Understanding Perimenopause

Perimenopause typically begins in the 40s, although timing can vary. It marks the shift from regular menstrual cycles (premenopause) to menopause, when periods have stopped for 12 consecutive months.

During perimenopause, hormonal fluctuations—particularly in estrogen and progesterone—can cause physical and emotional changes. Some people may notice:

• Irregular or heavier menstrual cycles
• Hot flashes or night sweats
• Sleep disturbances
• Changes in mood or energy levels
• Vaginal dryness or discomfort during intimacy
• Cognitive changes, such as difficulty concentrating

The experience is highly individual, and not everyone will have the same symptoms or severity.

Hormonal Changes and Their Effects

The ovaries gradually release fewer eggs, and the hormonal system that regulates reproduction (the hypothalamic-pituitary-ovarian axis) becomes less consistent. Over time, estrogen and progesterone production decreases, which can influence multiple body systems.

These shifts may contribute to:

• Bone density changes
• Alterations in cholesterol and lipid metabolism
• Changes in skin elasticity
• Mood variations or anxiety
• Urogenital changes, such as urinary incontinence or increased risk of urinary tract infections

Potential Long-Term Health Considerations

If significant hormonal changes are not addressed, some individuals may be at higher risk for:

• Cardiovascular changes
• Reduced bone mass and increased fracture risk
• Changes in body composition, such as increased central fat
• Ongoing mood or cognitive changes

These potential impacts highlight the importance of monitoring and, if necessary, discussing management options with a healthcare provider.

Traditional Approaches to Perimenopause Symptom Management

Management strategies may include:

• Lifestyle adjustments: Balanced nutrition, regular physical activity, stress management, and sleep hygiene can support overall well-being.
• Non-hormonal therapies: Some may benefit from non-hormonal prescription or over-the-counter options for symptom relief, depending on individual needs.
• Supplements: Certain vitamins, minerals, or plant-based products may be used, although their effectiveness can vary and they may interact with other medications.

What is BHRT?

Bioidentical hormone replacement therapy uses hormones designed to closely match those produced naturally in the body. Some are available through approved pharmaceutical products; others may be prepared by compounding pharmacies.

BHRT may be considered when symptoms are significantly affecting quality of life and other approaches have not provided adequate relief. It is generally tailored based on lab testing, medical history, and individual health goals.

How BHRT is Typically Managed

If BHRT is being considered, a healthcare professional may:

• Assess hormone levels through testing.
• Review medical history to identify potential risks or contraindications.
• Create a personalized plan with regular follow-up appointments.
• Monitor and adjust as needed to maintain effectiveness and minimize risks.

Important Considerations and Safety

• BHRT is not suitable for everyone.
• All hormone therapies carry potential risks, which may include increased risk of blood clots, certain cancers, or cardiovascular events.
• Compounded bioidentical hormones are not reviewed by Health Canada for safety, quality, or effectiveness in the same way as approved prescription products.
• Marketing claims about compounded products being “safer” or “more natural” are not supported by sufficient scientific evidence.

Any decision to start BHRT should follow a discussion of both potential benefits and risks with a licensed healthcare provider.

The Bottom Line

Perimenopause can bring significant changes, but it also presents an opportunity to take a proactive approach to long-term health. BHRT is one of several options that may be considered as part of a comprehensive plan developed with a qualified professional. The best approach is individualized, balancing symptom relief with safety.