Anemia Anemia is a condition in which the blood does not carry enough oxygen to the body's tissues, can intersect with perimenopause in ways that are easy to miss. Heavy or irregular periods, which are common during perimenopause, can lead to iron-deficiency anemia. The symptoms, fatigue, brain fog, weakness, and low mood, overlap significantly with perimenopausal symptoms, which means anemia is sometimes overlooked when hormonal changes are in the picture. If you are experiencing significant fatigue and have not had your iron levels checked recently, it is worth advocating for a diagnosis or ruling this out.
Bioidentical Hormones Hormones manufactured to be chemically identical in structure to those the body produces naturally. FDA-approved bioidentical hormones like estradiol and micronized progesterone are well studied and widely used. The term bioidentical does not automatically mean safer or better, and where a hormone comes from and how it is regulated matters.
Bone Density / DEXA Scan Bone density measures how strong and solid your bones are. A DEXA scan is the standard imaging test used to assess it and is typically recommended at or around menopause. If no one has mentioned it to you yet, it is worth asking about well before you reach age 65. Information, as you know well, is power.
Brain Fog Difficulty concentrating, memory lapses, word-finding issues, and a general sense of mental cloudiness that many women experience during perimenopause and menopause. It is real, it is hormone-related, and it is one of the most frequently dismissed symptoms of this transition.
Cardiovascular Risk in Menopause Estrogen has a protective effect on the heart and blood vessels, and as it declines, cardiovascular risk factors can shift. Heart disease is the leading cause of death in women in the U.S., and the timing of hormone therapy initiation is meaningfully connected to cardiovascular health. Starting hormone therapy earlier in the transition is associated with greater cardiovascular benefit.
Compounded Hormones Custom-made hormone preparations mixed by a compounding pharmacy. They are not FDA-approved or standardized, which means potency and consistency are not regulated the same way as manufactured medications. They may be appropriate in specific situations but are not inherently superior to approved products.
Estrogen / Estradiol The primary female sex hormone, though it is a hormone that is integral to far more than a woman's reproductive system. It is involved in bone density, cardiovascular health, brain function, bladder health, mood, and sleep. Estradiol is the most potent and biologically active form, and the one most commonly used in hormone therapy.
FSH (Follicle-Stimulating Hormone) A hormone produced by the pituitary gland that signals the ovaries to produce estrogen. As the ovaries become less responsive during perimenopause, FSH rises. A single FSH test is not a reliable indicator of where you are in the transition because levels fluctuate significantly. If something feels off, that matters more than one number.
GSM (Genitourinary Syndrome of Menopause) A collection of symptoms related to changes in the vulva, vagina, urethra, and bladder that occur when estrogen and androgen levels decline. Includes vaginal dryness, painful sex, urinary urgency, and recurrent UTIs. It is extremely common, tends to worsen without treatment, and is highly treatable. Women as young as their 20s can experience GSM due to factors like oral contraceptive and acne treatment medications. We talk about this constantly because most women have never heard of it until they are already dealing with it.
Heart Palpitations A feeling of a racing, fluttering, or irregular heartbeat that can be alarming if you do not know it is connected to the menopause transition. Estrogen plays a role in cardiovascular regulation, and as it fluctuates during perimenopause, palpitations are a common result. They are frequently investigated as a cardiac issue before anyone considers hormones as a contributing factor. If a woman has had a cardiac workup that came back normal and she is in her 40s or 50s, perimenopause is worth discussing with a menopause-trained provider.
Hormonal Headaches and Migraines Headaches and migraines that are triggered or worsened by fluctuating estrogen levels. Many women who have experienced hormonal headaches around their periods find that perimenopause intensifies them, at least initially, as estrogen becomes more erratic. Understanding the hormonal connection changes the conversation about treatment options significantly. Migraines with aura were once thought to be a contraindication to HRT, but that is no longer the case.
Hot Flashes A sudden sensation of intense heat, usually in the upper body and face, often accompanied by sweating and sometimes followed by chills. Sometimes referred to as hot flushes, particularly outside the United States. They are caused by the hypothalamus becoming more sensitive to changes in core body temperature as estrogen declines. These are known to have a tie to cardiovascular and cognitive risk. They are real, they are disruptive, and the good news: they are treatable.
HRT / Hormone Replacement Therapy / MHT The use of hormones, most commonly estrogen, progesterone, and sometimes testosterone, to support the body through perimenopause and menopause. Also called hormone therapy (HT) or menopausal hormone therapy (MHT). The evidence supporting it for symptom management is strong, and understanding your options is a big part of what we work through together.
