Perimenopause and menopause — Reclaim Power Telehealth patient library

Perimenopause and Menopause: Symptoms, Hormone Therapy, and the Other Options

Hormones, Heart & Labs
September 20, 2026
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Women's health · Hormones

You do not have to white-knuckle this. The options are better than they were, and the advice about hormones has changed.

Written for my patients. If you are not one, read "call me" as "call your own clinician", and take the questions here to them.

What is happening

Menopause is one day: 12 months in a row without a period. In the U.S. the average age is about 51. The years leading up to it are perimenopause, and they can last several years. That is when hormone levels swing the most, which is why symptoms are often worst before your periods stop.

Common symptomsHot flashes, night sweats, broken sleep, mood swings or anxiety, brain fog, joint aches, irregular or heavier periods, vaginal dryness, and needing to pee more often.
Quieter changesFat shifts toward the belly, LDL cholesterol rises, and bone is lost fastest in the first few years after the last period. These do not announce themselves, so we check for them.

What changed about hormone therapy

For 20 years, estrogen carried the FDA's strongest warning, based on an early-2000s study of women who were mostly older and years past menopause. In November 2025, the FDA announced it was removing the boxed warnings about heart disease, breast cancer, and dementia, and updated labels began arriving in 2026. The warning about uterine cancer stays for estrogen taken without a progestogen by women who still have a uterus.

The expert consensus, from The Menopause Society: for healthy women under 60 or within 10 years of their last period, the benefits of hormone therapy for hot flashes and bone protection generally outweigh the risks.

Hormone therapy: the basics

Patch, gel, or pillEstrogen through the skin (patch, gel, spray) carries a lower risk of blood clots and stroke than pills. It is what I usually start with.
If you have a uterusYou also need a progestogen, such as micronized progesterone, to protect the uterine lining.
Vaginal estrogenFor dryness, painful sex, and urinary symptoms. Very little reaches your bloodstream, so it is safe for most women, including many who cannot take other hormones.
Real risks remainBlood clots, stroke, and gallbladder disease, mostly with pills and in women who start later. We look at your personal risk before deciding.
Not for you ifYou have had breast cancer, a blood clot, stroke, or heart attack, unexplained vaginal bleeding, or active liver disease.

If hormones are not for you

Recommended

Newer prescriptionsFezolinetant (Veozah) and elinzanetant (Lynkuet) calm the brain's temperature center directly. They are hormone-free. Fezolinetant needs liver blood tests.
Older prescriptionsLow-dose paroxetine and some other antidepressants, and gabapentin, reduce hot flashes.
CBT and hypnosisCognitive behavioral therapy and clinical hypnosis reduce how much hot flashes bother you. Recommended by The Menopause Society.

Not recommended

SupplementsBlack cohosh, soy, and most "menopause blends" have not held up in good trials. The Menopause Society does not recommend them.

What helps every woman

  • Strength training 2 to 3 times a week. It is the best thing you can do for bone and muscle now.
  • Protein at every meal, about 30 grams.
  • Less alcohol. It triggers hot flashes and wrecks sleep.
  • A cooler bedroom, layers, and a consistent wake time.

Call me right away for

  • Any bleeding after you have gone 12 months without a period. It is often harmless, but it always needs to be checked.
  • Very heavy bleeding (soaking a pad or tampon every hour), or thoughts of harming yourself. In a crisis, call or text 988.

I wrote this for my patients, and it reads the same for everyone: general information, not a plan. If you would like your own numbers read against your own story, that is what a Lab Second Look is for. If you are not sure where to start, the free intro call is fifteen minutes.

Read next: Better sleep · Your thyroid · How much protein

A note on how to use this. General information for my patients, not individualized advice. Whether hormone therapy fits you depends on your history and risks.

  1. The Menopause Society. 2022 hormone therapy position statement. Menopause 2022;29(7):767–94.
  2. The Menopause Society. 2023 nonhormone therapy position statement. Menopause 2023;30(6):573–90.
  3. Makary MA et al. Updated labeling for menopausal hormone therapy. JAMA 2025 (doi:10.1001/jama.2025.22259).
  4. U.S. Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. 2026.

Trang Ca Laube, FNP-BC, FMACP · Reclaim Power Telehealth · Updated September 2026

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Trang Ca Laube, FNP-BC, FMACP

Board-certified Family Nurse Practitioner and Functional Medicine Certified Practitioner. Founder of Reclaim Power Telehealth, seeing adults in Indiana, Colorado, Utah, Washington and Arizona. Author of The Safety Switch. These handouts are general information written for my patients, not individualized advice.

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