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Perimenopause and Menopause: Symptoms, Hormones and Treatment Options


Reviewed by Leigh Ann Scott, MD of Forum Health Las Colinas


Wish you could hit the “pause” button on perimenopause and menopause? It’s no coincidence that these occur around the time that midlife starts. We have all heard the term, “midlife crisis,” which can seem to happen as our bodies begin to go through the “change.” 


A lot of women find that this is often a time to “pause” and step back and take a closer look at who they have been, and who they want to become. The physiological changes of the “pause” can also coincide with a shift in perspective. Many may find themselves looking for more meaning in their life, or looking further into their spirituality, life goals, etc. These physiological life changes can also trigger feelings of uncertainty which is perfectly normal (even though it may not feel that way)!

The hormonal changes that accompany perimenopause and menopause can be daunting as you may not feel like your old self again or feel like you are aging more rapidly. Fortunately, the providers at Forum Health are experts in Bioidentical Hormone Replacement Therapy and can help you transition through your life changes with more ease. 

Perimenopause and Menopause

Perimenopause and menopause are inevitable for all women. Some experience symptoms that can be mild while others may be more severe. Our philosophy is that everyone is different which means that everyone’s experience will be different. There is no one-size-fits-all approach to treatment, and here at Forum Health, we understand this and create a customized treatment protocol for each individual based on your unique symptoms, and lab test results.

The symptoms of perimenopause and menopause can overlap. Perimenopause is the transition between child-bearing years and menopause. Pregnancy is still possible because ovulation does still occur, but this is the time when hormones begin to fluctuate. The average age that a woman enters perimenopause is 40, however, everyone is different and it could be earlier or later. It can last just a few years, or it can last up to 10 years. It all depends on the individual.

Symptoms of both can and will overlap, however as a woman gets closer to menopause, symptoms can increase in number and severity.

Menopause “officially” occurs when the ovaries stop producing and the menstrual cycle ceases altogether. A woman is not confirmed to be menopausal until her cycles have ceased for one year, so it’s easy to see that you’re not necessarily perimenopausal one day, and then menopausal the next. Perimenopause and menopause aren’t events; they are transitions and gradually move from one into the other. However, there are things that can contribute to a more difficult transition, including some of the following:

  • Surgical removal of the uterus and/or ovaries – this can bring on sudden menopause and symptoms are generally much more severe
  • Smoking
  • Obesity
  • Diabetes and other chronic health conditions
  • Insulin resistance
  • Family history of early menopause
  • Some types of cancer; additionally, some cancer drugs cause the ovaries to stop producing hormones
  • Estrogen dominance
  • Imbalanced hormones prior to the life change occurring
  • Poor diet
  • Chronic, high-stress levels

The average age for menopause in the United States is 51 years old, however, this can also vary based on different factors, and each woman is different. By the time menopause is reached, hormone production will have significantly declined and menstruation stops altogether.

However, in perimenopause, hormones can fluctuate up and down. This fluctuation can cause women to have especially heavy or irregular periods. Estrogen, progesterone, and testosterone levels begin to change, and thyroid hormone production can also be affected.

Normally, the hormones estrogen and progesterone both increase and decrease according to a woman’s cycle and maintain a delicate balance with one another.

In early perimenopause, progesterone usually starts to decrease first. Progesterone helps to regulate the cycle; its main job is getting the uterus ready for pregnancy by thickening the uterine wall to prepare it for an egg. If there is no egg, progesterone levels drop, and the lining is discharged via menstruation. As progesterone levels begin to fall in perimenopause, the ratio between estrogen and progesterone can become off balance which can feel like estrogen is the dominant hormone. This can cause more thickening of the uterine lining and create fibroids and may cause endometriosis. Prolonged or heavier periods, and even clotting, may start to occur since these conditions are both fueled by estrogen.

Not only can these hormonal fluctuations produce unpleasant symptoms, but the balance between the two can widen and increase symptoms and/or the extent of how they are experienced. Usually one of the first symptoms noticed in perimenopause is trouble sleeping due to progesterone levels declining.

Testosterone is the third sex hormone, however, its wane is more gradual, beginning at around age 30 and continuing to decline as a woman gets older. 

It is not uncommon for women to also experience depression while going through these life changes. Unfortunately, a lot of doctors will want to treat this with antidepressants, however, most of the time those just treat the symptoms and not the actual cause. Conversely, our providers understand that the root cause of depression can also be caused by imbalanced or low hormone levels. Treating the root cause of the symptom is much more effective than prescribing an antidepressant.

There was a study published in the January 10th issue of Jama Psychiatry that was reported by Harvard University’s Women’s Health Watch. There were 172 perimenopausal and early menopausal women who participated between the ages of 45 and 65. These women were followed for six years. One group was given estradiol and intermittent progesterone pills and the other was given a placebo. 32% of the placebo group developed significant clinical depression compared to only 17% of the group taking the hormones.

Not all women will experience significant symptoms of perimenopause, but some can feel them intensely. There have been research studies completed as to why this is, but so far, nothing has been conclusive. However, generally, the healthier someone is, the better they will tolerate these changes, though that isn’t always the case.

