"The average woman in the U.S. goes through menopause at 51, but my mom went through menopause when she was just 40 years old. Menopause is defined by not having a period for 12 months, so that means that while she was 39, she had her last period ever.
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Not going to lie, not having a period anymore does sound a little dreamy. But for up to 10 years before a woman has her last period, a time commonly called perimenopause, and then for years after she hits menopause, there are a host of not-so-dreamy symptoms that can accompany the transition.
For my mom, this meant things like terrible brain fog, so bad that one day she ended up driving an hour in the wrong direction because she simply had a series of space cadet moments, and weight gain that no matter how hard she tried, she couldn’t work off.
Symptoms of menopause and perimenopause
I would have been a freshly minted teenager when she was going through all of this, which definitely didn’t help her mental state (sorry, Mom). For other women going through perimenopause and menopause, symptoms include hot flashes and night sweats, disrupted sleep patterns, loss of sex drive, and mood changes. Hop on a perimenopause Reddit or Threads and you’ll find women sharing all sorts of other perimenopause symptoms not often discussed: itchy ears, dry eyes, burning feet, racing heart, anxiety, and many more. In fact, social media has been described as a “lifeline” for women on their menopause journey, empowering them to come to their doctors armed with knowledge to get their symptoms taken seriously.
It took my mom years to get the right support from her doctor to help combat her symptoms. Considering half the population will go through this transition, it’s a sad fact that recent surveys from AARP and Menopause found only about 20-30 percent of OB-GYN programs reported menopause training during residency.
“Only 20-30 percent of OB-GYN programs have any sort of menopause training during residency.”
I’m turning 39 in November and frankly want to avoid her experience at all costs if I can, which is why I’m learning all about Hormone Replacement Therapy (HRT), the most effective way to treat symptoms of menopause, now. I talked with Dr. Bruce Dorr, senior medical advisor at Biote, to learn more about all things HRT.
Bruce Dorr, M.D., Senior Medical Advisor
Bruce Dorr attended medical school at Wayne State University and completed his OB-GYN residency at the University of Colorado. He is board subspecialized in Female Pelvic Medicine and Reconstructive surgery, leads the OB-GYN department and robotic surgery section of Littleton Hospital, and he was a proctor for Davinci intuitive. Dr. Dorr joined Biote in 2013 and is one of the leading offices in the country for pelleting.
Editor’s Note: Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
What is Hormone Replacement Therapy for menopause?
As your body approaches menopause, two key hormones in your body start to change and become unbalanced: estrogen and progesterone. Hitting menopause and having an end to your period means that your ovaries are no longer producing eggs and signals the end of a woman’s ability to conceive.
Normally, during one of your menstrual cycles, your body produces more progesterone after ovulation, but as your periods become more irregular during perimenopause, your body begins to stop egg production. Because eggs are no longer released, your progesterone level drops. Your ovaries also make estrogen, but as your periods become more irregular, estrogen can build or become dominant. Estrogen levels will then drop as you approach menopause.
Having these two hormones get out of whack is what causes the ill-talked-about symptoms associated with perimenopause and menopause. As the name suggests, HRT is taking one or both of the affected hormones to replace what your body is no longer producing.
“Rebalancing and replenishing hormones may significantly improve a woman’s quality of life and help mitigate perimenopause and menopausal symptoms,” says Dr. Dorr. “Women should seek providers to help them and review all options for therapy.”
As you progress through perimenopause and into menopause, Dr. Dorr explains that you might use a different combination of treatments to help with your symptoms. “Early perimenopause is mainly estrogen dominant that needs to be balanced with progesterone,” he says, and by balancing progesterone, many women see relief with their symptoms.
In later perimenopause, very low-dose estrogen might be used in addition to progesterone, and Dr. Dorr says that sometimes testosterone might be needed. “In menopause, when bleeding and cycles have stopped for a year, all three hormones can safely be given together,” he adds.
What are the risks of HRT?
In 2002, the Women’s Health Initiative published a report saying that the risks of taking HRT outweighed the potential benefits, claiming that HRT increased the risk for heart attacks, strokes, and breast cancer. However, the results of the study have recently been called into question for a number of reasons, including that “the majority of women in the study were between the ages of 60 and 69—not the target age for initiating HRT”, according to a September, 2024 article in Fortune Well.
“At that time, medical professionals immediately stopped prescribing HRT, and to this day, concerns of HRT being linked to breast cancer has scared both patients and practitioners away from education and therapy,” says Dr. Dorr, even though subsequent research by the same group found that HRT for women under 60 generally had greater benefit than risk.
“What matters here,” Dr. Dorr advocates, “is what and how you put the replacement hormones in your body. When done correctly, there are minimal risks and really great benefits.”
How will I take HRT?
HRT comes in a variety of options, ranging from pills to patches to sprays, gels, and creams, or even injections. Dr. Dorr and his team at Biote specialize in pellet therapy, where a small pellet about the grain of rice is placed under your skin and replaced twice a year.
“The important thing when considering which method to use is to find a way to make it something that can fit into your lifestyle long term,” stresses Dr. Dorr. “If you have trouble remembering to do something every day or if patches irritate your sensitive skin, then that isn’t the best option for you, but if an implanted pellet seems too scary, then other options may be better.” He recommends discussing with your doctor about the different options and what might be best for you.
As for how long you would expect to stay on HRT? Dr. Dorr says that varies widely and really just depends on each individual’s case. He says it is important to note that “once treatment ends, symptoms usually return, so it comes down to finding a dose that minimizes the risk but preserves the quality of life.”
Feeling prepared to tackle perimenopause and menopause
Just because my mom went through menopause so early doesn’t mean I will, but Dr. Dorr does say genetics play a role in timing. I’m already showing signs that I’m headed that way. I could chalk the brain fog and sleep trouble up to two young children who still wake up in the middle of the night, and the stubborn weight hanging around my middle to too many Goldfish crackers, but some recent blood work showed that my progesterone levels have started to drop.
If you’re curious about whether you’re entering perimenopause or not, there are hormone tests through companies like Everlywell, Quest Health, and Allara Health that can give you some idea.
“There are no blood tests to ‘diagnose’ perimenopause,” warns Dr. Dorr, as it’s technically defined by symptoms and cycle irregularities, but says a woman can get an indication of whether she’s potentially in perimenopause through her follicle-stimulating hormone (FSH) and estradiol levels.
I’m glad I’ve taken the steps to learn more about what symptoms to look out for so that I can be on top of trying to most effectively manage what I’m feeling. I’ve already started taking progesterone, which has already helped with my sleep, and will continue to monitor my hormones and symptoms with my doctor.
Elliott Harrell, Contributing Writer
Elliott is a mom of two little girls and is based in Raleigh, NC. She spends her days running a sales team and doing laundry and her nights writing about the things that she loves. She’s passionate about all things motherhood and women’s health. When she’s not working, writing or parenting you can find her trying a new restaurant in town or working on her latest needlepoint project.