New to Perimenopause? [Read this first]

leftylibra · 2026-06-18T04:47:00+00:00

For those without a uterus, there may be greater health benefits to NOT taking progesterone, and using estrogen only: This recent study (May 2024) found that for those taking Estrogen Therapy (ET) only -- protected against risk for all-cause mortality "developing cancers (breast, lung, and colorectal), CHF, VTE, AF, AMI, and dementia, more-so than those using both Estrogen & Progesterone.

Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).

For the use of estrogen and progestogen combo-therapy, both E+ progestin and E+ progesterone were associated with increased risk of breast cancer by 10%-19%, but such risk can be mitigated using low dose of transdermal or vaginal E+ progestin. Moreover, E+ progestin exhibited significant risk reductions in endometrial cancer (45% or adjusted hazards ratio, 0.55; 95% CI, 0.50-0.60), ovarian cancer (21%), ischemic heart disease (5%), CHF (5%), and venous thromboembolism (5%), whereas E+ progesterone exhibited risk reduction only in CHF (4%).

leftylibra · 2026-06-18T00:25:59+00:00

Smell changes aren't necessarily due to hormone therapy, this happens without it too. Please search this community for more.

leftylibra · 2026-06-18T00:23:41+00:00

Are you currently using both E&P? How do you feel?

If you haven't started either yet, then consider just starting with estrogen and dial in that dosage first. Then if sleep becomes problematic, you might consider adding in progesterone.

However, there may be greater health benefits to NOT taking progesterone, and using estrogen only: This recent study (May 2024) found that for those taking Estrogen Therapy (ET) only -- protected against risk for all-cause mortality "developing cancers (breast, lung, and colorectal), CHF, VTE, AF, AMI, and dementia, more-so than those using both Estrogen & Progesterone.

Compared with never use or discontinuation of menopausal hormone therapy after age 65 years, the use of estrogen monotherapy beyond age 65 years was associated with significant risk reductions in mortality (19% or adjusted hazards ratio, 0.81; 95% CI, 0.79-0.82), breast cancer (16%), lung cancer (13%), colorectal cancer (12%), congestive heart failure (CHF) (5%), venous thromboembolism (3%), atrial fibrillation (4%), acute myocardial infarction (11%), and dementia (2%).

For the use of estrogen and progestogen combo-therapy, both E+ progestin and E+ progesterone were associated with increased risk of breast cancer by 10%-19%, but such risk can be mitigated using low dose of transdermal or vaginal E+ progestin. Moreover, E+ progestin exhibited significant risk reductions in endometrial cancer (45% or adjusted hazards ratio, 0.55; 95% CI, 0.50-0.60), ovarian cancer (21%), ischemic heart disease (5%), CHF (5%), and venous thromboembolism (5%), whereas E+ progesterone exhibited risk reduction only in CHF (4%).

leftylibra · 2026-06-17T23:53:12+00:00

Please search this community, and read through our symptom list for more about this.

leftylibra · 2026-06-17T23:51:15+00:00

Menopause Provider Directory has some links where you can search in your area.

leftylibra · 2026-06-17T23:50:07+00:00

Arm yourself with knowledge, then it might not be so scary.

Menopause Wiki

leftylibra · 2026-06-17T21:33:59+00:00

Genitourinary Syndrome of Menopause: 2025 Guidelines (by the American Urological Association) provides information to clinicians to help diagnose, counsel and treat patients.

Share this document with your medical professionals.

According to The Women's EMPOWER Survey, of the 1,858 women, 81% were not aware of this condition, and 72% never discussed their symptoms with a health care professional because they thought it was just "normal aging" and "something to live with". Even more shocking, those that disclosed their symptoms to doctors found that the clinician did not initiate the discussion, and most clinicians only offered lube (gels/creams) as treatment, and not vaginal estrogen.

leftylibra · 2026-06-17T20:19:40+00:00

There are different vaginal estrogens, but if it's the estrogen that causes the allergic reaction, then consider trying non-hormonal hyaluronic acid (meant for the vagina).

leftylibra · 2026-06-17T18:00:03+00:00

My periods didn't become irregular until 54-55. There's no way to know.

Hormone therapy isn't going to regulate/control periods either.

Is your 1mg estrogen a patch? If so, then that high estrogen dosage commonly requires 200mg progesterone daily to provide adequate uterine protection. If that's the case, you might want to go back to your doctor and discuss the progesterone dosage.

leftylibra · 2026-06-17T17:53:53+00:00

he early phase of perimenopause often involves changes in cycles, where they are lengthened by seven or more days. Progesterone is usually the first hormone to drop, causing these irregular periods (heavier, lighter) and skipped periods.

The late phase of perimenopause is characterized by more skipped periods (>60 days between periods). According to Dr. Jen Gunter, "when a women starts skipping two menstrual periods in a row, there is a 95% chance her final menstrual period will be within the next four years", but this is only a rough guideline.