Symptoms of Perimenopause and Menopause (notice they can overlap)

  • Trouble sleeping
  • Low libido
  • Anxiety and depression
  • Irritability
  • Weight gain
  • Hot flashes and/or night sweats
  • Inability to concentrate
  • Decreased ability to handle stress
  • Irregular periods (perimenopause)
  • Heavier or lighter periods (perimenopause)
  • Endometriosis
  • PCOS
  • Lower energy levels
  • Inability to lose weight, even if exercising and eating right
  • Loss of muscle tone and/or muscle mass
  • Hair loss
  • Changes in hair texture
  • Decreased sex drive
  • Memory issues/Brain fog
  • Acne
  • Joint inflammation
  • Fibroids
  • Vaginal dryness
  • Increased frequency of vaginal infections
  • Painful sex
  • Thinning skin
  • Osteopenia/osteoporosis
  • Increased risk for diabetes and cardiovascular disease
  • Increased inflammation levels

Roles of the Different Sex Hormones


Estrogen is one of the three sex hormones for women. It stimulates the growth of tissue such as breast development and the uterine wall. It is mainly produced in the ovaries through estrone, a weaker form of estrogen. Estrogen affects sleep quality/quantity, mood, libido, memory, and focus. It also helps to preserve bone mass. Taking bioidentical hormones can prevent osteopenia and osteoporosis and drastically slow the progression of an existing condition. It also helps to increase HDL, the good cholesterol. Some studies have shown that estrogen depletion can contribute to metabolic diseases, obesity, and cardiovascular disease.

It also helps to maintain collagen which affects the elasticity of skin and hair growth. As well, estrogen plays a role in the health of the vagina by preventing thinning of the wall and lubricating tissue. For childbearing women, estrogen stimulates growth of the egg follicle and increases and maintains the mucous membrane that lines the uterus wall.


Progesterone acts as the “protector” and has a calming effect on the mind and body. When balancing hormones for women, it’s important to maintain the correct ratio between estrogen and progesterone. Adequate amounts of progesterone are vital for sleep quality. It is produced mainly in the ovaries, but also in the adrenal glands. For menopausal women who have adrenal fatigue, this hormone can be almost nonexistent without bioidentical hormone replacement. Depleted amounts of progesterone also affect mood and can cause increased anxiety and/or depression.

It also prevents the overgrowth of cells and shields against nerve damage. For women in their childbearing years, it helps to get the uterus ready for pregnancy by thickening the lining of the uterus to allow for hospitable conditions for the egg to grow. Progesterone also affects metabolism as it contributes to the use of fat for energy. Additionally, it helps block plaque from forming on arterial walls and lowers triglycerides. It’s essential for helping to build bone. Progesterone is also important to the proper function of the thyroid gland.

Progesterone complements estrogen and it’s important to have a proper ratio of estrogen to progesterone. Otherwise, if this ratio gets out of balance it can cause a condition called estrogen dominance to occur which can cause fertility problems, endometriosis, fibroids, weight gain, and even endometrial cancers.

In fact, studies have shown that post-menopausal women who are only taking estrogen are 80% more likely to develop endometrial cancer compared to women who take both estrogen and progesterone.  Studies have also shown that progesterone is not just a sex hormone, but is also a “neuro-steroid” that plays an important part in brain function.


While we often think of testosterone as masculine, it’s also a sex hormone for women, although in much lower levels than for men. Healthy testosterone levels help with muscle mass and fat distribution and help maintain bone mass. It affects libido and fertility as well. Testosterone deficiencies result in feeling sluggish, generalized fatigue, low mood, impaired sleep, and weight gain. Imbalances can cause a poor tolerance for exercise and a lack of motivation.  Some women have too much testosterone which can cause symptoms such as acne, hair loss on the head, unwanted hair on other parts of the body, and infertility. So ensuring this is properly balanced is important.

The process of aging causes all individuals, regardless of sex, to experience varied and unique symptoms as their hormone levels change over time. Perimenopause (the transition from childbearing years to menopause) and menopause usually occur gradually. However, if a woman has a hysterectomy, symptoms can come on quite suddenly. If the ovaries are not removed, their function will still decrease more quickly because removal of the fallopian tubes can interrupt their blood supply. If the ovaries are removed during the hysterectomy, menopausal symptoms can be much more severe.

Treatment Options

Bioidentical Hormone Replacement Therapy (BHRT)

There are many hormones in the human body; all are chemical messengers that are part of the endocrine system and work together as a symphony of sorts. If you have one or two “instruments” that are “off-key,” or out of balance, it can affect the entire symphony. By taking this holistic approach to balancing your hormones and looking for other root causes of symptoms, we are able to make our patients feel significantly better, have more energy, and age gracefully! 
The proper way to address hormone imbalance, particularly as women age, is through an integrated, personalized, comprehensive, and regularly monitored program like the one we offer with Bioidentical Hormone Replacement for women.
Our program incorporates advanced laboratory testing, provider consultation, comprehensive health assessment, medically proven supplements, and professionally compounded Bioidentical Hormones tailored for your individual needs.

Benefits of BHRT

  • Corrects hormone imbalance
  • Prevents memory loss and brain fog
  • Improves cardiovascular health
  • Decreases symptoms of menopause and perimenopause such as hot flashes and night sweats
  • Promotes better sleep
  • Improves sexual health including vaginal dryness, urinary issues, and painful sex
  • Prevents bone thinning and osteoporosis

We want you to remain healthy and maintain the optimal balance of all things necessary to ensure that your overall wellness is the best it can possibly be. Bioidentical hormone replacement therapy can not only alleviate your symptoms and help to combat premature aging but can also provide long-term health benefits.


Our program relies on the expertise of our providers. They will use their training and experience to help you make the best decisions regarding diet, exercise, stress management, hormone balance, and pharmaceutical grade supplements as you work to achieve optimum physical and mental health so that you can lead the active and productive lifestyle that you desire!


The effects of aging and hormone imbalances can be counterbalanced with the right tools, medical guidance, and lifestyle changes. With the assistance of bioidentical hormone replacement therapy for women and proper nutrition, we work with you to sustain a lifetime of wellness.

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