Help! I’m Perimenopausal and My Instagram Feed Won’t Stop Selling Me Solutions
Remember when no one wanted to talk about “the change”? Now midlife influencers and celebrities can’t stop peddling wonder cures. But what actually helps—and what doesn’t? (Hint: It’s not always what’s trending on TikTok.)
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Photo via Getty Images
At 44, I wet my pants for the first time since toddlerhood. I was sitting on my couch when a whoosh of fluid seeped into my cushions. I crab-walked to the bathroom. I’ll spare you the details, but it was basically a period unlike anything I’d experienced since puberty.
Shortly thereafter, I was in a paper gown getting a transvaginal ultrasound, an internal scan that looks for cysts, fibroids, or worse. The tech, about my age, gave me an empathetic look as I splayed like a Thanksgiving turkey, legs akimbo, vulnerable in every way.
“Sweetie, didn’t anyone tell you that weird bleeding is part of perimenopause?”
They hadn’t.
But once the “p” word was uttered (and nothing unusual was found), I felt like I had permission to contemplate what had been happening to my body long before my leak. My periods were worse. I spotted. I woke up to pee. And why did my feet hurt all the time? Even the quickest Google search confirmed that these were perimenopause symptoms, every single one.
In short order, I drowned in a rabbit hole of symptoms and solutions far more confusing than my first hormonal transition as a tween circa 1991. Back then, I giggled in health class when my sixth-grade teacher illustrated tampon insertion. In high school, my mom marched me to her OB-GYN for a candy-pink packet of ortho tri-cyclen birth control (to help my skin, she said, though I’m sure there were other motives). My periods lightened. My pimples vanished. Done.
I missed those days. Now, I was being bombarded with products geared toward midlife women, promising to treat hot flashes, weight gain, tiredness, night sweats, and more. There were Instagram Stories (should I rub magnesium on my feet to sleep?), TikTok influencers (maybe colostrum would boost my immune system?), books, podcasts, and Substacks breaking down the finer points of hormone therapy. Even celebrities were hawking peri products: Gwyneth Paltrow launched Madame Ovary vitamin packs a few years ago; Drew Barrymore endorses Dr. Kellyann &Me Peri + Menopause supplements.
It seemed that relief—from all of it, even issues I didn’t even know I had—was just a scroll or a click away. Midi Health, a virtual care platform, offered “a roadmap to relief” with hormonal and non-hormonal treatments, plus supplements and botanicals for hair, skin, mood, memory, and libido. Alloy, another online midlife provider, offered a $29.99 tube of O-mazing, a cream to help with orgasms. The downtown medspa where I get forehead Botox was even selling vitamin injections for fatigue and lasering to plump my vaginal tissue. Smooth forehead and a plump vagina? If not for the terrible parking, I’d be all in.
Meanwhile, one of the most widely read menopause Substacks, the Vajenda by Jen Gunter, an OB-GYN and author, offered a warning: “Anyone can make a supplement and sell it. Anyone. The only real requirement for success is having a large social media following, being in healthcare, or preferably both.”
Gulp. Where to turn?
Fortunately, Boston has long been ahead of the curve (or flow) in terms of menopause treatment. Impactful research has origins here, including the Study of Women’s Health Across the Nation (SWAN), an extensive multisite longitudinal examination of women’s psychological and physical health during midlife; the Kronos Early Estrogen Prevention Study, addressing the effect of timely menopausal hormone treatments on cardiovascular health; the Women’s Health Initiative (WHI), a long-term national health study on women and aging, launched in the early ’90s; and the Nurses Health Studies, one of the largest investigations into the risk factors for major chronic diseases in women.
Beyond the research, patient care is also booming: In 2014, Mass General also created a specialized Midlife Women’s Health Center; in 2020, Brigham and Women’s Hospital launched a Menopause and Midlife Clinic. There are currently 58 Menopause Society Certified Practitioners accepting new clients in Massachusetts—not including those whose schedules are filled—who must pass a competency exam with demonstrated expertise in the field. Compare that with states that have a similar 7 million population: Tennessee has 34 such available providers; Arizona has 31.
Access to savvy clinicians is important, since menopause still isn’t a focus in medical school. Many doctors haven’t kept pace with influencers peddling products—and with a new generation of women used to self-advocacy who are demanding answers. “You might feel like [you know] more than your doctor because a lot of this movement has come from celebrities talking about their experiences and women during the pandemic talking about their experiences. That’s fantastic. But the medical training hasn’t caught up yet,” says Heather Hirsch, an internist and menopause specialist who founded the Menopause and Midlife Clinic at Brigham and Women’s and now runs a virtual telemedicine practice. “In medical schools, we need educators who can teach on those things. What I’m seeing is that there tends to be a gap between what women now know—and they’re asking very nuanced, very mature questions.”
