What to do about your symptoms (that actually helps)

23 hours ago

3 min read

Are you thinking: "OK, it might be perimenopause. Now what?"

You don't have to try everything at once (please don't!). Here's where I'd start, based on the research.

1. Track your symptoms

A few weeks of notes on your cycle, sleep, mood and symptoms turns "I just feel off" into a clear picture. It helps you spot patterns, and it gives your doctor something concrete to work with.

2. Prepare for your appointment

Appointments are short, and it's easy to forget what you wanted to ask (or to leave with "it's probably just stress"). Bring your tracker, your health history and your top three questions. If you're an expat, write them down in both languages.

Not sure when to start the conversation? Endocrinologist Ada Cheung recommends talking to your doctor in your 40s about your symptoms, your bone and heart health, and whether hormone therapy is right for you (ABC News, 2026).

3. Know your treatment options

Hormone therapy (HRT). HRT is effective for symptom relief. For most healthy women under 60, or within 10 years of their last period, the benefits outweigh the risks (The Menopause Society, 2022). It also protects your bones and, evidence suggests, your heart.

What's new in 2026. The research keeps getting more reassuring, and more nuanced:

In the big Nature Medicine study, women on HRT appeared to have much smaller changes in their lab results around their final period. Promising, but trials are needed to confirm it.
Worried about breast cancer? A 2026 review of 10 randomised trials found estrogen-only HRT was linked to a lower breast cancer risk: 3.6% compared with 4.7% on placebo (Kaunitz et al., 2026).
A 2026 analysis of 34 studies found the extra risk was linked to combined estrogen-progestin HRT, not estrogen alone, and that the type of HRT and how long you take it both matter (Annals of Medicine, 2026). Body-identical micronised progesterone appears to have a safer breast profile than older synthetic progestins.

The takeaway: the type of HRT, when you start it and how long you take it all matter. That's why a personal conversation beats a scary headline every time.

Options without hormones. If HRT isn't for you, or you'd like to add something alongside it, cognitive behavioural therapy (CBT) and clinical hypnosis are both recommended for hot flushes by The Menopause Society (2023). There are also prescription non-hormonal medicines your doctor can discuss with you.

Vaginal and bladder symptoms. Low-dose vaginal estrogen is effective for GSM and is considered safe for most women, including many who can't take HRT (The North American

Menopause Society, 2020).

4. stress, sleep, nutrition, movement

Sleep, stress, nutrition and movement all affect how you feel in perimenopause, and they affect each other. Trying to fix everything at once usually means fixing nothing. Pick the one area that bothers you most and start there.

You don't have to figure this out alone

This is what I do. I've read the research (so you don't have to!), I've been there myself, and I'll help you build a plan that fits your real life, from your doctor's appointment to diet and stress reduction, we will get you feeling like yourself again.

Book a free "Is this Perimenopause?" session https://www.menopauser.com/free-call and let's talk about what's going on for you.

Sources: The North American Menopause Society (2022), The 2022 hormone therapy position statement, Menopause. The Menopause Society (2023), The 2023 nonhormone therapy position statement, Menopause. The North American Menopause Society (2020), The 2020 genitourinary syndrome of menopause position statement, Menopause. Pridham, Hayut et al. (2026), Nature Medicine. Kaunitz et al. (2026), Menopausal estrogen therapy and risk of breast cancer, Obstetrics & Gynecology. (2026), Relationship between menopausal hormone therapy and incidence risk of breast cancer: systematic review and meta-analysis, Annals of Medicine. Ada Cheung quoted in ABC News, 13 October 2026.