Frequently Asked Questions
Clinical Care Options & HRT
Your doctor will consider factors like your age, menstrual patterns, and any symptoms or body changes you're experiencing. In certain cases, healthcare providers may measure follicle-stimulating hormone (FSH) levels, but routine testing isn't always available or reliable due to changing hormones throughout the day. Very rarely do doctors recommend hormone (estrogen) level tests, these are usually not perceived as helpful in the diagnosis of perimenopause—except for thyroid function tests, as thyroid issues can impact hormone levels.
HRT is safe and effective for managing many (peri) and menopausal symptoms. New research from the National Institute for Healthcare Excellence (NICE), advised GPs to offer hormone replacement therapy (HRT) as the first-line treatment for menopause symptoms, with talking therapy as an additional option. After reviewing extensive data, it concluded that HRT does not impact life expectancy, despite previous concerns about links to conditions like heart disease, stroke, and cancer.
But HRT may not be for everyone. Women who are at high risk for breast cancer or have a history of heart disease, stroke, and blood clots should talk to their doctor about whether HRT is the right option for them. In those cases, low-dose antidepressants have been shown to reduce the severity of hot flashes.
Also, speaking with a community of people that you trust and who are experiencing similar symptoms can be beneficial. This not only helps to foster a sense of belonging, but shared stories can encourage women to feel more validated in what they’re experiencing and can help reduce the stigma and make talking about Perimenopause and Menopause easier with family and others.
There are multiple benefits to using HRT, including relief from vasomotor symptoms (hot flashes and night sweats) and prevention of bone loss. Additionally, many other studies have demonstrated the benefits of HRT, including improvements in cognitive function, mood, sleep, colon health, joint pains, and cardiovascular health and wellness.
A recent study published in the Journal of the American Medical Association (JAMA) found that the benefits of HRT for menopausal symptoms outweigh the risks for most women under age 60. The determination was made based on two decades of follow-up data of the 160,000 postmenopausal women ages 50 to 79 from the original Women’s Health Initiative (WHI) study.
HRT can be administered as gels, creams, pessaries, tablets, patches, or sprays and is sometimes prescribed during perimenopause when hormones begin to fluctuate before menstruation stops. When choosing the best HRT for you, discuss all the options available with your trusted healthcare professionals so that they can assess your situation and provide the best choice for you based on the comprehensive information you’ve provided to support informed treatment choices.
Although commonly associated with male physiology, testosterone also plays a significant role in female health, contributing to libido, energy levels, and overall well-being. In some cases, women will experience reduced sexual desire during menopause. Testosterone supplementation can be considered for menopausal women with low sexual desire if HRT alone isn’t effective.
Non-hormonal options include selective serotonin reuptake inhibitors (SSRIs) or antidepressants and gabapentin (an anticonvulsant), which can help alleviate vasomotor symptoms (hot flashes).
If you’re in your mid-to late 40’s it is probably perimenopause. Sure, night sweats, hot flashes and brain fog are all classic signs that you might be going through “the change,” but they could also be signs of other health issues — some of them more serious. You can use a symptom tracker to help better understand if there is a cause and effect for what’s happening and consult with your doctor to differentiate (peri)menopausal symptoms from other potential health issues.
Managing Physical Symptoms
To manage hot flashes, start with simple lifestyle changes:
Wear layers so you can cool down easily
Avoid spicy food, alcohol, caffeine, and hot drinks
Try relaxation exercises like yoga
Stay in a cool room when possible
Some people also try supplements like soy, tofu, or black cohosh.
HRT is the most effective treatment.
Speak with your healthcare provider to find the best solution for you.
Many women experience sleep problems during menopause due to hormonal changes, stress, hot flashes, and other health issues like joint pain or bladder problems. Research shows that up to 60% of postmenopausal women deal with sleep disturbances, which can worsen if combined with anxiety or insomnia. If menopause symptoms are keeping you awake, it’s important to address the root causes and make changes that support better sleep.
