Your guide to perimenopause and menopause hormone therapy for women

Reviewed by: Megan Bradway, NP

Hormone therapy for women: What to know

  • During perimenopause, female hormones start to fluctuate and decline. Many women notice a variety of symptoms during this time.
  • Hormone therapy (HT) can help with symptoms of perimenopause and menopause. These include irregular periods, mood changes, sleep problems, and brain fog.
  • There are different types of hormone therapy medications. Some contain hormones, and others do not. Some treat symptoms in just the vagina, while others ease symptoms around the body.
  • Lemonaid Health offers convenient online consultations with licensed clinicians. If HT is right for you, they’ll prescribe safe, effective hormone therapy.

What are perimenopause, menopause, and post-menopause?

Every woman goes through these natural stages of aging. But timing, symptoms, and experiences vary from person to person.

Perimenopause: When hormone levels fluctuate and decline. Symptoms can affect the entire body. Pregnancy is less likely, but still possible.
Menopause: When you haven’t had a period for 12 months in a row. Symptoms may continue or stop. Pregnancy is no longer possible.
Post-menopause: The years after menopause. Symptoms are possible but less likely.

When does perimenopause start for women?

For many women, perimenopause starts in their mid-40s. It can begin as early as the 30s or as late as the 50s. In the US, the average age for menopause is 52.
If you think you may be starting perimenopause, learn more in this Lemonaid blog post.
Symptoms can be mild or strong at any time during perimenopause and menopause. The good news is that many treatments can help you feel better.

Symptoms of perimenopause and menopause

Hormones like estrogen and progesterone affect many parts of your body—not just reproduction. As these hormones decline, you may notice changes in your periods, mood, thinking, sleep, weight, and more.
For many people, symptoms start or get worse the closer you get to menopause. But they can affect your health and well-being at any time.
For details about potential symptoms, read this Lemonaid blog post.

Period changes

Declining estrogen directly affects reproduction. During perimenopause, periods often become irregular. Eventually, they will stop altogether.

Periods may become:

  • Shorter
  • Longer
  • Heavier
  • Lighter
  • Less frequent

Mood symptoms

Estrogen affects brain areas that support mood and emotions. Less estrogen may make it difficult to manage mental health—especially if you’ve struggled in the past.

You may experience new or worsening:

  • Anxiety
  • Irritability
  • Depression
  • Mood swings

Brain symptoms

Estrogen directly supports brain health. As estrogen levels decline, everyday tasks may become harder. Other symptoms you may experience during this time, like hot flashes and trouble sleeping, may also worsen functioning.

You may struggle with:

  • Brain fog
  • Memory issues
  • Trouble learning
  • Trouble concentrating
  • Trouble remembering or using words

Sleep symptoms

Estrogen and progesterone help regulate sleep. For some women, sleep problems are worse early in perimenopause. For others, they get worse as you experience more hot flashes.

At night, you may have:

  • Trouble falling asleep
  • Trouble staying asleep
  • Insomnia
  • Night sweats

Body changes

Estrogen affects systems throughout the body. Some symptoms may seem obvious in perimenopause and menopause, while you may not link others.

You may experience:

  • Hot flashes
  • Fatigue
  • Joint pain
  • Weight gain
  • Skin changes

Vaginal and urinary changes

Lower estrogen can weaken tissues around the vagina and lower urinary tract, causing symptoms. But some people develop symptoms in this area even when their hormone levels are not particularly low.

These symptoms include:

  • Vaginal dryness
  • Vaginal discomfort
  • Painful sex
  • Lower libido
  • Frequent urination
  • Trouble with bladder control
  • Frequent urinary tract infections

Benefits of hormone therapy for perimenopause, menopause, and post-menopause

These natural life stages are not conditions that require treatment. Instead, hormone replacement therapy (HRT) calms common symptoms. It won’t stop hormones from declining or prevent menopause. But it can help you feel more in control of your body during this long transition.​
Depending on your health history and symptoms, your treatment may include a medication containing estrogen, progesterone, or both. Non-hormonal medications may also suit your symptoms, risks, and preferences best.

Who should not take hormone therapy?

Hormone therapy risks differ by medication ingredients and how you take it, like orally or through your skin. A clinician can help you compare the risks and benefits of HRT.

