Perimenopause treatment

In perimenopause the ovaries make less estrogen and some months don't release an egg, so cycles and symptoms become less predictable.^1,3

• Periods can come closer together or further apart, get lighter or heavier, or be skipped.¹
• Hot flashes can come a few times a month or several times a day, and night sweats can wake you.¹
• Sleep can be harder, and vaginal dryness or pain with sex can start.^1,2

Some women have few symptoms and others have many.¹ Perimenopause ends at menopause, which is confirmed after 12 months without a period.¹ If your periods have already stopped for a year, see menopause treatment.

Changes in your periods are expected in perimenopause, but some bleeding should be checked. ACOG advises telling a provider about bleeding or spotting between periods or after sex, or periods that are much heavier than usual.³

Your provider asks about bleeding before discussing estrogen, because unexplained vaginal bleeding is a reason not to start it.⁴

Hormone therapy can relieve symptoms of perimenopause as well as menopause, according to ACOG, and there are options without hormones.²

• Estrogen, with a progestogen if you have a uterus, treats hot flashes and night sweats. The progestogen protects the lining of the uterus.²
• Local vaginal estrogen treats dryness and pain with sex.²
• Prescription medicines without hormones can treat hot flashes, and over-the-counter moisturizers and lubricants help with dryness.¹

Because you can still become pregnant during perimenopause, your provider asks about contraception and pregnancy plans before choosing a treatment. Menopause hormone products are not indicated for use in pregnancy.^3,4

Hormone therapy has risks that depend on your age, health and the type of hormone, and its label warnings changed in 2025 and 2026.

Estrogen is not used if you have unexplained vaginal bleeding, breast cancer or a history of it, an estrogen-dependent cancer, blood clots or a stroke or heart attack now or in the past, liver disease, or an inherited clotting disorder.⁴ The Menopause Society notes that risks differ by type, dose, how long you use it, how it's taken and when you start.⁶

Read the Important Safety Information for hormone therapy

Care starts with a call with your coordinator, then any labs your provider needs, then a visit at your local office or by secure video.

Before your visit

Your coordinator explains each step and its cost and books what comes next. It helps to note when your periods come, how heavy they are, and when hot flashes or sleep problems happen.

Your visit

Your provider goes through your symptoms, cycle and bleeding history, pregnancy plans, health and family history, and explains the options and their risks. Hormone levels go up and down in perimenopause.² Your provider decides whether labs are useful, and any labs are ordered for you at a lab near you. Lab testing

If treatment fits

Your provider explains the plan, and your coordinator goes over the order and its cost before you pay. Each new supply needs your provider's prescription and your OK. Follow-up visits review how you're doing as your cycle keeps changing. If treatment doesn't fit, nothing is prescribed.

You pay for each step as you reach it: any labs, a provider fee for a set period and, if your provider prescribes treatment, a medication supply paid in full up front for a set period. Costs are explained before you pay, and you get a receipt by email. No long-term contract, no membership and no automatic billing. How pricing works

Start at your local office or by secure video where your state allows. Find an office

Prescription treatment requires an evaluation by a licensed healthcare provider, who decides whether treatment is appropriate for you. Not everyone qualifies. Completing an assessment, booking a visit, or paying a fee does not guarantee a prescription.

1. ACOG. The Menopause Years (patient FAQ): perimenopause, signs and symptoms, menopause definition www.acog.org/womens-health/faqs/the-menopause-years
2. ACOG. Hormone Therapy for Menopause (patient FAQ) www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
3. ACOG. Perimenopausal Bleeding and Bleeding After Menopause (patient FAQ) www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause
4. DailyMed. Estradiol and progesterone, prescribing information: indication, contraindications, warnings (label effective 2026-09-29) dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=59eadb88-c9f3-4871-b176-7ddd98faf9bc
5. FDA. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies (content current as of 02/12/2026) www.fda.gov/drugs/drug-safety-and-availability/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations
6. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767-794 (abstract) pubmed.ncbi.nlm.nih.gov/35797481/
7. DailyMed. Estradiol (estrogen-alone), prescribing information: boxed warning (label effective 2026-03-26) dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e9702c4-f2d7-4ea8-b6e8-7dca31671864

Medical services are provided by independently licensed physicians, nurse practitioners and physician assistants of affiliated professional corporations and their affiliated professional entities. Vitality Testosterone Replacement Therapy provides administrative and technology support and does not practice medicine. All treatment decisions are made at the sole discretion of the treating provider. Medications are dispensed by licensed pharmacies. This website is an advertisement for medical services and is not medical advice. If you have a medical emergency, call 911.