Can Menopause Hormone Therapy Be Used During Perimenopause?
January 14, 2026 2026-01-15 21:05Can Menopause Hormone Therapy Be Used During Perimenopause?
Introduction
Menopause hormone therapy during perimenopause remains an option for symptomatic women, particularly when menstrual changes, sleep disturbance, or vasomotor symptoms begin to affect quality of life.
Using menopause hormone therapy during perimenopause is a common and important question for women experiencing symptoms that may begin in the mid-30s, often without recognising their hormonal origin.
Perimenopause is a phase of marked hormonal fluctuation that ends with a rapid hormonal decline in the years just before menopause (the menopause transition). Understanding this phase helps women decide whether hormone therapy may be considered and when.
Guide Overview
This article will explain:
- What perimenopause is and when it begins
- How symptoms present
- How menopause hormone therapy can be used during perimenopause
- Why the final stage of perimenopause matters
Perimenopause: What It Is and Why Symptoms Begin
What Is Perimenopause?
Perimenopause is the transitional phase before menopause, typically beginning in the mid-30s to early 40s, characterised by declining ovarian reserve and unstable hormone production.
Ovulation becomes inconsistent, progesterone levels fall first, and oestrogen levels fluctuate widely, sometimes becoming very high (often described as “oestrogen dominance”).
This hormonal instability explains why symptoms can appear years before menopause.
How Perimenopausal Symptoms Present
Perimenopausal symptoms are often misattributed, because cycles may still appear “regular”.
Common presentations include:
- Heavy or unpredictable bleeding
- Sleep disruption without clear hot flushes
- Mood changes, anxiety, irritability
- Fatigue and reduced stress tolerance
- Gradual abdominal weight gain and metabolic changes
Many women attempt to manage these symptoms with supplements, lifestyle changes, or stress reduction — without recognising a hormonal cause.
Menopause Hormone Therapy during Perimenopause. can it be used?
Which hormonal approaches can be used in perimenopause?
Yes, menopause hormone therapy during perimenopause can be used, particularly if symptoms affect quality of life.
According to the International Menopause Society, menopause hormone therapy may be used off-label during perimenopause, based on medical judgment.
Because ovulation may still occur, sequential hormone therapy is preferred (oestrogen daily, progesterone for part of the month, allowing a monthly bleed).
Common evidence-based options include:
- Oestrogen daily with progesterone for part of the month
- A levonorgestrel intrauterine device (e.g. Mirena) with added oestrogen if needed
- Combined hormonal contraception, when contraception is also required
The final stage of perimenopause: why it matters
Unlike early perimenopause, when hormone levels fluctuate up and down, the final stage of perimenopause is marked by a rapid and sharp decline in oestrogen.
This rapid decline continues into the first year after the final menstrual period. Together, the late stage of perimenopause and the early postmenopausal year form a short but critical phase called the menopause transition, during which the most significant health changes occur — including:
- ↑ LDL cholesterol, ↑ triglycerides, ↓ protective HDL
- ↑ blood pressure, with 30–50% of women developing hypertension before age 60
- Bone loss, with increased risk of osteopenia and osteoporosis
- ↑ inflammatory and immune activity, with higher risk of thyroid disease, Sjögren’s syndrome, rheumatoid arthritis, and lupus
This is why medical care during perimenopause and menopause transition matters, even for women who choose not to use hormone therapy.
Conclusion
Menopause hormone therapy can be considered during perimenopause in symptomatic women. It is often “off-label” at this stage (meaning used outside the official licence but supported by medical guidance and clinical experience). Because late perimenopause marks the start of important metabolic and cardiovascular changes, perimenopause care matters beyond symptom control.
References
1.N Panay et al Menopause and MHT in 2024. IMS White Paper
2. A Mass et al Cardiovascular health after menopause transition . ESC report 2021