I had no shortage of them. What I needed were answers. But those can be tough to find—even in Boston—when perimenopause feels as much like a marketing slogan as it does a major life transition.
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Right: Photo by Getty Images
Related: The Great Menopause B(l)oom
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- Myth Vs. Fact
- What to Expect
- The Truth About Hormones
- Ask an Expert: Four Modern Remedies
- Boston’s Research Breakthroughs
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The far-reaching effects of hormonal changes during perimenopause can trigger a bewildering array of symptoms—from anxiety to joint pain to weight gain—making it difficult to distinguish from other midlife health issues.
Traditionally, perimenopause is the body’s segue before menopause. It usually starts in your mid-forties (like me) but can begin as early as the mid-thirties (surprise!). It’s marked by fluctuating hormones—estrogen and progesterone are key players—behaving like dueling soap-opera stars acting out a script rife with hot flashes, night sweats, mood swings, erratic periods, vaginal dryness, weight gain, and more. Finally, periods become irregular; after 12 consecutive months without a period, you’ve won the golden tampon and crossed the finish line into menopause.
My mom never told me about perimenopause, and that’s because nobody talked about it 25 years ago, mostly due to misinformation and fear of social stigma. Now, we’re more open. Partially, this is because my generation of fortysomething women are social media savvy and have no problem sharing (and oversharing); we’re used to demanding better childcare options and work-life balance, and better midlife health is no different.
But it’s also because many symptoms can now be treated with hormones, a therapy that’s shed its once-controversial reputation—as I quickly discovered while my knees creaked, my sleep worsened, and my periods (and midsection) got heavier. In my mom’s era, hormone replacement got a bad name based on the WHI study that began more than 30 years ago. It examined the health effects of women, ages 50 to 79, taking estrogen-only or combined hormone-replacement therapy (with progestin, progesterone’s synthetic form), compared with a placebo. The study was halted back in 2002 over concerns about small risks of increased breast cancer, heart disease, and stroke among women given both estrogen and progestin. This had a predictably chilling effect among women and throughout the medical community: Could symptom relief also lead to cancer? Better to quietly endure hot flashes than to roll the dice.
Now, more than two decades later, an analysis published in the Journal of the American Medical Association (JAMA), led by JoAnn Manson, chief of the division of preventive medicine at Mass General Brigham, found that, for women under 60, the benefits of hormones outweigh the risks for short-term treatment of symptoms such as hot flashes and night sweats. Moreover, the risks in the original study were seen mainly in older women—not in the younger women who could benefit most from help.
Even still, many doctors base treatment on the outdated study and are struggling to catch up, while women like me want relief now. As a result, influencers looking to cash in on the perimenopause-awareness trend tout hormone pellets not approved by the FDA and untested, often expensive supplements to offset symptoms (bovine colostrum, anyone?). “You want to look for a doctor who can help you with FDA-approved, safe, well-studied hormone therapy,” Hirsch tells me when I complain that I don’t know where to turn.
Meanwhile, each woman’s delicate balance of hormones and resulting symptoms are unique. One woman’s estrogen paradise could be another’s nemesis. There’s no silver bullet. Treatment requires a clinician skilled in perimenopause and willing to embrace nuance, plus women willing to embrace trial-and-error at a time of life when we’re already busy. I barely have time to shave my legs, let alone experiment with estrogen. “It’s almost like a Chipotle of symptoms,” Hirsch says, “and everyone’s Chipotle bowl is different.”
With each Instagram scroll, my Chipotle bowl seemed to be overflowing: The more I read about perimenopause’s laundry list of symptoms, the more troubles I acquired. Did I weigh too much? Was my hair thin? Did my shoulders hurt? Soon, I wasn’t just counting symptoms—I was counting the specialists I’d need to see just to feel like myself again.
The answer, thankfully, is not too many—the trick is to find a practitioner who listens and who looks at (and ideally can treat) your entire medical picture. I quickly learned this after spending an embarrassing amount of money on collagen powder (for shinier hair and better metabolism, but it made me constipated). “If we treat with the right hormones based on a woman’s symptoms, scientifically, she will feel better in many different areas of her life [and won’t need] to go see five other specialists,” says Robyn Kievit, a Concord-based nurse practitioner, psychopharmacologist, and dietitian who works with midlife patients. “I look at a patient’s soup-to-nuts picture: I want to know what sleep is like, what their joints feel like, what their relationship is like.”
Kievit is one of the growing number of practitioners embracing hormone treatment in the wake of the WHI study and its new analysis, though she emphasizes that any kind of midlife treatment, hormones or otherwise, should focus on lessening bothersome symptoms, not on looking better. “We go through life thinking we have to change this or change that,” she says. “Our body needs to be a certain way: eat this, not that.”