Induced / Surgical Menopause Menopause that occurs because the ovaries are surgically removed or damaged by radiation or chemotherapy. Unlike natural menopause, which happens gradually, surgical menopause is immediate. The hormonal shift is abrupt, and symptoms can be significantly more intense as a result.
ISSWSH (International Society for the Study of Women's Sexual Health) A professional organization focused on women's sexual health, including the effects of the menopause transition. Their guidelines on GSM, low libido, and testosterone therapy in women are among the most current available. They also maintain a provider directory.
Local / Vaginal Hormone Therapy Low-dose hormone therapy applied directly to vaginal and urinary tissues. This can be in the form of estradiol and DHEA. Because the dose stays largely local and is low-dose, it is considered safe for nearly everyone, including many who cannot or choose not to use systemic therapy. It is one of the most effective treatments for GSM, vaginal dryness, and recurrent UTIs, and it is dramatically underused.
Low Libido and Hypoactive Sexual Desire Disorder (HSDD) Changes in sexual desire are common during perimenopause and menopause and have multiple contributors including declining estrogen and testosterone, GSM, sleep disruption, and mood changes. When low libido is persistent and distressing, it can be evaluated by a medical professional for HSDD and it is treatable with medications that can target varying drivers.
Menopause Technically, menopause is not a phase. It is a single day: the day that marks 12 consecutive months without a menstrual period. Everything before that is perimenopause. Everything after is post-menopause.
Musculoskeletal Syndrome of Menopause (MSM) A recently recognized condition describing the collection of musculoskeletal symptoms that emerge during the menopause transition, including joint pain, muscle aches, stiffness, and increased risk of injury. Estrogen plays a significant role in maintaining muscle and connective tissue, and as it declines, the body feels it in ways that are often attributed to aging rather than hormones. MSM is still gaining recognition in clinical practice, which means many women are experiencing it without a name for it. You are not imagining it, and it is worth raising with a provider who is trained in menopause.
Night Sweats Similar to hot flashes, but these occur during sleep. They can interrupt sleep multiple times a night and have a significant ripple effect on energy, mood, and cognitive function the next day. These are known to have a tie to cardiovascular and cognitive risk. Women who are told to just sleep with a fan deserve better information than that.
Osteoporosis A condition in which bones become less dense and more fragile, increasing fracture risk. Estrogen plays a protective role in bone health, and its decline accelerates bone loss during perimenopause and menopause. Hormone therapy is FDA-approved for osteoporosis prevention, and calcium, vitamins D and K, and strength training all contribute.
Pelvic Floor A group of muscles, ligaments, and connective tissues that support the bladder, bowel, and uterus. The pelvic floor is highly sensitive to hormone changes and can be impacted regardless of a history of pregnancy. During the menopause transition, declining estrogen affects pelvic floor tissue in ways that can contribute to urinary leakage, urgency, pelvic heaviness, and changes in sexual sensation. Pelvic floor physical therapy can be a highly effective tool during this phase, and one we regularly point our clients to consider.
Perimenopause The transition before menopause, and the phase that catches most women completely off guard. Hormone levels, particularly estrogen and progesterone, begin to shift and fluctuate, sometimes years before your last period. The symptoms most women associate with menopause, the sleep disruption, the mood changes, brain fog, heightened anxiety, joint pain, and hot flashes, are largely happening here.
Perimenopause Anxiety Anxiety that emerges or intensifies during perimenopause is common and connected to hormonal shifts, particularly estrogen fluctuations. Many women are treated for anxiety before anyone connects it to perimenopause. It is worth making sure you have a provider who knows the importance of considering the hormonal picture first.
Post-menopause The period of time following the day you reach menopause. Once you have gone 12 months without a period, you are post-menopausal for the rest of your life. Symptoms do not necessarily stop here. In fact 20% of bone loss happens after menopause and this is a silent shift happening within our musculo-skeletal system. Most menopausal women will not have regular withdrawal bleeds, but any unexpected bleeding after menopause always requires medical attention.
Premature Menopause / Early Menopause Menopause before age 40 is considered premature. Before age 45 is considered early. Both can result from various factors including genetics, autoimmune conditions, and medical treatments, and both deserve specialized care from a provider who understands the nuances, risks, and tools available to women.
Primary Ovarian Insufficiency (POI) When the ovaries stop functioning normally before age 40, but unlike premature menopause, it is not always permanent. Some women with POI still have occasional periods and may even conceive. It is different from premature menopause, though the two are often confused. If you are under 40 and experiencing hormonal symptoms or irregular periods, this is worth discussing with a specialist.