HRT risks include:

  • A history of stroke
  • A history of heart attack or coronary heart disease
  • Unexplained vaginal bleeding
  • Liver disease
  • Pregnancy/trying to get pregnant
  • Breastfeeding

What testing and diagnosis are involved in HRT?

Female hormone levels naturally rise and fall throughout the month, and there is no “perfect” hormone level. Rather than diagnose through blood work, clinicians often base their recommendations on age, symptoms, and health history.
Some people with certain risk factors may need to track hormone, cholesterol, and bone density levels. Others may do blood work if they experience certain side effects of hormone therapy.


Your clinician will guide you through a safe treatment path.

Get online hormone therapy with Lemonaid Health

At Lemonaid Health, we understand perimenopause and menopause—and we’re here to help.

Take an online consultation to connect with a licensed clinician. They’ll help you understand how HRT can ease your specific symptoms and prescribe the best treatment.

With your Lemonaid membership, you get:

  • Convenient but detailed consultation care from the comfort of your home
  • A safe, affordable HT medication personalized for your health and symptoms
  • Your treatments delivered right to your door
  • Regular monitoring by clinicians to keep you safe
  • A treatment plan that adapts with your age, symptoms, and lifestyle

What are hormone therapy treatments?

Again, hormone therapy treats the symptoms of perimenopause and menopause. Depending on your age, symptoms, and other factors, treatment may include:

  • Estradiol, a type of estrogen, in a cream, patch, or pill
  • Progestin, a type of progesterone, taken by mouth
  • A non-hormonal medication that treats specific symptoms

Each treatment comes with its own risks and side effects. Clinicians personalize treatment to keep you safe and healthy. When side effects do happen, they’re usually mild and go away as your body adjusts.

Combination birth control pills

​Combination birth control contains estradiol and progestin. Taken daily, it smooths hormone fluctuations to soothe symptoms throughout the body. Because lower estrogen is linked with bone loss, it may also help preserve bone health.

Common, mild birth control pill side effects include:

  • Nausea
  • Vomiting
  • Headache
  • Swelling of the ankles/feet
  • Breast tenderness
  • Weight changes
  • Bleeding between periods
  • Irregular periods

Estradiol skin cream

You apply this medication to the skin of the upper arm or inner thigh, usually once daily. It contains estradiol, an estrogen, to treat symptoms like hot flashes, mood changes, and vaginal dryness. It may also help preserve bone health.

Learn more about estradiol medications in this Lemonaid blog post.

Common, mild Estradiol cream side effects:

  • Breast tenderness
  • Headaches
  • Nausea
  • Bloating
  • Mood changes
  • Skin irritation

Estradiol cream risks

Taking Estradiol alone may increase the risk of uterine cancer. Taking a progesterone medication with this cream reduces that risk.
Because you apply it to your skin, this medication may accidentally transfer to partners, children, or pets. To prevent this, wash your hands after applying the medication, let it dry fully, and cover treated skin with clothing.
​For post-menopausal women, estrogen medications may increase the risk of certain cancers, stroke, blood clots, and dementia. If you also take a progesterone medication, your risk of heart disease also increases.

Estradiol patch

You apply this patch to the skin of your lower abdomen, usually once or twice weekly. Absorbed into the body, it reduces symptoms like hot flashes, mood changes, and vaginal dryness. It may also help preserve bone health.

Common, mild Estradiol patch side effects include:

  • Skin redness or irritation around the patch
  • Nausea or vomiting
  • Bloating
  • Breast tenderness
  • Headache
  • Weight changes

Estradiol patch risks

Taking Estradiol without progesterone increases the risk of uterine cancer.
For post-menopausal women, estrogen medications can increase the risk of certain cancers, stroke, blood clots, and dementia. If you’re also taking a progesterone medication, heart disease risk also increases.
Increased patch prescriptions have caused a supply shortage, which may make it difficult to fill a patch prescription. To guarantee continuous treatment, your Lemonaid clinician will likely suggest you first try an Estradiol skin cream.

Estradiol vaginal tablets and creams

These low-dose estrogen medications are inserted into the vagina, usually daily for a little while and then twice weekly. They treat vaginal and urinary symptoms, including vaginal dryness, pain during sex, and bladder issues. They do not treat symptoms elsewhere in the body, like hot flashes and skin changes.