To improve sleep, consider hormone replacement therapy (HRT) if it’s safe for you, or try natural methods like exercise, relaxation techniques, and a consistent bedtime routine. Avoid caffeine, alcohol, and heavy meals before bedtime, and keep your bedroom cool to help prevent night sweats. If insomnia persists for months, consult your doctor or a sleep specialist for additional support. Simple lifestyle changes can make a big difference in getting restful sleep during menopause.
Vaginal moisturizers and lubricants can provide relief for some. For others it will be best to have a conversation with your doctor to discuss whether low-dose vaginal estrogen therapy may also be effective for you.
In an 18-year Nurses’ Health Study, vaginal estrogen use was not to be associated with a higher risk of cardiovascular disease or cancer. The findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause.
Yes. Many women notice that their joints become stiff and painful during perimenopause and menopause, and they may struggle to build and maintain muscle. Some women at this stage may even be diagnosed with fibromyalgia—a condition characterized by widespread body pain, fatigue, and sleep disturbances. In some cases, these symptoms are linked to declining hormone levels, particularly oestrogen. For many women, HRT can help alleviate many of these issues by restoring hormonal balance.
Some women find that switching up their exercise routine can help with joint and muscle pain. Yoga is a good full-body workout that not only builds strength and flexibility but can also ease menopause symptoms like sleep issues, fatigue, low mood, and anxiety. Speak to your doctor if you’re still having issues in this area.
Physical Appearance
Memory issues are common during Perimenopause and Menopause, often caused by a mix of stress, fatigue, and shifting hormones. The good news is, there are plenty of ways to support brain health and keep your mind sharp. Eating a nutrient-rich diet, staying active, avoiding smoking, limiting alcohol, and keeping your brain engaged can all make a difference. The key is to be active—challenge your brain with new activities regularly, learning, and problem-solving to keep it strong (think crossword puzzles, Wordle, Words with Friends, etc.)
Every experience is personal, but hair loss and thinning will happen to many of us. Women experiencing hair loss during Perimenopause and Menopause will often experience diffuse thinning—gradual shedding across the scalp, especially on the top, sides, or front. This happens because estrogen and progesterone levels drop, slowing hair growth, while increased androgens (male hormones) can shrink hair follicles, making hair thinner.
It’s not an overnight cure, but some treatments can help. Supplements, like saw palmetto, ashwagandha, and marine collagen, may help support hair growth by balancing stress hormones and reducing inflammation. Minoxidil is a well-known topical treatment that stimulates hair follicles, while spironolactone and finasteride (prescription options) block DHT, a hormone linked to hair loss. For a more advanced approach, platelet-rich plasma (PRP) therapy—where your platelets are injected into the scalp—has been shown to slow shedding and improve hair thickness. Whatever the method, patience is key, as real results often take several months.
First, it’s very normal to have these feelings. About 4 in 10 women have mood symptoms during Perimenopause and Menopause that are similar to PMS, or premenstrual syndrome, according to the American College of Obstetricians and Gynecologists (ACOG). Hormone shifts during Perimenopause and Menopause can impact mood, and physical symptoms often add stress and fatigue. Life’s demands—work, family, and caregiving—can make this even harder.
If you're struggling, it’s important to talk to a trusted healthcare professional as well as empathetic friends and family. Treatment options include therapy, antidepressants, and even estrogen therapy for perimenopausal depression. Prioritizing sleep can also make a big difference. There are solutions available – you don’t have to do this alone.
Therapy and complementary lifestyle and behavioral support services can provide valuable help during this time. This can include acupuncture, functional medicine, chiropractic treatments, meditation, yoga/pilates, sleep training, etc.
Perimenopause and Menopause is not a one-size-fits-all approach, so it’s essential to assess and treat perimenopausal hormone patterns such as estrogen dominance, suboptimal hormone metabolism, and hormonal insufficiency for each individual.
Every woman’s experience with skin changes during Perimenopause and Menopause is unique, influenced in part by factors like sun exposure and skincare habits over the years and her genetics. As women, we start losing collagen in our 30’s, so if we’re thinking about how to treat our current issues then much of what we need to look at is also prevention. In perimenopause, one of the most common concerns is increased dryness, ironically many women also notice an increased number of breakouts.
