Since all the negative symptoms of perimenopause seem to arise due to loss of estrogen, can I get a prescription for estrogen now to proactively try to counteract that loss? I’ll be 45 next month, so I’m sure I’m in peri.
—Rita
I think you are asking two questions here. First, is it possible to preempt the symptoms of perimenopause with estrogen? If so, when should you consider doing so?
The short answer to the question of whether you can start estrogen proactively before symptoms start is: yes. There is some subtlety as to how practically to go about doing it. This gets at the second question of when to start this preemptive estrogen.
You note that because you are 45, you must be in perimenopause. We determine what reproductive stage you are in based on your periods, though, rather than by age. If your periods are regular at 45, you are most likely in the late-reproductive stage. If your periods are irregular — meaning they vary by more than seven days from the first day of one period to the first day of the next, so a 24-day cycle followed by a 35-day cycle followed by a 21-day cycle — but occur at least over 60 days, then you are in early perimenopause. If you have gone 60 days or more between periods but have not yet gone a year without a period, you are in late perimenopause.
When women are in the late-reproductive stage or early perimenopause and they would like to take estrogen, either because they are having symptoms or to prevent them, doctors would typically recommend a birth control pill. This is because in these stages, women are ovulating regularly. The estrogen and progesterone levels in hormone replacement therapy may not suppress ovulation and, as a result, women can experience irregular bleeding. Birth control pills provide estrogen while suppressing ovulation and providing contraception if needed, all with a minimum of irregular bleeding.
Most women can safely take birth control pills until the average age of menopause, about 51. Around that time, most doctors will recommend switching to hormone replacement therapy — typically an estrogen patch or gel plus progesterone. With this progression from birth control pills to hormone replacement therapy, you might completely avoid perimenopausal symptoms or decrease the severity and frequency with which you do experience them.
The takeaway: You can start estrogen at any time; you do not need to wait to become symptomatic. If you are still having frequent periods, you might start with birth control pills before transitioning to hormone replacement therapy in your early 50s.
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