Perimenopause is a hot topic in healthcare and reasonably so! A journalist recently said the last 20 years of perimenopause management is the biggest mistake in modern medicine.
For years, people between the early 40s and menopause have complained of symptoms such as brain fog, insomnia, mood changes, and hot flashes. These complaints have been dismissed because of age or because the labs did not show menopause.
This led to patients being miserable, feeling crazy and dismissed. All contributing to the mistrust of the healthcare system.
Dismissing the symptoms of perimenopause also led to significant health impacts after menopause. Increased cardiovascular risks and bone loss as well as mental health impacts caused significant issues for people after menopause.
In 2025, new research released showed that the safety and health preservation of hormone replacement therapy outweighs any of the previous possible risks.
There is no increased risk of breast, ovarian, or endometrial cancer from appropriate hormone replacement therapy in the latest research.
Latest recommendations from the menopause experts recommend starting hormone replacement therapy when you have symptoms of perimenopause. They do not recommend doing labs because the labs do not contribute valuable information or guide treatment.
Symptoms of Perimenopause
Symptoms of perimenopause include hot flashes, memory fog, joint pain, insomnia, itchy ears, mood changes, irregular periods, frozen shoulder, increased anxiety, vaginal dryness, decrease in libido, frequent bladder infections, and more.
It’s important to consider whether contraception is still needed. Irregular periods and increasing age does not mean you cannot get pregnant. Until you have not had periods for an entire year, you can still get pregnant.
Hormone Replacement Therapy
Hormone replacement therapy consists of estrogen and progesterone.
If pregnancy prevention is still needed, combined oral contraceptive pills can be a great method to replace hormones.
Estrogen can be replaced with a patch changed weekly.
Estrogen cannot be replaced in the body without progesterone. If there is no progesterone with the estrogen, you are at risk of developing endometrial cancer.
Not everyone is a candidate for estrogen. If you have high blood pressure, a history of a blood clot in your legs or your lungs, migraines with aura or seeing flashy lights, use nicotine, or just had a baby, you are not a candidate for estrogen. Estrogen use puts anyone with these conditions at higher risk for blood clots or worsening heart disease.
Vaginal Estrogen
All patients should start vaginal estrogen, even if you haven’t had dryness or frequent bladder infections. Vaginal estrogen will keep the tissue healthy as you approach menopause. It is better to maintain healthy tissue than it is to try to repair it in the future. All patients can have vaginal estrogen, regardless of risk factors, because it works locally on the vagina. Vaginal estrogen should be continued throughout the lifespan.
Progesterone
Progesterone can be replaced with a pill or a hormone IUD.
Patients are encouraged to use hormone replacement therapy until menopause. Menopause is when it has been 12 consecutive months without a period.
Research is still ongoing regarding the benefits of hormone replacement therapy after menopause. There is concern about the risks of cardiovascular disease with estrogen use in the late 50s–60s. Shared decision making should be used to decide if you wish to continue hormone replacement therapy after menopause.
Perimenopause and Menopause Care in Greensboro and Across North Carolina
Haven Health provides perimenopause and menopause care in Greensboro, North Carolina and by telehealth across the state for patients who are experiencing symptoms and want evidence-based treatment options.
Many patients have been told their symptoms are “just aging” or that their labs are normal. Haven Health focuses on symptom-based care and hormone replacement therapy to improve quality of life and protect long-term health.
Patients from Greensboro, High Point, Jamestown, Oak Ridge, Summerfield, Kernersville, and surrounding Guilford County communities visit Haven Health for compassionate menopause care.
If you live anywhere in Winston-Salem, Charlotte, Raleigh, Durham, Asheville, Wilmington, or anywhere in NC, you can meet with a provider virtually to discuss your symptoms and have lab monitoring completed at a lab near you.
Haven Health provides patient-centered, evidence-based hormone care both in person and online across North Carolina.