Menopause and the years leading up to it, known as perimenopause, mark a significant stage in a woman’s health journey. It’s something so many of us go through, yet it’s still not talked about enough. The hormonal changes that happen during this time don’t just affect your period. They can influence your mood, sleep, libido, metabolism, and more.

Understanding the Hormonal Shift

As a practitioner who supports women through this transition every day, I want to share what’s going on in your body, what the latest research tells us, and what options you have. My goal is to help you make informed decisions to feel your best. 

Perimenopause can begin as early as your mid-30s, although most women notice changes in their 40s. During this time, estrogen and progesterone levels fluctuate in unpredictable ways. These hormones do more than regulate your cycle. They play a role in mood, brain function, bone strength, cardiovascular health, and your gut microbiome.

As estrogen declines, it can trigger a range of symptoms:

  • Hot flashes and night sweats
  • Trouble sleeping
  • Vaginal dryness and lower libido
  • Mood swings or anxiety
  • Brain fog and trouble concentrating
  • Irregular or heavy periods
  • Weight gain and joint discomfort

Despite how common these symptoms are, they’re often dismissed or misdiagnosed. Many women are told their symptoms are just stress. But just because something is common doesn’t mean it’s normal or that it has to be tolerated without support.

What Is Hormone Replacement Therapy?

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), involves supplementing the body’s declining levels of estrogen and sometimes progesterone. It remains the most effective treatment for hot flashes, night sweats, and other genitourinary symptoms, such as vaginal dryness and recurrent UTIs.

It also helps protect against bone loss and lowers the risk of fractures. This is important since approximately 50 percent of women over age 50 will experience a fracture due to osteoporosis, according to the National Osteoporosis Foundation.

HRT can be delivered in different forms:

  • Patches
  • Pills
  • Creams or gels
  • Vaginal rings or suppositories

Many of my patients additionally explore options like bioidentical hormone therapy. These are hormones that are chemically identical to what your body naturally produces. They are available in FDA-approved formulations and, when sourced from trusted providers, they may offer symptom relief with fewer side effects than older options.

Revisiting the WHI Study

The conversation around HRT often circles back to the 2002 Women’s Health Initiative (WHI) study, which caused widespread fear around hormone therapy. 

Here’s what is important to understand today:

  • The WHI used one specific formulation: conjugated equine estrogen and medroxyprogesterone acetate. This is different from the bioidentical and transdermal options many women use.
  • The average participant in the study was 63 years old, which is beyond the window of time when starting HRT is considered most effective.
  • More recent studies and follow-up data have shown that estrogen alone was associated with a reduced risk of breast cancer in some women. 
  • Starting HRT before age 60 or within 10 years of menopause appears to carry the most benefit and the least risk. 

If you’ve been told HRT is unsafe or come across that general sentiment, I encourage you to revisit the data. Dr. Natalie Scheeler provides an excellent breakdown of the WHI findings, explaining the nuances in an accessible and evidence-based way.

Is HRT Right for You?

Not every woman needs hormone therapy. But if your symptoms are interfering with daily life, it’s a conversation worth having with a knowledgeable provider.

You might be a good candidate for HRT if:

  • You have frequent hot flashes or night sweats
  • You’re struggling with mood swings, fatigue, or memory issues
  • You’re experiencing vaginal dryness, low libido, or pain during sex
  • Your sleep is disrupted by hormonal symptoms
  • You’ve been diagnosed with low bone density or osteopenia

Women with a history of certain conditions like breast cancer, blood clots, or stroke may need to explore non-hormonal treatments. These can include SSRIs or SNRIs, gabapentin, lifestyle changes, and targeted supplements. Personalization is key. Your care plan should reflect your symptoms, your goals, and your history — not just your age.

Menopause by the Numbers

Still unsure whether what you’re going through is “normal”? Consider the data:

  • More than 80% of women experience hot flashes or night sweats 
  • 40-60% of menopausal women report persistent sleep disturbances
  • More than 50% of menopausal women suffer from low sexual desire
  • Up to 70% of women report both attention and memory problems 

These numbers make one thing clear: this life transition affects most women. 

Supporting the Whole Person

Hormones are a major part of the puzzle, but they’re not the only one. I take a holistic approach to midlife health because every system in the body is connected.

Some of the most impactful areas we focus on include:

  • Nutrition: Stabilizing blood sugar, supporting gut health, and reducing inflammation can make a big difference.
  • Movement: Strength training, walking, and mobility exercises help with weight management, mood, and bone strength.
  • Stress and cortisol: Chronic stress can worsen symptoms. Supporting your nervous system is essential.
  • Supplements: Depending on your needs, we may explore magnesium, B vitamins, omega-3s, or adaptogens.
  • Sleep hygiene: Creating an evening routine that helps your body wind down is essential for hormone balance.
  • Mind-body support: Tools like acupuncture, breathwork, and meditation can ease anxiety and improve sleep quality.

Reclaiming Your Health at Midlife

Let’s be clear. You do not have to accept feeling off as your new normal.

This chapter of life is about deeper awareness, renewal, and strength.

Seeking support is not a weakness. It is a form of self-respect. Recognizing what your body needs and advocating for yourself can be a powerful step toward well-being.

If your concerns have been brushed off or you’ve felt confused by conflicting information, know that better care is out there. You deserve to feel in control of your health.