During menopause skin becomes thinner, less firm, and more wrinkle-prone, which can make bruising easier. This is largely due to a sharp decline in collagen and elastin—the proteins responsible for keeping skin plump and resilient. This loss happens rapidly at the start of menopause before gradually slowing over time, contributing to sagging, fine lines, and an overall reduction in skin volume.
The best way to protect your skin is through preventative care and having a good skincare routine that’s easy to stick to. Hyperpigmentation and age spots are a common concern for people over the age of 50. Start with the basics. A cleanser, nothing too foaming or aggressive. Moisturizer and SPF. If you manage, add a decent vitamin C in the morning (before your SPF) and a retinoid depending on your main skin concerns (in the evening), followed by moisturizer.
In Perimenopause and Menopause, brain fog is common, causing memory lapses and trouble concentrating. A nutrient-rich diet like the Mediterranean or MIND diet, regular exercise, good sleep, and avoiding smoking can help. Some supplements, like phytoestrogens, curcumin, and Ginkgo biloba, show promise, while probiotics may support mood and sleep. If you're on HRT or other medications, check with your doctor before taking supplements—herbal remedies like St John’s Wort, which can interact with HRT and are not advised. It’s best to discuss any supplements you’re taking with your doctor to ensure it’s advisable.
Cognitive and Mental Well-Being
Memory issues are common during Perimenopause and Menopause, often caused by a mix of stress, fatigue, and shifting hormones. The good news is, there are plenty of ways to support brain health and keep your mind sharp. Eating a nutrient-rich diet, staying active, avoiding smoking, limiting alcohol, and keeping your brain engaged can all make a difference. The key is to be active—challenge your brain with new activities regularly, learning, and problem-solving to keep it strong (think crossword puzzles, Wordle, Words with Friends, etc.)
Every experience is personal, but hair loss and thinning will happen to many of us. Women experiencing hair loss during Perimenopause and Menopause will often experience diffuse thinning—gradual shedding across the scalp, especially on the top, sides, or front. This happens because estrogen and progesterone levels drop, slowing hair growth, while increased androgens (male hormones) can shrink hair follicles, making hair thinner.
It’s not an overnight cure, but some treatments can help. Supplements, like saw palmetto, ashwagandha, and marine collagen, may help support hair growth by balancing stress hormones and reducing inflammation. Minoxidil is a well-known topical treatment that stimulates hair follicles, while spironolactone and finasteride (prescription options) block DHT, a hormone linked to hair loss. For a more advanced approach, platelet-rich plasma (PRP) therapy—where your platelets are injected into the scalp—has been shown to slow shedding and improve hair thickness. Whatever the method, patience is key, as real results often take several months.
First, it’s very normal to have these feelings. About 4 in 10 women have mood symptoms during Perimenopause and Menopause that are similar to PMS, or premenstrual syndrome, according to the American College of Obstetricians and Gynecologists (ACOG). Hormone shifts during Perimenopause and Menopause can impact mood, and physical symptoms often add stress and fatigue. Life’s demands—work, family, and caregiving—can make this even harder.
If you're struggling, it’s important to talk to a trusted healthcare professional as well as empathetic friends and family. Treatment options include therapy, antidepressants, and even estrogen therapy for perimenopausal depression. Prioritizing sleep can also make a big difference. There are solutions available – you don’t have to do this alone.
Therapy and complementary lifestyle and behavioral support services can provide valuable help during this time. This can include acupuncture, functional medicine, chiropractic treatments, meditation, yoga/pilates, sleep training, etc.
Perimenopause and Menopause is not a one-size-fits-all approach, so it’s essential to assess and treat perimenopausal hormone patterns such as estrogen dominance, suboptimal hormone metabolism, and hormonal insufficiency for each individual.
