Perimenopause: how to handle this hormone-laden time with grace – and a smile

Kathryn Rivera was about 47 when things started feeling, well…off.  “I don’t know myself anymore,” the Palm Bay woman recalls thinking.

Rivera was becoming more forgetful. Experiencing hot flashes, erratic periods and, oddly, a pain in her thigh bone, the now-55-year-old began chatting with coworkers about her symptoms and began to realize, “Okay, so it’s not just me,” she said.

But Rivera’s appointment with Ann Quesada, APRN, Health First Medical Group-Gateway, who specializes in gynecology, introduced a conversation that put her on a path to relief. She began taking hormone replacement therapy (HRT), which was “a game changer.”

With a combination of estradiol and progesterone, within a few weeks, Rivera began feeling more like herself.

“It goes into everything,” Rivera said of estrogen loss – and adding it back in for symptom relief. “It won’t make you feel 35, but it will make it manageable.” 

Sound familiar? You’re not alone. You’re not losing it. You’re just entering a new phase of life.

“You don’t have that estrogen buffer anymore,” Quesada explained. “It allowed us to multitask, sleep better, remember things. Without it, everything feels harder.”

While most women aren’t necessarily looking forward to menopause, think of it this way – “it’s a privilege of being alive,” Quesada said.

And, luckily, the topic isn’t taboo like it was just a couple of decades ago.

Thanks in part to social media, perimenopausal women are becoming more vocal – and viral – when dishing about it. There are blogs and websites devoted to educating women about the transition, as well as ways to handle symptoms. Then, the social media accounts, with women (and even some men) posting about what it’s like to experience (or live with someone) going through the so-called “change.” There are memes and motivational shares galore.

All of this is good. Because the more educated women are about this massive life change, the easier it is to navigate it – and find solutions that bring comfort and help restore a sense of normalcy.

Quesada helped break down what it all means – and how women can find the care they need.

What is perimenopause?
 

It’s like your hormones are throwing a farewell party. You just never got the memo.

According to the Menopause Society, perimenopause is the time span that sees changes with the start of their menstrual cycles and other symptoms. It can last up to 10 years. (Yes, you read that right.) This stretches into actual menopause, which is your final period, and the year that follows. This change is due to the ovaries’ erratic production of hormones, as well as fewer ovulations. Period lengths can vary, as well as your cycle’s blood flow.

“Sometimes you’re making hormones, sometimes you’re not,” Quesada said. “Your symptoms bounce around. It’s like a flickering fluorescent light.”

As early as a woman’s 30s, perimenopause can start. As estrogen drops, symptoms begin to roar. Estrogen has the biggest impact

Let’s break those down:

• Abnormal uterine bleeding: Every woman’s cycle is different, but in perimenopause, things change. If your cycle is usually consistent, this can be one of the first signs.
• Weight gain: “You’re not doing anything different, and your body is changing,” Quesada said. So, if your pants don’t fit, it’s not necessarily because of your diet.
• Mood swings: “You cry at a commercial you never cried at before,” Quesada explained. “You get ticked off easier. Even if you can hide it, you’re the person behind the smiling face on a stick.” 

•  Brain fog: Sudden moments of forgetfulness become more commonplace. “You don’t have that estrogen buffer anymore. It allowed us to multitask, sleep better, remember things,” Quesada said. “Without it, everything feels harder.” 

  Maybe you can’t remember where you parked your car. Or you keep telling the same people the same stories. “Your husband says, ‘You told me that three times already,’ ” Quesada used as an example. The Menopause Society notes the distress it causes, despite affecting 40% to 60% of perimenopausal women.

