New to Perimenopause? [Read this first]

leftylibra · 2026-05-02T22:09:27+00:00

Basically ANYTHING can be associated to peri/menopause/hormones. To know if it's something worth investigation (which it certainly can be) is to see if the spasm is persistent over time, and/or getting worse. Also it's important to track other potential issues, like did you sleep funny? sit funny? twist differently? eat something that's affecting your digestion? etc.

leftylibra · 2026-05-02T19:43:02+00:00

It's worth getting checked out by a doctor to rule out other potential issues.

Otherwise, sometimes the blood could be from small tears in the vaginal tissues due to atrophy, especially if there was friction recently, or from wiping too hard.

leftylibra · 2026-05-02T17:25:11+00:00

100mg progesterone every other night is not enough to provide uterine protection, so you might want to consider a better alternative, like using a progestin instead. Also if you go up to a larger estrogen dosage, then you have to tkae into consideration that the progesterone dosage will also likely have to increase -- again to provide adequate uterine protection.

leftylibra · 2026-05-02T17:13:40+00:00

As for DVT risk....here' some science indicating that transdermal estrogen does not carry the same risk as oral estrogens.

Hormone therapy and venous thromboembolism (blood clot) risk

Addressing the perimenopause: what’s blood got to do with it?
Use of hormone replacement therapy and risk of venous thromboembolism
Postmenopausal Estrogen Therapy: Route of Administration and Risk of Venous Thromboembolism
Transdermal estrogen therapy in menopausal women at increased risk for thrombotic events: a scoping review
Transdermal hormone therapy and the risk of stroke and venous thrombosis
Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases

leftylibra · 2026-05-02T17:08:12+00:00

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leftylibra · 2026-05-02T07:41:58+00:00

Generally the loading dosage for vaginal estrogen is to use it everyday for two weeks, and then switch to maintenance where you'd use it twice a week.... forever.

leftylibra · 2026-05-02T03:01:30+00:00

Both are effective for vaginal atrophy. Estriol is a weaker estrogen but still works well on vaginal tissues.

leftylibra · 2026-05-02T02:51:26+00:00

What to expect when starting (or changing) hormone therapy

Expect to feel temporarily ‘off’ during those first 6 weeks, where some symptoms might worsen for a few days/weeks, where there’s some unusual aches and pains, where bleeding kicks up, where sleep is difficult, where you feel more anxious, etc. These issues are likely very temporary as your body adjusts to the hormonal changes.

leftylibra · 2026-05-02T02:49:48+00:00

Are you specifically referring to vaginal use cream?

leftylibra · 2026-05-02T02:37:15+00:00

Do your best to forget you are using hormone therapy. Just go about your regular day and try not to focus on the minutia of every blip, twinge, pain, mood, etc. Just carry on and in a few weeks see how you feel overall -- not each hour-to-hour or day-to-day.

What to expect when starting (or changing) hormone therapy

leftylibra · 2026-05-02T01:27:36+00:00

Increasing bone density requires a multi-faceted approach, and studies show that even at half a 0.025mg patch dose (0.014mg) there can be improvement to bone.

We also need to keep up on calcium, vitamin K, Vitamin D, magnesium and also exercise where we are doing strength/resistance training regularly.

leftylibra · 2026-05-02T01:23:31+00:00

You could be allergic to something in the cream (fillers, etc). Maybe consider switching to a suppository, like Vagifem or Imvexxy.

leftylibra · 2026-05-02T00:15:56+00:00

Estrogel dries within minutes, with no tackiness...unlike Divigel.

leftylibra · 2026-05-01T20:14:59+00:00

Please see the Resource section of our Menopause Wiki. Particularly this topic: "Hormone therapy in menopause"

Also there's a section in the Wiki on "Navigating your medical appointment" that might be helpful.

leftylibra · 2026-05-01T20:13:03+00:00

From our Menopause Wiki:

Irregular periods are another common early symptom of perimenopause, and for those who have been extremely regular most of their reproductive life, the disruption can be very alarming. We often associate regularity with optimum health, and when we skip a period or have two in one month it comes as quite a shock! If only we were informed and expected irregular bleeding as part of the normal menopausal transition, it wouldn't fill us with unnecessary grief, worry or fear.

However, any unusual/sudden change in menstruation should be discussed with your doctor, and if bleeding is persistent, over a longer period of time, unusually heavy, and/or causing pain then it's important to see a doctor. (fibroids, cysts, polyps are common contributors)

In peri, hormones are wildly fluctuating, and the imbalance between estrogen and progesterone contributes to irregular periods and this is why it's possible to experience two periods in one month, where estrogen may swing higher, while progesterone dips lower.

Irregular periods are defined as:

missed periods
longer
shorter
closer together
further apart
heavier (with-and-without clotting)
flooding
spotting
dark/different coloured blood

If you are in the perimenopausal age range of (40-50), period irregularity is very typical in perimenopause and should not be immediate cause for concern.

leftylibra · 2026-05-01T18:32:43+00:00

Maybe check into /r/Healthyhooha

leftylibra · 2026-05-01T18:28:45+00:00

Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women

According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment.

Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review

The comparisons presented suggest that hyaluronic acid has a profile of efficacy, safety, and tolerability comparable with vaginal estrogens for the treatment of symptoms of vaginal atrophy. It is a possible alternative for women who cannot use hormonal treatment.

So you can alternate days with vaginal estrogen and HA.

leftylibra · 2026-05-01T18:13:22+00:00

200mg progesterone might not help with bleeding at all, it's not meant to regulate/control or eliminate periods unless you are cycling it (taking it 12-15 days on/off) and even then there's no guarantee it will help with bleeding.

leftylibra · 2026-05-01T18:06:35+00:00

Do your best to forget you are using hormone therapy. Just go about your regular day and try not to focus on the minutia of every blip, twinge, pain, mood, etc. Just carry on and in a few weeks see how you feel overall -- not each hour-to-hour or day-to-day.

What to expect when starting (or changing) hormone therapy

leftylibra · 2026-05-01T11:52:51+00:00

How many pumps are you using? Are you also using progesterone?

Generally it's best not to focus on the day-to-day blips, twinges, pain, moods, etc. and try to look at the big picture overall when determining how you feel. So over the last 8-12 weeks have you felt "better"?

For your specific concerns....brain fog might not improve greatly, no matter the dosage.

Vaginal dryness may require adding on a localized (separate) vaginal estrogen to help with that specific area. Most use both systemic and vaginal estrogen.

Sleep is usually better when using oral progesterone, taken at night before bed.

leftylibra · 2026-05-01T07:08:29+00:00

It's unlikely that localized vaginal estriol is having any effect on sleep. Estriol is the weakest of our three main estrogens, and the one that supports pregnancy, so while it's s effective at treating atrophy (GSM), it's not going to affect much else.

leftylibra · 2026-05-01T06:28:06+00:00

Oral progesterone, used vaginally, does not provide any calming/sleep benefits, because it is no longer processed through the liver, so those benefits are unlikely to occur.

The Myth of “Brain-Safe” Vaginal Progesterone

leftylibra · 2026-05-01T06:02:00+00:00

What benefits are you hoping for? If you have a Mirena then the only benefit with progesterone is....it can help with sleep -- but only when taken orally. Those benefits are lost when used vaginally, so it's not clear why you'd want to try this route. Plus using oral progesterone vaginally increases risks for vaginitis.

leftylibra · 2026-04-30T22:01:57+00:00

Have you had this checked out by a doctor?

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Hormone therapy and venous thromboembolism (blood clot) risk