Every woman’s experience with skin changes during Perimenopause and Menopause is unique, influenced in part by factors like sun exposure and skincare habits over the years and her genetics. As women, we start losing collagen in our 30’s, so if we’re thinking about how to treat our current issues then much of what we need to look at is also prevention. In perimenopause, one of the most common concerns is increased dryness, ironically many women also notice an increased number of breakouts.
During menopause skin becomes thinner, less firm, and more wrinkle-prone, which can make bruising easier. This is largely due to a sharp decline in collagen and elastin—the proteins responsible for keeping skin plump and resilient. This loss happens rapidly at the start of menopause before gradually slowing over time, contributing to sagging, fine lines, and an overall reduction in skin volume.
The best way to protect your skin is through preventative care and having a good skincare routine that’s easy to stick to. Hyperpigmentation and age spots are a common concern for people over the age of 50. Start with the basics. A cleanser, nothing too foaming or aggressive. Moisturizer and SPF. If you manage, add a decent vitamin C in the morning (before your SPF) and a retinoid depending on your main skin concerns (in the evening), followed by moisturizer.
In Perimenopause and Menopause, brain fog is common, causing memory lapses and trouble concentrating. A nutrient-rich diet like the Mediterranean or MIND diet, regular exercise, good sleep, and avoiding smoking can help. Some supplements, like phytoestrogens, curcumin, and Ginkgo biloba, show promise, while probiotics may support mood and sleep. If you're on HRT or other medications, check with your doctor before taking supplements—herbal remedies like St John’s Wort, which can interact with HRT and are not advised. It’s best to discuss any supplements you’re taking with your doctor to ensure it’s advisable.
Long-Term Health Considerations
Memory issues are common during Perimenopause and Menopause, often caused by a mix of stress, fatigue, and shifting hormones. The good news is, there are plenty of ways to support brain health and keep your mind sharp. Eating a nutrient-rich diet, staying active, avoiding smoking, limiting alcohol, and keeping your brain engaged can all make a difference. The key is to be active—challenge your brain with new activities regularly, learning, and problem-solving to keep it strong (think crossword puzzles, Wordle, Words with Friends, etc.)
Menopause increases the risk of osteoporosis, cardiovascular disease risk, and a greater risk of type 2 diabetes. Regular screenings and preventive measures are important once you’re in Perimenopause and Menopause and it’s important to help maintain and stay healthy during this time.
Bone density testing and lipid profiles are recommended.
First, it’s very normal to have these feelings. About 4 in 10 women have mood symptoms during Perimenopause and Menopause that are similar to PMS, or premenstrual syndrome, according to the American College of Obstetricians and Gynecologists (ACOG). Hormone shifts during Perimenopause and Menopause can impact mood, and physical symptoms often add stress and fatigue. Life’s demands—work, family, and caregiving—can make this even harder.
If you're struggling, it’s important to talk to a trusted healthcare professional as well as empathetic friends and family. Treatment options include therapy, antidepressants, and even estrogen therapy for perimenopausal depression. Prioritizing sleep can also make a big difference. There are solutions available – you don’t have to do this alone.
Therapy and complementary lifestyle and behavioral support services can provide valuable help during this time. This can include acupuncture, functional medicine, chiropractic treatments, meditation, yoga/pilates, sleep training, etc.
Perimenopause and Menopause is not a one-size-fits-all approach, so it’s essential to assess and treat perimenopausal hormone patterns such as estrogen dominance, suboptimal hormone metabolism, and hormonal insufficiency for each individual.
A balanced diet and regular physical activity, including walking, cycling, swimming, yoga/pilates and lifting weights are all important to help maintain and stay healthy during this time.
In Perimenopause and Menopause, brain fog is common, causing memory lapses and trouble concentrating. A nutrient-rich diet like the Mediterranean or MIND diet, regular exercise, good sleep, and avoiding smoking can help. Some supplements, like phytoestrogens, curcumin, and Ginkgo biloba, show promise, while probiotics may support mood and sleep. If you're on HRT or other medications, check with your doctor before taking supplements—herbal remedies like St John’s Wort, which can interact with HRT and are not advised. It’s best to discuss any supplements you’re taking with your doctor to ensure it’s advisable.