What perimenopause actually is

Perimenopause is the transition phase before menopause, when estrogen and progesterone production becomes erratic and then declines. It typically begins in the 40s — sometimes the late 30s — and lasts four to eight years. Roughly three-quarters of women experience hot flashes, and for many, symptoms persist for seven years or more.

The symptoms women describe most

  • Periods that become irregular, heavier, or lighter
  • Hot flashes and night sweats
  • Sleep that breaks at 3am and won’t resume
  • Mood swings, anxiety, or a shorter fuse than usual
  • Brain fog — names, words, and focus slipping
  • Lower libido and vaginal dryness
A key point many women are never told: treatment doesn’t require waiting until periods stop. Perimenopause symptoms can be treated as they happen. Studies of FDA-approved hormone therapy show that for many healthy women under 60, or within about 10 years of menopause, the benefits for symptoms often outweigh the risks. Compounded hormones have not been studied in the same way.

What treatment looks like

Estradiol is a form of estrogen used to treat hot flashes and night sweats. For women with a uterus, progesterone is prescribed with it to lower the risk of uterine lining overgrowth. Estrogen carries serious risks, including blood clots, stroke, and endometrial and breast cancer, which your provider will review with you. Dosing is personalized and adjusted over the first few months.

Treatment is usually guided primarily by symptoms, with a baseline hormone panel as a helpful anchor for personalizing dosing and tracking progress over time.

Hormone therapy

Talk to a provider about your options.

Estradiol and progesterone protocols, personalized by a licensed provider. Explore the protocol →