The best approach to treatment, she says, is a holistic one. “The combination, if a woman needs it, of hormone therapy, psychopharmacology, and the right nourishment plus working with them on body image can be hugely life-changing.” The challenge, she emphasizes, is finding the right expert: “someone who’s really going to ask you about you—not tell you something about you.”
When I really thought about it, the biggest issue was my bladder. I often felt like I had a UTI. I leaked. So I went to pelvic-floor physical therapy, which addresses the tightness, weakness, and inelasticity that comes with midlife stress, weight gain, and declining estrogen levels.
It can be awkward (picture an hourlong gynecological exam, but friendlier), but it’s an underrated option for perimenopausal women with bladder, bowel, and sexual health struggles. Often, treatment is complemented with estrogen cream to plump the vaginal tissue, leading to more elasticity and moisture.
Sometimes, it’s overshadowed by newer, quicker fixes. And that’s fair: Insurance doesn’t always cover pelvic-floor therapy (I pay with an HSA card). Wait times can be long. And many midlife women just don’t know to ask about it, assuming that it’s only for postpartum moms. But quick fixes aren’t personalized, as I discovered when I tried to do a Kegel exercise from TikTok, only to feel worse—and to learn from my therapist that, because I have pelvic tightness, they were actually harming me. “Pelvic-floor PT has been around for a long time, but we weren’t really hearing about it. [Women] are finding a lot of stuff online now about perimenopause and menopause,” says Lindsay Davis of Davis Pelvic Health in Westford. “The information is getting out there. But I think we’re almost overloaded with information: Who’s actually telling me the truth?…It’s really crucial to understand what exactly is unique to you to make changes.”
With that in mind, I started to wonder about compounded bioidentical hormone therapy, which also had begun creeping into my feed late at night (when I wasn’t sleeping). Basically, these are bespoke hormones, custom-formulated in a lab as a more precise, individualized alternative to FDA-approved hormone therapies that are commercially manufactured.
It’s a tempting option for fed-up women who want help, fast. With compounded hormones, “Women feel like they’re getting a more personalized approach,” says Danielle Grimm, the clinical director of obstetrics and gynecology at Roxbury’s Dimock Center, a federally qualified health center. “[Compounding] is not necessarily bad. The issue is that there are variations based on how they’re made. I can’t guarantee that patient X is going to be getting the same dose as patient Y.”
The Dimock Center’s OB-GYN team provides perimenopause and menopause treatment access primarily to underserved women: a 2022 scientific review of 25 years of research based on SWAN reported that Black women reach menopause an average of eight-and-half months earlier than white women. They also have worse symptoms and are less likely to receive hormone therapy. “Right now,” Grimm says, “a lot of specialized menopause providers are in [areas] that my patients can’t get to or have significant wait times.”
Meanwhile, she—like most traditional medical providers—offers FDA-approved therapies. This causes conflict for plugged-in patients who would prefer non-FDA, tailored hormones and also for patients who feel that they’ve been ignored or underserved.
While some practitioners are willing to experiment, the American College of Obstetricians and Gynecologists warns against it: “Evidence to support marketing claims of safety and effectiveness is lacking. Compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved formulations exist,” the group’s committee wrote in a 2023 clinical consensus statement.
With that in mind, I ended up at the office of my own longtime OB-GYN, Vlassis Travias at Emerson Health affiliate Concord OB/GYN, who delivered both my kids. I wanted to be seen, in person, by somebody who had actually met me. He was not a TikTok influencer, but he did know me well. My periods were heavier. My cramping was worse. Could hormones make it all go away? Why was this all so confusing?
Basically, he told me, the medical community is re-embracing hormone therapy now that the WHI worries have been debunked more than 20 years after the initial study came out. This has caused a backlog of frustration and misinformation. “It’s embarrassing that it happened two decades later,” Travias admits.
But we can’t blame everything on the WHI problem. Travias also tells me that the issue with perimenopause and menopause treatment is that we just don’t have all the answers yet, and each woman comes with such a distinct constellation of symptoms. Some complaints are clear-cut to treat: Erratic bleeding, for instance, could be addressed with an IUD. Weight gain? Emotional changes? Lower libido? There’s not a magic fix, much as we’d prefer one. “There’s no one right answer, at least not an FDA-approved answer” with long-term research and outcomes, he says. Some clinicians are willing to experiment. Others aren’t. Meanwhile, women like me are surrounded by noise. “Information is changing month by month, even among clinicians,” he says.
But luckily, I’m entering midlife at just the right time, when women are asking more questions, and the medical community is responding. “It’s really hard to navigate, but one of the good things that’s happening now is that people are actually paying attention to women’s health in this age group and saying, ‘Let’s figure things out. Let’s do the studies. This isn’t good enough,’” Travias says.
