Gillian Goddard, MD

Oh I so wish there was a single answer to this question! Studies of different diets are notoriously difficult to do, so we really don’t have a lot of reliable data to help us here. There is no magic bullet. My best advice is pretty basic, just a healthy diet high in fiber and low in saturated fat, regular moderate intensity aerobic exercise and strength training. This is what I tell my patients and what I follow myself.

Right now the best reason to take HRT is because you have symptoms of perimenopause and menopause. We are going to take a deep dive into the evidence for HRT and dementia in Hot Flash in a few weeks. Stay tuned!

@Emilie I think this is overstating things a bit. You can imagine if this were true there would be women entering menopause in their 60s and 70s after a decade or two on the pill. That said, there is some evidence that long term birth control pill use may positively impact fertility later.

As I mentioned above for women with primary ovarian insufficiency (POI) the risk-benefit equation for HRT is heavily shifted. We strongly recommend HRT until you are in your early 50s. I mentioned several different formulations of estrogen and progesterone to consider above. I am sorry you are going through this though, it really is crummy.

So many of you have questions about POI today! I will definitely get into this in more depth in the future. To answer you question, about 1% of women are diagnosed with POF. There is not data to suggest the incidence of POI is increasing. I do think we have a much better understanding that early loss of estrogen has impacts on health later in life. I also think more women are having FSH and AMH checked during a fertility work up or egg freezing. What we do know is that continuing HRT into the early 50s is important for long-term health.

@Lauren and @Alex Ugh! Yes, no one wants to be battling pimples and wrinkles at the same time! The reality is the adult acne is common. The same hormones that drive changes in mood and cause breast pain in the late-reproductive years can also lead to an increase in testosterone and DHEA in the second half of our cycles. That results in more acne. There are LOTS of treatment options from pills to topicals, so definitely talk to your doctor to see what might work best for you.

@Kara Having periods that are 60 or more days apart puts you in late perimenopause according to STRAW +10 definitions. Typically, late perimenopause lasts 1 to 3 years. So, most likely you are almost done. HOWEVER, women ovulated in at least 25% of periods that are 6 months or more apart. If you ovulate and have penetrative sex you can get pregnant. One of my patients got pregnant accidentally at 47 and that kiddo is 4 years old. It happens! So if you don’t want to be pregnant use contraception until you are in menopause.

@Danielle Yes the hot flushes and night sweats (collectively called vasomotor symptoms or VMS) with estrogen blockers can be intense! There are a number of non-hormonal prescription medications that are used off-label for VMS. There is also a new medication called Veozah which I am excited about. It is not hormones and is safe for women who cannot take estrogen. If you haven’t tried it already it is worth a shot!

@Leona You are not alone! So many of my patients struggle with weight gain in their 40s and 50s. On Tuesday Hot Flash is all about WHY we gain weight in midlife. You also mentioned that you are using Depo for contraception. Depo is great for contraception but it is associated with weight gain. You could consider exploring other contraceptive options that might be more “weight neutral” with your doctor.

@Carly I am sorry this happened to you. Given the number of questions here I think a whole newsletter on premature ovarian insufficiency is in order. Because of your age, I agree with your doctors that estrogen is important for you. Estrogen protects your bones and your heart and blood vessels. This prevents early osteoporosis and heart disease. If you haven’t already it would be worth trying different forms of estrogen (oral, patches, gels) to see if a particular form works better for you. Also the type of progesterone often makes a difference for many women. You could talk to your doctor about trying progesterone in a patch (usual in combination with estrogen like Combipatch) or using a Mirena for estrogen. There are lots of options, so definitely talk to your GYN or endocrinologist about all the options out there.

@Emily Hormonal acne in our 40s is no fun! The good news is you can take your birth control pill until your are in menopause. Many women transition straight from birth control pills to hormone replacement therapy. For most women hormonal acne goes away when we are no longer having hormonal fluctuations once we are in menopause.

@Lindsay Probably not by much. So, you wouldn’t expect to have menopause 10 years later. However, hypothalamic in your 20s will impact your bone density. Once you are in menopause you should be screened for osteoporosis immediately instead of waiting until 65.

@Nadine The hallmark of perimenopause is irregular periods. It sounds like you might be in the late-reproductive stage. I wrote about it here https://parentdata.org/is-this-perimenopause/ Most women enter the late-reproductive stage between the ages of 40-45 so you are right on time. You should definitely mention your symptoms to you doctor and discuss possible treatments.