Perimenopause: Signs, Irregular Cycles and When HRT Fits

STRAW+10 dates the transition from lasting changes in cycle length, so with truly regular cycles you are more likely in the late reproductive stage. Hot flashes or sleep changes can still start early, so log them and mention them to a clinician (ACOG).

Yes. ACOG describes hormone therapy for symptoms of perimenopause as well as menopause, and Winona’s FAQ says you can start while your periods are irregular. A clinician decides after reviewing your history.

Usually not. NIH’s NICHD says blood tests are not required. In the late transition FSH swings between the menopausal range and the younger range (STRAW+10), so one result can mislead.

Yes, if you do not want to get pregnant. NIA advises birth control until a full 12 months after your last period. The Menopause Society notes that a levonorgestrel IUD, used off-label, can protect the uterine lining during hormone therapy too.

Sleep problems often start in perimenopause and are closely tied to night sweats. The Menopause Society says hormone therapy improves sleep in women with bothersome night sweats by reducing nighttime waking.

Forgetfulness and trouble concentrating are on NIA’s list of transition symptoms, and poor sleep makes them worse. The Menopause Society does not recommend hormone therapy to prevent or treat a decline in memory or thinking.

Some change is expected, but ACOG lists heavy bleeding, bleeding between periods and bleeding after sex as reasons to see your ob-gyn, because polyps or a thickened lining can be the cause.

In the SWAN study, frequent hot flashes lasted a median of 7.4 years in all and 4.5 years past the final period. They lasted longest for women whose flashes began early in the transition.

For hot flashes the forms work about equally well (The Menopause Society). ACOG says patches, sprays and rings may carry less clot risk than pills. Compounded creams are not FDA-approved.

It depends on the plan. With cyclic therapy you take a progestin 10 to 14 days a month and usually get a monthly bleed; with continuous-combined therapy you take both every day (ACOG). Spotting is common at first and usually stops within 6 months (ACOG); report any bleeding that worries you.

The Menopause Society notes that lower doses can take 6 to 8 weeks to bring enough relief, so give a new dose time before judging it.

The Menopause Society’s 2023 statement recommends cognitive behavioral therapy, clinical hypnosis, SSRI or SNRI antidepressants, gabapentin and fezolinetant for hot flashes, and does not recommend supplements or herbal remedies.

At Winona, #1 in our women’s HRT ranking, it is from $54/mo for estrogen tablets, or from $93/mo with progesterone if you have a uterus (billed every 28 days). The doctor, messaging and shipping are included.