Perimenopause describes the years leading up to menopause when your hormone levels begin to fluctuate. This can begin as early as your mid-to-late thirties. Symptoms of perimenopause vary among women but can include irregular periods, prolonged or heavy periods, sleep disruptions, acne, mood swings, irritability, anxiety & depression, weight gain and occasional hot flashes or night sweats.

Menopause is the day that signals 12 consecutive months without having a menstrual period (off all hormonal contraception). Following that day you will be postmenopausal for the rest of your life. For many women that is 40% plus of their lifetime.

Hot flashes are one of the most commonly reported menopausal complaints. Night sweats are just the after hours version of hot flashes. Your brain is very sensitive to estrogen levels and estrogen affects an area of the brain responsible for temperature regulation. When estrogen levels begin to decline in menopause it impacts how our bodies respond to temperature. A hot flash occurs when your brain thinks that it needs to cool your body down. They may happen at any time and can be quite distressing.

Menopause Hormone Therapy is the newer term for what was previously known as HRT or hormone replacement therapy. THe name change more accurately reflects what happens in your body when you take MHT. MHT is not intended to replace the hormones to the level that they were prior to menopause. The goal is to use the amount of hormone therapy that adequately treats your symptoms. The amount of estrogen used in MHT is much less than the ovaries produce at ovulation and about 1/3 the dose in a low dose oral contraceptive pill. The Menopause Society published a position paper in 2017 stating that MHT is safe and effective for the overwhelming majority of healthy menopausal women.

The term “bio-identical” simply means that the chemical structure of the estrogen (either patch or pill) is the same as the estrogen the ovaries make naturally. This has nothing to do with how the hormones are made. The FDA approved estradiol pills and patches that I prescribe are considered bio-identical. Unfortunately, this term has been used to market to women under the guise of more ‘natural’ treatments and to drive prices higher using compounded formulations.

Absolutely. After initial assessment of your medical history and your symptoms with a menopause trained provider, MHT is most certainly on the table as an option to manage perimenopausal symptoms. You do not need hormonal testing to prove necessity for treatment, nor do you need to be fully menopausal to start therapy.

Testosterone is very much a female hormone and the drop in this hormone can result in a number of unpleasant symptoms in women including low libido, fatigue, brain fog, recurrent injury and worsening muscle and joint aches/pains. We currently do not have an FDA approved transdermal testosterone cream for women in the US but both male formulations and compounded formulas are used off-label for women very safely and with good effect when done appropriately and closely monitored.