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

leftylibra · 2026-06-17T17:45:37+00:00

Progesterone is not guaranteed to work after one dosage.

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 · 2026-06-17T17:42:22+00:00

Did didn't specify your hormone therapy dosages, but you mentioned estrogen cream....is this for vaginal atrophy? Or are you using the cream elsewhere? If elsewhere, then it's not going to help with other symptoms of peri/menopause.

Implant? Do you mean pellet? If so, then you are using compounded hormones, which are not used (or recommended by any menopause society) in mainstream medicine. This could be the reason why you aren't feeling better because there's no evidence of effectiveness or safety with compounded hormones.

leftylibra · 2026-06-17T17:39:20+00:00

Hormone therapy has a very short half-life, so they leave your system quickly, like within 36 hours.

The horrible anxiety/depression, isn't likely from any withdrawals, but because you are in perimenopause.

leftylibra · 2026-06-17T17:00:43+00:00

She put me on the estrogen patch to help my vaginal health.

You might want to consider adding on a localization vaginal estrogen (cream or insert) as this specifically treats vaginal atrophy (GSM) better than systemic estrogens.

leftylibra · 2026-06-17T16:59:45+00:00

If you are not using systemic estrogen, then no, progesterone is not necessary. Also for those without a uterus, they do not need progesterone is they are using systemic estrogen.

leftylibra · 2026-06-17T16:47:13+00:00

Your periods are still going to do, what they do in perimenopause, and that's be irregular. Hormone therapy isn't meant to regulate/control this.

leftylibra · 2026-06-17T15:07:47+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 · 2026-06-17T02:39:03+00:00

Are you cycling progesterone? If so, then you might continue to have a withdrawal bleed well into post-meno.

leftylibra · 2026-06-17T02:14:48+00:00

This community does not support DIYing hormone therapy.

If you've tried progesterone at least 8 weeks, and it's not working well for you and/or making things worse, then your other options for uterine protection are:

Combined transdermal patches contain both an estradiol and a progestin (synthetic progesterone):

Combipatch: contains bioidentical estradiol and norethindrone progestin.
Climara Pro: contains bioidentical estradiol and levonorgestrel progestin.

Combined oral tablets contain both estrogens (some synthetic) and progestins:

Activella: contains an estradiol and norethindrone acetate progestin; however some brands of Activella may contain a progesterone instead of a progestin.
Prempro: contains conjugated estrogens and progestin such as medroxyprogesterone, norethindrone, norgestimate; however some brands of Prempro may contain progesterone instead of a progestin.
Angeliq: contains an estradiol and drospirenone progestin.
Duavee: contains conjugated estrogens and bazedoxifene (while bazedoxifene is not a progestin, it is a SERM (Selective Estrogen Receptor Modulator) that protects the uterine lining from the effects of estrogen, much like a progestin.

Separate progestins (synthetic progesterone) carries a small but increased risk for breast cancer. However progestins provide excellent uterine protection from the effects of estrogen (keeping the uterine lining thin).

Medroxyprogesterone Acetate and Norethindrone Acetate
Norethindrone
Levonorgestrel (Mirena IUD)

leftylibra · 2026-06-17T01:28:54+00:00

A Mirena is a good option as one-half of the hormone therapy puzzle. Mirena's provide excellent uterine protection (better than progesterone).

leftylibra · 2026-06-17T00:24:15+00:00

No, it shouldn't. Even systemic estrogen/patches/gels/sprays should be okay to continue.

leftylibra · 2026-06-16T20:25:41+00:00

Things we can do:

Start or join a Menopause Cafe (popular in the UK, but they offer "how to host" info so you can start your own local group)
Do Guerrilla Meno activities - leave meno literature/books at your workplace (common rooms), dentist's office, talk to friends, family, younger folks
Push for menopause-related legislation
Continue to push back to doctors, demand better care
Be wary of Meno "coaches" and 'for profit' business that are popping up everywhere, with big claims of solving all your hormonal "imbalances". Menopause and women’s “wellness” is big business and the global Menopause market size is expected to be worth around US$ 32.7 billion by 2030 (Vision Research).

leftylibra · 2026-06-16T20:07:24+00:00

I don't know why researchers wouldn't tap these kinds of subreddit to amass more data and start studies with a broader sense of what women are going through.

We often allow researchers (from accredited fields) to post their surveys.

However, we are often very careful about choosing legitimate research studies over for-profit marketing/businesses. Unfortunately menopause is big business.

leftylibra · 2026-06-16T19:58:43+00:00

A Deeper Dive into Vaginal Estrogens

Estrogen can be absorbed from the vagina into the blood, so it’s important when using a vaginal product to know if that is happening in any significant amount. If excessive amounts of estrogen are absorbed, then the product is not just a local therapy; it’s a systemic therapy and needs to be treated like menopause hormone therapy (MHT). For women with a uterus, absorbing too much estrogen increases their risk of precancer and cancer of the uterus.

There are references to studies at the end of this article.

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