of these changes is perimenopause, which usually starts around the age of 40 but can also begin as early as your 30’s. Perimenopause is a transition period marked by irregular menstrual cycles as the ovaries produce less estrogen resulting or even spikes of estrogen and also fluctuations in progesterone. Menopause is the permanent cessation of menstruation and is diagnosed after 12 months without a period. The average age of menopause is 51 years old, but it can occur earlier or later.
One of the most common symptom of perimenopause and menopause is hot flashes, which are sudden feelings of warmth that are not related to an external heat source. Hot flashes are often accompanied by redness in the face, neck, and chest. They can last anywhere from a few seconds to several minutes and can occur several times a day or night. Other very common symptoms include unexplained weight gain, vaginal dryness, sleep disturbances, mood swings, brain fog, decreased sex drive, and urinary problems or urinary track infections (UTIs).
While these symptoms are common, you don’t have to suffer in silence! In fact, these hormone imbalances don’t just mess with the quality of your everyday life, they can have serious long term health effects. This includes increasing your risk of dementia, heart attack, and osteoporosis. So if you are suffering from annoying symptoms, it’s a sign to reach out to an expert and explore how to balance your hormones in the most effective way, while mitigating any risks involved. I can also explore if bioidentical hormone replacement is right for you.
Hormone therapy should be individualized and regularly re-evaluated. Absolute contraindications include active hormone-positive breast cancer, active uterine cancer, and unexplained postmenopausal bleeding, any bleeding after menopause should be thoroughly investigated before considering hormone therapy, as it can indicate an underlying cancer. Relative contraindications, where treatment may still be appropriate but requires extra caution and careful individualization, include heart disease, elevated risk for blood clots or stroke, and chronic liver disease. In these cases, we avoid hormone forms that increase clot risk.
Other relative contraindications include questionable mammogram results or unresolved breast symptoms, large symptomatic fibroids, possible pregnancy, and migraines with aura. Transdermal estradiol is often preferred in women with metabolic syndrome, migraine with aura, elevated triglycerides, or higher VTE risk. Local (vaginal) estrogen is very low-dose and typically safe for GSM, including many women who cannot use systemic HT, though oncology co-management is advised after hormone-dependent cancers. Use shared decision-making, keep up with breast cancer screening and cardiovascular risk assessment, and review therapy at least annually to adjust dose, route, or consider non-hormonal options as needs change.
Perimenopause is the transition (often mid-40s, sometimes earlier) where estrogen and progesterone fluctuate and cycles become irregular. Menopause is confirmed after 12 straight months without a period; ovaries have largely stopped releasing eggs and estrogen levels are consistently low.
Sex hormones influence brain, sleep, metabolism, temperature regulation, pelvic tissues, and immune signaling. Fluctuations can show up as hot flashes, night sweats, mood shifts, brain fog, sleep disruption, weight gain, vaginal dryness, and urinary issues – even when routine labs look “normal.”
Foundations (sleep, nutrition, resistance training, alcohol moderation, stress skills) help a lot – especially for weight, sleep, and mood. But moderate–severe vasomotor symptoms (VMS) or genitourinary syndrome of menopause (GSM) often respond best to evidence-based hormone therapy, with lifestyle as the base.
Many FDA-approved products are bioidentical (e.g., 17-β estradiol, micronized progesterone). “Compounded bioidentical” is different: it’s custom-mixed and the combination is not FDA-approved but are manufactured from FDA approved hormones in the facilities regulated by state’s board of pharmacy
If you still have a uterus, yes – adequate progestogen (often micronized progesterone) protects the endometrium. If you’ve had a hysterectomy, we still recommend progesterone to everyone due to the multitude of benefits throughout the body other than the uterus.
Transdermal estradiol (patch/gel/spray) avoids first-pass liver metabolism and is often preferred for women with metabolic risk, migraine with aura, or higher VTE risk. Oral is reasonable in low-risk patients who prefer it.
Hot flashes often improve within 2–4 weeks, with full benefit by ~8–12 weeks. Sleep, mood, and sexual comfort can improve over weeks to a few months when the plan (and dose) are right.
Hormone replacement therapy isn’t a weight-loss drug, but it can reduce sleep fragmentation and VMS that drive overeating, and it may help limit central fat gain when combined with training and nutrition.
Best benefit–risk tends to be within 10 years of menopause onset or before age 60 (“window of opportunity”). Starting later can still be considered case-by-case, but cardiovascular and thrombotic risks need closer review.
Yes – SSRIs/SNRIs, gabapentin, oxybutynin, and the neurokinin-3 antagonist fezolinetant are evidence-based options for VMS when HT isn’t desired or appropriate; vaginal moisturizers/lubricants and local therapies help GSM.
Pristine Hormones & Weight is located in Reno, Nevada, and serves patients throughout the Greater Reno Area.