04/25/2026
We had a client recently come in for a consultation and tell me she was told she didn’t qualify for estrogen when she first saw a doctor about her perimenopause symptoms. She absolutely had a laundry list of symptoms and her labs were crazy. Actually, her estrogen wasn’t even measurable.
Her doctor initially assumed she was in menopause because of the labs and started talking about estrogen in addition to progesterone. But then she mentioned (whoops!) she was still having periods.
Bang. The conversation stopped. Period = no estrogen. Despite being 48, with severe symptoms and mood swings that felt genuinely scary. Despite insomnia, hot flashes, vertigo, itchiness, dry everything, and on and on.
She was offered cyclic progesterone, but for her it wasn’t enough. In fact, the cycling made things worse. Every time she came off of it, her mood would drop like a rock. She was still anxious, and this made me even worse when she knew she would have to cycle off the progesterone.
I see this playing out in real time around me.
A woman at my gym brings a handheld fan with her. In the middle of lifting, she’ll suddenly turn bright red, stop what she’s doing, and try to cool herself down enough to continue while she rides out a hot flash.
You can see it happening. It’s not subtle.
I asked about if she was on estrogen, but she’s been told her labs are normal. She still has a period. She’s also given progesterone, but no estrogen.
But let’s be clear, a period is not proof of hormonal balance. It’s just proof that the uterine lining is shedding. Perimenopause is not a steady decline. It’s a storm.
Estrogen can spike high and then crash low. It’s a lot of chaotic ups and downs. It’s often those lows that drive the symptoms, and the more silent, insidious long-term health effects. You can be still cycling and still be dealing with major estrogen deficiency. And as we have discussed a lot, estrogen is VERY protective for long term health of bones, brains, hearts, metabolism, and more.
And labs?
They’re a snapshot of a moving target. It’s like chasing smoke when diagnosing perimenopause. Estradiol can look normal one day and be in the basement the next. Progesterone can be absent in an anovulatory cycle even if bleeding still occurs.
This is why we also offer the DUTCH test—a comprehensive profile of what your hormones are doing throughout the day.
So basing care on a single lab or a calendar definition misses what’s actually happening in a woman’s body.
But finally the conversation is starting to shift.
Research presented at the annual meeting of The North American Menopause Society in October of 2025 analyzed over 120 million patient records and looked at when women started estrogen therapy, and the timing mattered a lot.
Women who started estrogen therapy during perimenopause, years before their final period, had:
About a 60% lower risk of breast cancer
About a 60% lower risk of heart attack
About a 64% lower risk of stroke
compared to women who waited or never used it.
I also want to address being offered birth control vs bioidentical HRT to manage symptoms in perimenopause, because birth control and HRT are not the same thing. However it’s very common for birth control to be the default offering.
Birth control acts like a ceiling. The synthetic hormones suppress your natural hormones and keep them from going too high.
HRT acts like a floor. It supports your body when hormones drop too low and helps stabilize what feels wildly unstable. Bioidentical HRT uses molecules identical to the ones our bodies have used our whole lives.
Let’s be super clear, a period should not be a disqualifier for care. If a woman is 35+, clearly symptomatic, and asking for help, she needs more than “come back when your periods stop.”
Also, estrogen is not something women should have to earn by suffering long enough. HRT isn’t a prize for enduring suffering.
Have you been told you are too early (or too late) for HRT, estrogen, etc?
