If you’re a woman in your mid-40s, 50s, or beyond, you may already have experienced some of the unpleasant symptoms that typically occur during perimenopause and menopause: fatigue, weight gain, hot flashes, night sweats, disappearing libido, vaginal dryness, thinning skin, and decreasing muscle mass, to name a few.

These symptoms are caused by decreasing estrogen and progesterone, and hormone therapy does exactly what you might guess: it replenishes the body’s stores of one or both of these critical building blocks. But how do you know if—and when—it’s right for you?

Background on menopause

Let’s start with some basics. Menopause is defined as the period in time when a woman stops menstruating, usually occurring between the ages of 45 and 56 (the average age of menopause is 51). Most women will experience their first menopausal symptoms sometime during perimenopause, the transitional period leading up to menopause, usually beginning a few years (and up to 8 years) before her last period. You're "in menopause" after 12 months with no period.

Gradually during perimenopause, the levels of estrogen and progesterone released by the ovaries will begin to decline. The drop in production is caused by a depletion in the number of estrogen-producing follicles in the ovaries. Once a woman hits menopause, estrogen and progesterone levels drop even further.

Estrogen and progesterone don’t just regulate your menstrual cycle, they’re also critical for countless other functions in the body—from maintaining bone density to regulating cholesterol to sustaining your sex drive. This is why you start to experience so many symptoms when you approach menopause. It’s also why hormone therapy works for so many women. When you restore your body’s supply of estrogen and progesterone, you reduce or eliminate those symptoms.

How do I know whether I am in menopause or perimenopause?

The first sign of perimenopause is typically a disruption in your menstrual cycle, either the length or intensity. Perhaps your period starts a little earlier or later than normal, and your menstrual flow is heavier or lighter than is typical. Aside from menstrual irregularity, some of the first symptoms to show up during perimenopause include trouble sleeping, fatigue, mood changes, night sweats, breast tenderness, and a drop in libido.

Symptoms that show up a little further into the menopausal transition include weight gain and weight redistribution around the midsection, thinning skin, joint pain, and brain fog. Menopause can be diagnosed based on your age, menstrual pattern, and symptoms.

Some women like to get bloodwork to determine hormone levels because they believe it will provide definitive answers about where in the menopausal transition they are. Unfortunately, bloodwork can be misleading, as most women's hormone levels fluctuate too much for one measurement to be meaningful. For most women, blood testing is not necessary to treat menopausal symptoms. It's the symptoms that are being treated after all, not the hormone levels.

When is it okay to start taking hormone therapy (HT)?

Most women can safely begin taking hormones once they are in perimenopause or menopause and are displaying the symptoms of reduced or fluctuating estrogen and progesterone. Your doctor can help you determine your eligibility based on your symptoms and some other key questions about your medical history. If symptoms are bothering you, menopausal hormone therapy is worth considering given its efficacy at diminishing menopause symptoms.

What kind of hormone therapy should I be taking?

If you decide that you want to try MHT, and you have a uterus, you will likely be prescribed a combination of estrogen and progesterone. This is because in women with a uterus, estrogen—if taken without progesterone—increases the risk of cancer of the endometrium, the lining of the uterus. During a woman's reproductive years, cells from the endometrium are shed during menstruation. When the endometrium stops shedding at menopause, estrogen can cause an overgrowth of cells in the uterus, a condition that can lead to cancer. Progesterone protects against this risk, and so is included in most women’s hormone therapy.

If you have had a hysterectomy and no longer have a uterus (and therefore no endometrium), you will be prescribed estrogen alone. Estradiol is the main form of estrogen produced by the ovaries, and is the preferred type of estrogen prescribed at Evernow.

Are there conditions that make me not a candidate?

Women with certain medical conditions or predispositions will need to be assessed more closely by a medical provider to determine their eligibility for HT, and type of HT. These risk factors are highly personalized and vary depending on a woman’s age and her individual medical history.

Women with a personal history of breast or uterine cancer, or certain heart or vascular conditions—such as blood clots, stroke, heart attack, coronary heart disease, or uncontrolled hypertension—may be at higher risk of vascular complications on HT, and should talk to their doctors. And finally, HT may be contraindicated in women with liver disease, gallbladder disease, lupus, or unexplained vaginal bleeding.

Screening for these risk factors is a standard part of the assessment for HT eligibility and treatment. Evernow’s health profile includes careful screening for risk factors that incorporates guidelines of trusted medical societies such as NAMS (North American Menopause Society) and ACOG (American College of Obstetricians and Gynecologists).

If I decide to try HT, what can I expect?

Relief from your menopause symptoms—fatigue, hot flashes, night sweats, brain fog, vaginal dryness, low libido, etc.—comes quickly after HT is commenced, typically within a few weeks to a few months. It is normal to experience some short-term side effects as your body adjusts to your hormone therapy, such as breast soreness, bloating, and mood and sleep changes, but these typically subside after the first month.

The benefits of HT may go beyond mitigating the unpleasant symptoms of menopause. Over the longer term, HT can lower the risk of many conditions tied to prolonged low estrogen, such as osteoporosis, osteoarthritis, and diabetes.

I’m interested in exploring hormone therapy. What are the next steps?

If you are interested in finding out whether you are a candidate for HT, you will need to work with a provider who treats menopause. If you choose to try Evernow for this, the first thing you will need to do to kick things off is complete an online health profile. We’ll ask about your age, blood pressure, symptoms, mammogram history, and other medical information relevant to your treatment. Then we’ll connect you with an Evernow OBGYN or NP who will review your answers in-depth and create a detailed treatment plan for you.