At some point, all women will experience perimenopause and then menopause. This time period often brings noticeable changes, both physically and emotionally. Your doctor can help you manage those changes with treatment, including hormone replacement therapy (HRT).
Perimenopause is a natural stage of a woman’s life, usually occurring in her 40s, though for some it can occur as early as the 30s or as late as the 50s. Perimenopause is often accompanied by a variety of symptoms, including irregular periods, hot flashes and trouble sleeping.
For many years, the proven, go-to treatment to alleviate perimenopausal side effects has been HRT. Unfortunately, there has been a lot of conflicting information circulating about HRT over the last quarter century, leading to a decline in the number of women taking advantage of this treatment.
“Privia Medical Group North Texas (PMGNTX) physicians want our patients to have the facts about perimenopause and HRT,” says Dr. Elisabeth Wagner, an OB/GYN in Fort Worth. “There are unfortunately a lot of myths floating around out there and we are here to help cut through those and get personalized care that works for you.”
Periods, Perimenopause & Menopause
Menstruation (also known as a period) is the process in which a woman’s body sheds the lining of her uterus. This a natural part of the reproductive cycle in which the female body continuously prepares for pregnancy. A menstrual cycle averages 28 days in length but can range from 21-35 days. On average, menstruation begins at age 12, but it is not unusual for girls to experience their first period at a younger or older age. A period typically lasts for 3-7 days.
Menstruation typically continues until age 52 – though for some women it may stop sooner or a bit later. When a woman has gone a full year without a period, that means she has reached menopause. Menopause happens when the ovaries no longer produce eggs and the woman can no longer become pregnant.
Perimenopause is the time leading up to menopause. Also called the menopausal transition, perimenopause can range in duration from two to ten years.
The body undergoes hormonal changes during perimenopause, primarily caused by a decrease in estrogen levels. Estrogen, as well as progesterone, are hormones produced by the ovaries. When estrogen levels decline, the balance with progesterone is disrupted, leading to a variety of symptoms. During perimenopause, hormone levels go up and down – this fluctuation makes it difficult to test for hormone levels, as they are constantly changing.
Periods may occur less frequently, but pregnancy is still possible, as the ovaries are still producing eggs during perimenopause.
Signs & Symptoms of Perimenopause
“Due to fluctuating hormone levels, there is not a completely accurate medical test for perimenopause, but we are able to diagnose it based on the symptoms our patients are experiencing,” explains Dr. Wagner. “There are several signs that indicate perimenopause is underway.”
Those symptoms include:
- Periods at longer or shorter intervals or skipping periods altogether
- Heavier or lighter periods
- Hot flashes
- Night sweats
- Sleep problems
- Depression, anxiety, irritability and general mood changes
- More frequent urination
- Reduced sex drive
- Vaginal dryness
Lifestyle Adjustments to Help with Perimenopause
In addition to any treatments your physician may prescribe, there are several lifestyle modifications that may help to manage perimenopause symptoms:
- A healthy diet focused on fruits, vegetables, lean meats and fish and whole grains
- Exercise, including walking and strength exercises
- Focus on sleep by getting to bed at the same time each night and avoiding screens before bed
- Avoid excess consumption of alcohol and caffeine
- If you smoke, stop
Dressing in layers and keeping your home cool can help mitigate hot flashes and night sweats.
Hormone Replacement Therapy
HRT is one of the most common medical treatments for the symptoms associated with perimenopause and menopause. “For most of the 20th century, HRT was celebrated as a medical miracle,” writes Dr. Marty Makary in his book Blind Spots. “Millions of women using HRT found relief from the symptoms of menopause.”
Menopause HRT is estrogen that can be administered through oral medication, a skin patch, cream, gel or spray. If the woman still has her uterus (she has not had a hysterectomy), the estrogen is combined with progesterone, which helps reduce the risk of uterine cancer.
HRT helps even out hormone levels and can help alleviate many symptoms associated with perimenopause and menopause, especially hot flashes and night sweats.
This treatment provides other benefits, as well. It supports bone density, preventing or delaying the onset of osteoporosis. Studies have also linked HRT to lower risk of heart attack, colon cancer and diabetes.
“Hormone therapy is most effective for people younger than 60 and within 10 years of the onset of symptoms,” says Dr. Ashita Gehlot, a Fort Worth gynecologist. “Every patient is unique, so HRT may not be for everyone. Other treatments, such as birth control and antidepressants may also be effective. The bottom line is, we work with each patient to design the best treatment plan to address their specific symptoms and health needs.”
HRT Myths
So, if HRT has been called a “medical miracle,” why do some people have serious reservations about it? It goes back to an unfortunate chain of events nearly 25 years ago.
Back in 2002, the National Institutes of Health (NIH) announced that it had conducted a study that found HRT causes breast cancer. The announcement of the study results was unusually rushed, and some of the researchers involved did not have adequate time to review the purported findings. Following the public announcement, the news media reported the HRT-breast cancer link as fact – and repeated it often. These events quicky led to significant decline in the number of American women receiving HRT.
The only problem, according to Dr. Makary and others, is that the data did not exactly show what NIH said it did. In fact, it showed there was no increased risk of breast cancer mortality associated with HRT. Further, subsequent studies have shown that estrogen-only therapy is associated with a decreased risk of breast cancer.
Another misconception about HRT is that it is a “one size fits all” treatment. The debunked NIH study looked at only one specific form of treatment (a pill with a combination of estrogen and progesterone) in an older age cohort (average age 63).
In reality, HRT comes in many different forms and can be individualized to the patient’s specific needs and health history. Many physicians also find it is most effective when started early in the perimenopause stage.
Talk to Your Doctor
The main thing to know about perimenopause is that it is a natural and perfectly normal part of a woman’s life – and when symptoms arise, you should talk to your doctor.
“We all go through menopause and perimenopause,” says Dr. Gehlot. “And while it is a normal, natural process, that does not mean you have to deal with the symptoms and side effects on your own. Your doctor is here to help guide you through these years and if needed, develop a treatment plan for your specific needs.”
If you’re looking for a doctor to talk to about perimenopause or any other women’s health issue, check out PMGNTX’s directory of OB/GYNs here.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
Makary, MD, M. (2024). Blind Spots. Bloomsbury Publishing.