As for me? I go to weekly pelvic-floor physical therapy. I did try low-dose birth control for my heavier periods, but it made me spotty. I have another appointment in a few weeks to figure out a solution. And that’s the most important thing: finding a dialogue with a trusted provider instead of drowning in a stream of information telling me that I’m deficient, awkward, unsightly.
Like my ultra-light periods, I’d outgrown that phase in high school. ❟
What to Expect: Perimenopause
by Brittany Jasnoff
EARLY TRANSITION
PERIOD PROBLEMS
Many women start having irregular cycles in their early forties. “All of a sudden,” explains Zacharo Moditi, an OB-GYN with Tufts Medicine, “people are having periods that are further apart or closer together,” with potentially longer durations and heavier blood flow. Eventually, women may skip periods for several months before reaching menopause, which is defined as going 12 months without menstruation.
WEIGHT GAIN
The hormonal and metabolic changes of perimenopause, coupled with the unique challenges of midlife, can pack on unwanted pounds. “This is commonly a time when women are struggling with a lot of things: sandwich generation roles, you’re busy in your career,” explains Laura Doyon, a bariatric and gastrointestinal surgeon with Emerson Health—which may leave them little time to maintain healthy habits around sleep, diet, and exercise.
MID-TRANSITION
HOT FLASHES AND NIGHT SWEATS
These classic maladies are the most well-known signs of perimenopause, and they’re also the most dreaded. One of the worst parts? While “daytime hot flashes are easily recognized,” notes Jan Shifren, director of Mass General’s Midlife Women’s Health Center, “most women might not [even] realize that night sweats are disrupting their sleep.” Their frequency can indicate how close you are to menopause—the more hot flashes, the nearer you likely are.
MOOD AND MEMORY ISSUES
Experiencing more anxiety, fatigue, and brain fog during perimenopause? You’re not imagining it. As Shifren explains, “I tend to be a domino-hypothesis believer—when we are not sleeping well, all of those things will suffer. Good sleep is so critical for mood and energy.” If you’re struggling with mental health symptoms, be sure to discuss them with your clinician to get appropriate treatment.
LATE TRANSITION
VAGINAL DRYNESS
This tends to occur later in perimenopause and lasts into postmenopause, Shifren says, “although some women experience it earlier.” And it doesn’t just mess with your sex life—it can also make exercising, using the bathroom, and even walking uncomfortable. “All of these are signs of estrogen deficiency in the vagina and related areas,” she notes.
BONE AND MUSCLE LOSS
Plummeting estrogen levels during menopause pack a triple punch—sapping muscle mass, slowing metabolism, and weakening bones. “This idea of the musculoskeletal syndrome of menopause—it’s real,” explains Laura Silk, an OB-GYN with Emerson Health. And it puts women at higher risk for osteoporosis and fractures.
Menopause: Myth vs. Fact
by Brittany Jasnoff
Myth: The transition to menopause doesn’t start until you turn 50.
Fact: Even women in their late thirties and early forties can begin experiencing symptoms of perimenopause. “The timing is incredibly variable,” Shifren says.
Myth: Every menopausal woman needs hormone therapy to stay healthy.
Fact: While estrogen and progesterone can be a godsend for women struggling with hot flashes and night sweats during the menopause transition, they’re not required if you feel mostly okay. “We want to manage symptoms,” Shifren says, with the lowest effective dose. “If women really want to stay healthy after midlife, they should focus on the basics—daily exercise, healthy diet, healthy weight. There is no pill or patch or gel that a woman can take that will ever make up for an unhealthy lifestyle.”
Myth: No menopausal woman should use hormone therapy, because it carries dangerous health risks.
Fact: If you’ve heard that women should avoid hormones at all costs because they carry an increased risk of heart disease, strokes, and breast cancer—know that most perimenopausal women should do just fine with them. If you are “healthy and under 60 with bothersome menopausal symptoms” says Shifren, “the benefits of hormone therapy will outweigh the risk.”
Myth: All menopause symptoms get better with time.
Fact: Sorry to be a Debbie Downer, but some of those vexing problems may not improve after your very last period. “For most women, hot flashes get better with time, but vaginal dryness will worsen,” Shifren says. Luckily, there are plenty of solutions for that.
Myth: Most problems women experience in midlife can be attributed to perimenopause.
Fact: It’s important to understand that not every mental and physical health struggle is about “the change.” “Patients talk to their friends, and they go, ‘Well, it’s just perimenopause,’” Moditi says. “That’s a good way to miss other things like uterine cancer, polyps, and fibroids.”
First published in the print edition of the February 2025 issue as part of a package on menopause, with the headline, “The Great Menopause B(l)oom.”