Perimenopause

Let's talk about estrogen: what it's actually approved to treat, where the evidence is strong, and where we're still waiting for better data.

Studies estimate that 45–70% of women experience depressive symptoms during perimenopause, compared with roughly 25–30% of premenopausal women. One small study even found that the risk of depression was 14 times higher during the two years leading up to menopause than during the preceding three decades. No wonder so many of us feel like we're losing our minds.

Progesterone is an essential part of hormone replacement therapy for many women with a uterus. While most women tolerate it well—and some even sleep better because of it—a small percentage experience unexpected side effects like increased anxiety, mood changes, or feeling "not like themselves." If that's you, you're not imagining it.

oday, we're tackling another common—but surprisingly under-discussed—cause of painful sex: Genitourinary Syndrome of Menopause (GSM). GSM is a collection of symptoms caused by falling estrogen levels that affect the vagina, vulva, labia, clitoris, bladder, and urethra.

The pelvic floor is a group of 14 muscles located at the bottom of your pelvis. These muscles support your bladder, rectum, and reproductive organs. Imagine a hammock or sling stretching across the bottom of your pelvis. That supportive hammock is your pelvic floor. When it's functioning well, you probably don't think about it. When it's not, you'll know.

Why aren't we talking about perimenopausal sexual dysfunction? Women's health has spent decades being the black sheep of medicine. Conditions affecting millions of women have often been dismissed, minimized, or simply ignored. Sexual health may be one of the best examples. Let's fix that.

Let’s talk bones. Not the Halloween kind—the ones quietly holding you together while you scroll this. Osteoporosis is a condition where bone density decreases and the internal structure of bone weakens, increasing fracture risk. Osteopenia is the early stage of bone loss—the warning sign before osteoporosis develops. Osteoporosis affects 200 million people worldwide. Eighty percent of cases are women. After age 50, 1 in 2 women will have an osteoporosis-related fracture.

Burning mouth syndrome- an often overlooked condition of middle age

Estrogen. Let’s talk about the positive. More people in perimenopause are finally having their symptoms taken seriously and addressed. And in 2025, the FDA removed the black box warning on estrogen products—a pretty big shift. Back in 2002, the Women’s Health Initiative study linked hormone therapy to increased risks of heart attacks, strokes, and pulmonary embolism. That study changed practice overnight. But over the following decades, more nuanced research showed that those

“Hair” raising topic ahead. As estrogen decreases, its ratio to testosterone changes—and suddenly, hair changes enter the picture. There are two main things that can happen to hair in perimenopause and menopause. First: thinning or loss of hair on your head (we will talk about this in a future blog). Second: extra hair growth on your face. Bold and beautiful: A striking illustration captures the confident expression of a bald woman with vibrant red lips and a bright orange co

Sometime in my 40s, I started waking up with pain in my fingers. The joints ached, and I had to negotiate with them first thing in the morning before they would fully straighten. It wasn’t just my fingers. My back carried a dull, persistent ache when I got out of bed, and my ankles felt… less trustworthy. Those days of bounding down the stairs two steps at a time? Gone.Now I reached for the handrail and descended carefully — and, uncomfortably, images of my grandmother flashe

Okay—picture this. I’m standing in the grocery store with my arms crossed over my chest. Slowly, I start swaying left to right, arms still folded. I glance over my shoulder to make sure no one is watching. To an outsider, it probably looked like I was rocking myself, deeply unsettled by something in the frozen food aisle. A woman confidently stands with arms crossed in the freezer aisle, amidst the neatly organized frozen goods. This photo was generated by AI. A dance move?

What is it? Progesterone is a steroid hormone made in the adrenal glands, the ovaries (and the testes in men), and—during pregnancy—the placenta. After ovulation each month, the ovary releases progesterone to prepare the uterus for a possible pregnancy. If the egg is fertilized, the placenta eventually takes over progesterone production. If not, progesterone levels fall… and your period begins. Structural representation of progesterone, a steroid hormone with the chemical for

During the pandemic, a man named Josh Wardle invented a game for his partner, Palak Shah who was fond of word games. His game, Wordle became a world-wide phenomenon with people texting their family and friends the results every morning, encouraging some competition and a lot of camaraderie. My family and I joined the Wordle craze and then sought out other similar games. Taylordle, Quordle, Heardle and WORLDle- to name a few. One of my kids found another game called Framed. Th

The Night Shift- when you can't sleep

I was a medical student at the turn of the century (No- not THAT century! I’m not that old!). And during that time, attending physicians told me over and over that hormone replacement therapy was a must. I remember one female doctor going as far as to say that it was malpractice to not put a (peri)menopausal women on estrogen. That was medical school. And then 2002 came and BAM!!!! In the blink of an eye, EVERYTHING CHANGED. The Woman’s Health Initiative (WHI) study was pause