From hot flashes to weight gain to navigating hormone replacement therapy (HRT), perimenopause can be overwhelming. And with all the myths and misguided information circulating on social media, knowing the facts about perimenopause is more important than ever. That’s why we turned to the experts to separate fact from fiction.
Bruce Dorr, MD, FPMRS, FACOG, a senior medical advisor for Biote, says it’s important to understand the different symptoms and other changes that come with perimenopause and menopause.
Menopause is the life stage that happens when you’ve gone one year without having a menstrual period. It marks the end of a woman’s reproductive years. However, Dr. Dorr notes that women almost always start feeling symptoms of hormone imbalance seven to 10 years before menopause—which is known as perimenopause.
“In this stage, women experience an imbalance of the natural rise and fall of estrogen and progesterone from the ovaries, which causes unpredictable menstrual cycles,” he says. Here, experts debunk common perimenopause myths.
Myth: Women only experience hot flashes
While hot flashes are one of the most common perimenopausal symptoms, some women will also experience the opposite—a cold flash. Barbra Hanna, DO, FACOG, NCMP, board-certified OB-GYN and founder of MyMenopauseRx, explains that the hypothalamus regulates body temperature. And as we know, your estrogen levels fluctuate in perimenopause. “When estrogen drops, your hypothalamus becomes oversensitive, making your body suddenly feel cold, which results in a cold flash,” she says. Changes in circulation can also play a role.
Cold flashes are less common than hot flashes, but can be just as bothersome. “Managing cold flashes typically involves addressing the root causes, such as improving circulation with gentle exercise, staying well-hydrated and ensuring balanced blood sugar levels,” says Ena Cardona-Mason, FNP-BC, APRN, MSN, family nurse practitioner and owner at The Holistic Approach for Women. She adds that herbal remedies like black cohosh or sage may also offer relief.
Myth: Hormone replacement therapy is dangerous
During perimenopause, important hormones such as estrogen, testosterone and progesterone start to decline. “The resulting hormonal fluctuations and imbalance can cause a broad range of symptoms such as hot flashes and night sweats, poor sleep, difficulty concentrating, poor memory and more,” says Dr. Dorr. That’s where hormone replacement therapy comes in. HRT is simply replacing these hormones to restore balance.
He adds that it’s not dangerous as long as it’s “prescribed responsibly by a knowledgeable healthcare provider who is careful about what they are replacing the hormone with, how it is being delivered and what the treatment is being combined with.” In fact, according to the Menopause Society, HRT is one of the safest and most effective forms of treatment for perimenopausal symptoms. (Learn more about HRT here, plus how to talk to your doctor about HRT here.)
Myth: HRT is the only treatment option for perimenopause
Although HRT is effective in managing various perimenopause symptoms, it’s not a one-size-fits-all solution for every woman. According to Cardona-Mason, a holistic approach can also be incredibly helpful. “Nutritional support, stress management, exercise and sleep hygiene are essential components [to balanced hormone levels],” she says. “Supplements like magnesium, vitamin D, omega-3 fatty acids and adaptogens like ashwagandha or rhodiola can support hormonal balance and overall well-being.”
Dr. Dorr adds that hormones are a great option, but it’s important to understand that hormones are messengers that need a connection or receptor to work. “Receptors are influenced by diet, lifestyle, stress and genetics,” he says. Over-the-counter medications or prescriptions can also help temporarily, but it’s necessary to understand the root cause of your symptoms so you can find proper treatment.
Myth: You can’t get pregnant during perimenopause
Since your menstrual cycle is unpredictable and your periods are irregular at this time, it’s easy to believe you can’t get pregnant during perimenopause. However, that’s a common misconception. “Up to 40 percent of women will ovulate or release an egg within six months of their final menstrual cycle,” says Dr. Dorr. “While the likelihood of conception falls with age, spontaneous pregnancies can occur past 50 years.”
Perimenopausal women who are still having periods and are experiencing menopause symptoms often find relief using hormone therapy. However, Dr. Hanna notes that hormone therapy is not a contraceptive. “Perimenopausal women are still at risk of pregnancy if they do not use an alternative method of birth control,” she says. (Learn more about your odds of getting pregnant during perimenopause here.)
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