• Sleep problems: Finding yourself needing to change pajamas a few times a night? That’s another perimenopausal symptom. Hot flashes and night sweats – also known as vasomotor symptoms (VMS) – affect 80% of women during this time, according to the Menopause Society.  
• Mental health changes: One thing Quesada said she’s concerned about? Too many women are handed antidepressants when hormones are the real culprit. “Mood stabilizers can help, but you don’t want to jump to hormones unless your body has stopped producing them,” Quesada noted. “And antidepressants? They’re not always the answer.”
• Heart palpitations and anxiety: Changes in estrogen and progesterone can bring on heart palpitations and anxiety, according to the website Let’s Talk Menopause.
• Genitourinary changes: Some women experience pain during sex and vaginal dryness as estrogen crashes. Burning, itching and irritation are common, too, the Menopause Society said. Sometimes, this creeps up later but can be experienced in perimenopause. Incontinence can happen, too.
• Migraines: Headaches may increase due to hormonal shifts and may include sensitivity to sound, light and nausea and vomiting.
• Bone loss: You can’t feel bone loss — but it’s happening. “Bone loss is silent, like heart disease,” Quesada said. “It is silent until it gets you.” She refers her patients 50 and up to get a DEXA scan, a bone density test. It’s cheap, safe, and typically covered by insurance, she said. And if bone loss is found, supplements and other medications, including HRT, can help. Being proactive is essential.
• Libido: Yes, that’s affected, too. Sometimes, it drops; for others, sex drive can increase.
• Joint aches and pains: Yep. That can happen, too.

• HRT help – and the myths

   

Many perimenopausal symptoms are due to the drop in estrogen. Hormone replacement therapy (HRT) can help ease those. They come in pills, patches, gels, creams, sprays, vaginal inserts and more.

“Estrogen treats the whole gamut,” Quesada said. “If your symptom is due to menopause, estrogen is going to help it.”

Regardless, it’s critical not to go rogue. Ask a provider knowledgeable in menopause.

“You can just get online and start treating yourself,” Quesada said. “But there are consequences — and I’m the one seeing them.”

According to the Mayo Clinic, benefits of HRT may outweigh risks if you begin it before 60 or within 10 years of menopause.

While a 2002 Women’s Health Initiative study connected a slight cancer risk with women taking HRTs, the benefits should be weighed on a case-by-case basis, considering each patient’s personal health history, according to the MD Anderson Cancer Center.

It’s important to note that many women’s health experts feel the study did more harm than good, given it led to women and doctors abandoning HRT, a HONE article in July 2025 noted. The article added, “Years later, we learned the data had been misinterpreted, but the damage was already done.”

Still, it’s important to be cautious and consider your personal situation. Women with a history of breast cancer, especially triple negative or ER-negative breast cancer, are typically advised to not take HRT.

“Yes, you can feel much better,” Quesada said. “And I can get most of my patients off estrogen by their early 60s.”

For those who cannot – or don’t want – to take HRT, there are alternatives. The Menopause Society points to cognitive-behavioral therapy, clinical hypnosis, weight loss and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors and more.

There is also a new, nonhormonal FDA-approved medication, Veozah, which targets severe vasomotor symptoms (VMS) – those exhausting hot flashes and night sweats. However, given it is a relatively new drug, the cost might be prohibitive for some (but manufacturer coupons are available).

The perimenopausal treatment you seek boils down to your situation, risks and personal choice.  While menopause isn’t exactly cocktail party conversation, many think it should be.

“There’s a stigma about aging women,” Quesada said. “Menopause isn’t sexy. But the younger generation is different. They’ll talk about hormones, periods — no problem.

Survival tips

So, if you’re in the middle of perimenopause and wondering how you’re going to make it through, we’ve got you.

For those battling brain fog, start incorporating these tips:

• Set alarms like it’s your job
• Stick to routines
• Write everything down
• And if it’s messing with your life, get help.

For patient Rivera, HRT has been life changing. She’d love to see more medical providers to be schooled in menopause – and for perimenopausal conversations to be a normal part of women’s care.

“This should be pre-emptive,” she noted.

Bottom line? There are plenty of options out there to provide relief – and perimenopause is finding its way into more conversations.

“You’re not the old you,” Quesada added. “And that’s okay.”

Suffering from perimenopausal or menopausal symptoms? There’s no need. Get started by talking to your primary care provider or visit hf.org/findadoc.