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    Hormone Therapy for Menopause and Perimenopause

    The Long Goodbye continued...

    Not that every woman is miserable during the transition. Right now, Charlotte Pierce, a 51-year-old mother of two who runs a home-based publishing company, is only mildly bothered by irregular periods and occasional forgetfulness. That’s true for plenty of women, says Margery Gass, M.D., director of the University Hospital Menopause and Osteoporosis Center in Cincinnati. You’re just less likely to hear about those who cruise through with little disruption to their lives.

    But if you’re less fortunate than Pierce, there is help, whether you’re struggling with wildly unpredictable periods, annoying hot flashes, or sexual difficulties. What will work best depends on your symptoms. Here’s a guide to the new hormone decisions you may confront.

    If You Have Irregular or Heavy Bleeding

    Early in perimenopause, the time between menstrual cycles frequently shortens. Later, it’s typical for cycles to both shrink and expand as out-of-whack hormones stop triggering ovulation and releasing progesterone like clockwork. Skipped periods are common, sometimes contributing to heavier bleeding in the next cycle. Don’t be fooled by those missed months: Pregnancy is still a real possibility.

    Will hormones help? Yes, if your problem is hormonal. Your doctor may prescribe birth control pills, which suppress ovulation and provide more even levels of estrogen and progesterone. Another option for some women is taking progestin (the synthetic form of progesterone) alone, to help regulate cycles. But very heavy or prolonged bleeding could also signal fibroids, polyps, or possibly precancerous growths, so be sure to see a gynecologist to find out what’s behind your symptoms, says Marcie Richardson, M.D., director of the Menopause Consultation Service at Harvard Vanguard Medical Associates in Boston.

    If You Have Hot Flashes and Sweats

    Getting a close-up of global warming? As hormones fluctuate during perimenopause, roughly three out of four women experience hot flashes. One in 10 is truly miserable. During the day, these episodes, which last one to five minutes, range from mild to wildly uncomfortable and deeply embarrassing. At night, they can cause major misery, as sleep becomes an idle dream.

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