Hormone Treatment for Perimenopause: Can It Help?

Half of women experience hot flashes during the years leading up to menopause. And almost as many experience mood symptoms like irritability or tearfulness. Yet most people are blindsided by their symptoms because they’re not in menopause (defined as having your last ever menstrual period). 

That’s because symptoms associated with menopause can start earlier than you may think. There’s a period of about 4 to 8 years when your estrogen levels will gradually drop. This is called perimenopause. 

Along with hot flashes and mood symptoms, you may have vaginal dryness, irregular bleeding, and night sweats. 

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But you don’t have to wait until you’re menopausal to benefit from treatments like hormone replacement therapy (HRT). 

Here’s what to know about hormone therapy and other treatments that are recommended for symptoms of perimenopause.

Quiz: Are you in perimenopause?

How HRT works for perimenopause

Hormone therapy replaces reproductive hormones that start to decline during perimenopause. These hormones are estrogen and progesterone. Replacing them can help treat many symptoms of perimenopause.

Most people take a combination of estrogen and progestin (progesterone). But some people may take them separately or just take estrogen. 

Combination hormone therapy can be taken cyclically or continuously:

• Cyclical: You take estrogen daily, but you only take progesterone for part of your cycle. This may be recommended if you still have your period.

• Continuous: You take the same dose of hormones every day. This is usually for people who’ve reached menopause and no longer have their periods.

Hormone therapy comes in several different forms. There are pros and cons to each form, so it’s important to discuss your options with your primary care provider or gynecologist. Here are some common HRT options:

• Pills

• Skin patches

• Injections

• Gels, creams, and sprays

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Is hormone therapy effective in treating perimenopausal symptoms?

Yes, hormone therapy can help symptoms in perimenopause. It has been proven to work best on hot flashes and night sweats (called vasomotor symptoms). One review found that hormone therapy reduced the frequency of hot flashes by almost 80%. It also made the hot flashes less intense.

Most types of HRT — like pills, patches, injections, and creams — can help relieve many of the symptoms of perimenopause. 

HRT may help these symptoms: 

• Hot flashes

• Night sweats

• Poor sleep (HRT helps sleep issues related to night sweats)

• Mood changes

• Irregular or heavy periods

 Perimenopause increases your risk for depression. If you’re experiencing depression in perimenopause, HRT may not be enough to help. You may need an antidepressant too, says Heidi Flagg, MD, clinical assistant professor of obstetrics and gynecology at NYU Grossman School of Medicine. 

So, speak with your primary care provider or gynecologist if perimenopause is causing mood symptoms that are interfering with daily life.

How do you treat vaginal dryness in perimenopause?

Vaginal dryness is another symptom of perimenopause. As estrogen levels decline, vaginal dryness becomes more common. One study found that in postmenopausal women, nearly half of those who were sexually active reported vaginal dryness.

If vaginal dryness is the only symptom you want to treat, vaginal estrogen may be a good option. The estrogen is applied directly to the vagina, so it doesn’t treat most other symptoms of perimenopause. It does, however, help keep tissue in the urethra moist, which can help prevent urinary tract infections (UTIs).

Should you take HRT during perimenopause?

If your symptoms are bothersome or affecting your quality of life, talk to your primary care provider or gynecologist about whether HRT is right for you. Symptoms — like hot flashes — may be very severe in some people and mild in others. 

And some people may be less bothered by symptoms of perimenopause than others. Each person experiences this phase of life differently. So, there’s no one-size-fits-all way to treat symptoms. 

Menopausal hormone therapy is considered the most effective treatment for hot flashes and night sweats related to perimenopause and menopause. But there are other non-hormonal medications and alternatives if you don’t want to take HRT.

How safe is HRT?

You may be reluctant to use hormone therapy. And you’re not alone. Many people are concerned about the health risks. Research published more than 20 years ago influenced a generation of healthcare professionals and women to avoid HRT due to the reported increased risk of heart disease, stroke, and breast cancer. 

But that research had major limitations. For one, most of the people in the study were in their 60s and well past menopause. Also, the amount of estrogen in HRT was much higher during the study period than it is now.

Since then, many other studies have found that the health risks for most people in their 40s and 50s taking menopausal hormone therapy are relatively low. Hormone therapy is now considered safe for most people with no other health risks. Certain groups may be advised not to take it (more on this below).