Progesterone Often described as the balancing hormone to estrogen. In hormone therapy, progesterone protects the uterine lining for women who have a uterus. It also supports sleep and mood in ways many women find meaningfully helpful, whether they have a uterus or not. Progesterone is not the same as progestin, and we talk with our clients a lot about this critical distinction.
Sex Hormone Binding Globulin (SHBG) This is a protein produced by the liver that binds to sex hormones including testosterone and estrogen, and carries them through the bloodstream. When a hormone is bound to SHBG it is inactive. Only the free portion is biologically available to your cells. A woman can have a normal total hormone level on a blood test and still have very little available to her body if her SHBG is high. When reviewing labs, free hormone levels calculated alongside SHBG give a more accurate picture than total levels alone.
Sleep Disruption One of the most underrated symptoms of perimenopause. It shows up as difficulty falling asleep, waking through the night, or simply not feeling rested. It can be tied to hormonal changes, often compounded by night sweats, and has a real effect on mood, cognition, and overall wellbeing.
Systemic Hormone Therapy Hormone therapy absorbed into the bloodstream that addresses symptoms throughout the body, including hot flashes, night sweats, sleep disruption, mood changes, and brain fog. Available as patches, gels, sprays, and oral pills. Transdermal options, meaning patches and gels applied to the skin, are often are preferred by menopause specialists because they bypass the liver and reduce clotting factors but when working with a trained clinician, oral delivery methods can be great options as well. Women who struggle with GSM will not always experience relief from systemic hormone therapy, so we educate our clients on this topic regularly.
Telehealth Menopause Providers Virtual medical practices staffed by clinicians who specialize in menopause care. They can diagnose, prescribe, and provide ongoing medical management, which is outside the scope of what we do at Menopause Office Hours. For women who need or prefer remote medical care, telehealth platforms focused on menopause are a meaningful option, and several now accept insurance. We can help you understand what to look for and what a good fit might be for your specific situation.
Testosterone No, this is not just a male hormone. This is a human hormone. Women produce testosterone. Fun fact: women produce four to five times more testosterone than estrogen during the reproductive era. It is our most prevalent reproductive hormone. Crazy, right? Knowing this takes the stigma out of considering the use of this hormone. Testosterone plays a role in libido, energy, mood, muscle mass, bone density, and cognitive function. It declines beginning in a woman's 20s and 30s and is consistently both underacknowledged and underprescribed for women.
The Menopause Society The leading professional organization in North America dedicated to menopause research, education, and clinical practice. Their evidence-based guidelines are what the most current menopause providers follow, though many leading experts challenge the society’s more conservative approach to following guidelines saying that there is room for improvement and faster alignment with what evidence-based care data show. The society does maintain a directory of certified menopause practitioners.
The WHI Study (Women's Health Initiative, 2002) The study behind much of the fear around hormone therapy. Its findings were widely reported as showing that HRT causes breast cancer and heart disease, and millions of women stopped treatment as a result. The full picture is more nuanced: the population studied was older, further from menopause, in poorer health, and on hormone formulations not commonly used today. The current consensus among leading menopause specialists tells a significantly different story, and understanding what the results of this study showed is a topic we are so passionate about educating our clients on.
Thyroid Disorders and Menopause Thyroid dysfunction and perimenopause share many of the same symptoms: fatigue, weight changes, mood shifts, brain fog, sleep disruption, and irregular periods. This overlap means they are frequently confused, and women are sometimes treated for one when the other, or both, may be contributing to symptoms. If you are experiencing these symptoms, it is worth asking your provider to dive in at asses both.
UTI Recurrent UTIs are a common and underrecognized symptom of the menopause transition. When estrogen declines, the tissues of the vulva, vagina, and urethra become thinner and more vulnerable, and the vaginal microbiome shifts, reducing the protective Lactobacillus bacteria that keep harmful bacteria at bay. The result is a urinary tract that is significantly more susceptible to infection. Recurrent UTIs in midlife are frequently treated with repeated antibiotics without anyone addressing the hormonal root cause. This is part of a broader condition called Genitourinary Syndrome of Menopause (GSM). Local vaginal estrogen is one of the most effective treatments available and is dramatically underused.
Vaginal Dryness One of the most common and least talked about symptoms of perimenopause and menopause. When estrogen declines, vaginal tissue becomes thinner, drier, and more easily irritated. This affects daily comfort, sexual function, and urinary health. It is part of a broader condition called GSM and it responds incredibly well to treatment. You do not have to live with it.
Vasomotor Symptoms The clinical term for hot flashes and night sweats. Vasomotor refers to the way blood vessels dilate and constrict, which is what causes the sudden heat and flushing. They are the most commonly recognized symptoms of perimenopause and menopause, and one of the symptoms most effectively treated by hormone therapy.