Common, mild vaginal tablet and cream side effects

  • Nausea or vomiting
  • Bloating
  • Diarrhea
  • Breast tenderness
  • Headache
  • Weight changes

Oral Estradiol

Take oral estradiol by mouth with food, usually once daily. Like other estrogen medications, it treats symptoms throughout the body. It may be an appropriate option for those with skin sensitivities.

Common, mild oral Estradiol side effects include:

  • Bloating
  • Breast pain or tenderness
  • Hair loss
  • Nausea
  • Stomach pain
  • Vomiting

Oral Estradiol risks

Because it passes through the digestive tract and liver, this medication is linked to a higher risk of blood clots than other forms. Because of this, Lemonaid clinicians only prescribe oral Estradiol when other forms are not appropriate. For your safety, this medication may require more regular monitoring and blood work.

Veozah (Fezolinetant)

This non-hormonal oral medication reduces symptoms like hot flashes and night sweats. It does this by blocking a brain chemical involved in temperature control.

Common, mild Veozah side effects include:

  • Abdominal pain
  • Trouble sleeping

Fezolinetant risks

In rare cases, Fezolinetant can cause serious liver disease. Stop taking the medication and contact your clinician if you start to experience signs of liver damage, including:

  • Nausea or vomiting that doesn’t stop
  • Severe stomach pain
  • Loss of appetite
  • Yellowing eyes or skin
  • Dark urine

Oral Progesterone

This medication contains progestin, a type of progesterone, usually taken daily. Progestin helps thin the uterine lining so it can be shed during periods. Clinicians usually prescribe it with an estrogen medication to protect uterine health. Together, these safely treat symptoms like hot flashes, mood swings, and poor sleep.

Common, mild side effects of Progesterone include:

  • Nausea
  • Bloating
  • Breast tenderness
  • Headache
  • Change in vaginal discharge
  • Mood swings
  • Blurred vision
  • Dizziness
  • Drowsiness

Progesterone risks

In rare cases, combination HRT increases the risk of fatal blood clot problems, dementia, and breast cancer. Your clinician will consider factors like your personal health history and how long you use HRT when assessing your risk.

Hormone therapy treatment success

A short conversation with a clinician can drastically change your experience of perimenopause, menopause, and post-menopause. Start an online conversation to discuss your symptoms, health history, and treatment options.


If you qualify for HT, your Menopause Membership will include unlimited consultations and 90 days of medication. You can pay for your membership every three or six months, or yearly. No matter your membership, we’ll help you feel confident in your care.

Start a Lemonaid hormone therapy consultation today!

Frequently asked questions about hormone therapy

What are common HRT side effects?
Different HT medications cause different side effects. Depending on the medication you take, they may include breast tenderness, bloating, spotting or bleeding between periods, and headaches.


What is the best hormone therapy for women?
Hormone therapy treats specific symptoms and considers individual risk. So there is no “best” treatment course.

Lemonaid offers several HRT treatments, prescribed alone or with others, as your clinician recommends. For example, birth control containing estrogen and progesterone soothes symptoms throughout the body. Applying estrogen to the vagina treats vaginal and urinary discomfort and pain.


I don’t want to take a medication with hormones. Are there any other options?
Yes. For some patients, clinicians may prescribe Veozah (Fezolinetant). It blocks a brain chemical that controls temperature to reduce hot flashes and night sweats.


How long do symptoms of perimenopause and menopause last?
There is no “normal” timeline. For some women, symptoms stop with menopause, and they reach post-menopause. Others have symptoms for years or decades during perimenopause and beyond menopause.


Will I have to be on HRT indefinitely? When does treatment stop?
HT medications ease symptoms. Treatment can continue as long as symptoms last, or stop when they do.

Summary: hormone therapy

  • Hormone therapy for women treats the symptoms of perimenopause, menopause, and post-menopause.
  • Treatments include hormone medications that contain estrogen, progesterone, or both. Depending on the medication, they’re taken orally, on the skin, or in the vagina. Non-hormonal medications treat specific symptoms like hot flashes.
  • Each medication comes with specific side effects and risks. Work with a Lemonaid clinician for a safe, personalized treatment plan.