If you take hormone therapy, it’s recommended that you take the lowest effective dose for the shortest time period. This means monitoring your symptoms and checking in with your prescriber. Together, you can decide if and when it’s time to change the dose or the delivery method — or to stop taking HRT if it’s not working for you.

Weighing the risks and benefits of HRT

Hormonal therapy can increase the risk of some conditions and complications. For example, there’s some evidence that over the age of 60, HRT can increase your risk for heart disease, stroke, and dementia.

If you’re concerned about the risks of hormonal therapy, your healthcare team can help you weigh the risks and benefits for your own unique situation. They can also recommend the best type of hormonal therapy for you, depending on your individual symptoms and risks.

In some people, taking HRT may increase the risk for: 

• Breast cancer: There’s a link between estrogen therapy and breast cancer. But the increase in risk is very small for women in their 40s and 50s taking hormonal therapy for less than 5 years. Most healthcare professionals don’t recommend hormonal therapy for breast cancer survivors. 

• Uterine cancer: There’s a link between estrogen therapy and increased endometrial cancer (cancer of the lining of the uterus) in postmenopausal women. But taking progesterone along with estrogen lowers that risk. Women with early-stage endometrial cancer may be able to take some types of hormonal therapy. But it’s not recommended for those with more advanced endometrial cancer. 

• Blood clots: There’s a link between taking estrogen pills and an increased risk of blood clots. Lower doses of estrogen pills and other forms of estrogen don’t increase the risk of blood clots. If you’ve had a blood clot in the past, taking estrogen therapy may not be safe for you. 

• Strokes and heart attacks: If you’re younger than 60, or it’s been less than 10 years since you reached menopause, the risk of HRT causing a stroke or heart attack is probably low. The risk seems to go up if you’re 60 or older, or if you start hormonal therapy more than 10 years after menopause.

And keep in mind: There’s much we still don’t know about hormonal therapy risks. There are significant gaps in the research around different types and formulations of hormonal therapy, and among different groups of women. Most of the research to date has been in white, North American and North European women. It’s not clear if this data can be applied to non-white women. 

Who should not take HRT?

Some situations mean that you can’t take hormonal therapy safely. These include:

• You’re pregnant, or may become pregnant.

• You have a history of abnormal vaginal bleeding (not related to menstruation).

• You have active colon, breast, or endometrial (uterine) cancer.

• You’ve recently had a stroke, heart attack, or blood clot.

• You have active liver disease.

Can hormonal contraception be used to treat perimenopausal symptoms?

Oral contraceptives, or birth control pills, are another option for treating perimenopausal symptoms. They’re commonly used if you’re experiencing these symptoms but are still menstruating regularly. 

Oral contraceptives can help prevent pregnancy. They can also reduce perimenopause symptoms, like:

• Irregular periods

• Hot flashes

• Night sweats

Oral contraceptives are also really good at treating heavy bleeding, a common symptom of perimenopause, says Robert Kauffman, MD, professor of obstetrics and gynecology at Texas Tech University School of Medicine in Amarillo, TX. 

But it’s worth knowing this: The combined oral contraceptive pill contains estrogen and progestin. If you’re taking these, there’s typically a 7-day interval when you’re taking inactive pills. That means they don’t contain any hormones. You may find that hot flashes and other perimenopausal symptoms come back during this time.

If you want to use contraception, a low-dose birth control pill (10 mcg to 20 mcg) may be a good option, says Dr. Kaufman. The Mirena intrauterine device (IUD) or a birth control patch are also an option. 

Levels of estrogen are higher in oral contraceptives than in HRT. So, your gynecologist or primary care provider may recommend tapering off or switching to HRT once 12 months have passed since your last period. 

Birth control pills aren’t recommended if you smoke or have certain medical conditions. 

These conditions include:

• Heart disease or stroke (whether in the past, currently, or at risk of developing)

• Previous blood clot

• Current breast cancer

• Migraine headaches with aura (seeing flashing, zigzag lines)

• Long-standing diabetes 

• Severe liver disease

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Written by:

Cathy Garrard

Cathy Garrard is a journalist with more than 20 years of experience writing and editing health stories. Her work has appeared in print and online for Everyday Health, Reader’s Digest, Prevention, USA Today, Self, Men’s Fitness, and dozens of other media outlets and healthcare brands.

Edited by:

Laurie Tarkan

Laurie Tarkan is a senior health editor for general health and well-being at GoodRx. She has an extensive background in health journalism, and wrote regularly for The New York Times for a decade.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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