Perimenopause and Hormone Therapy: What the 2024–2025 Research Actually Says
If you are in your late 30s or 40s and something feels off — sleep is inconsistent, your mood shifts without much warning, the scale is moving in directions that don't match your habits — you may be in perimenopause. And you may have questions about hormone therapy that you haven't been able to get a straight answer on.
The science has moved significantly in recent years. Here is what the latest research actually says, in plain language, so you can have a more informed conversation with your provider.
What Is Perimenopause, Exactly?
Perimenopause is the transition period leading up to menopause — typically beginning in a woman's early-to-mid 40s, though it can start in the late 30s. It is not a single event. It is a gradual hormonal shift that can last anywhere from a few years to a decade, marked by irregular periods, fluctuating estrogen and progesterone levels, and a wide range of symptoms that vary enormously from woman to woman.
Common symptoms include:
Hot flashes and night sweats
Sleep disruption
Mood changes, anxiety, or irritability
Brain fog and difficulty concentrating
Vaginal dryness and changes in libido
Joint discomfort
Weight gain, especially around the midsection
These are not simply inconveniences to push through. They are signs of real hormonal change — and there are evidence-based options to address them.
What Is Bioidentical Hormone Replacement Therapy (BHRT)?
Bioidentical hormones are compounds structurally identical to the hormones your body produces naturally — primarily estradiol and progesterone. Some bioidentical hormones are FDA-approved medications (such as Estrace and Prometrium), while others are compounded — custom-prepared by a compounding pharmacy based on a provider's prescription.
It is worth knowing the distinction: FDA-approved bioidentical hormones have standardized quality control and established safety data. Compounded BHRT does not have the same regulatory oversight. National medical reviews, including a 2020 consensus report by the National Academies of Sciences, Engineering, and Medicine (NASEM), have consistently found no evidence that compounded BHRT is safer or more effective than FDA-approved bioidentical options. At OptimaVida, we work with you to find what's appropriate for your situation — and we'll always be transparent about what the evidence supports.
What New Research Is Showing
The evidence landscape for hormone therapy has shifted considerably in favor of well-timed, individualized treatment. Here are several key findings from 2024 and 2025.
The cardiovascular picture is changing. A major 2024 analysis of the Study of Women's Health Across the Nation (SWAN), published in JAMA Internal Medicine, found that hormone therapy initiated during perimenopause or early postmenopause was associated with a 22% reduced risk of cardiovascular disease events. The benefit was most pronounced in Black women (a 49% reduction) and in women who began therapy within 10 years of menopause onset. This is an important finding: timing matters, and early initiation appears to carry meaningful protective effects.
Micronized progesterone supports mood and cognition. A 2024 review published in Frontiers in Neuroendocrinology examined the effects of progestagens — including micronized progesterone and synthetic progestins — on mood, stress, and cognition in women. The review highlights the potential advantages of micronized progesterone over synthetic progestins, including a more favorable profile for mood and brain function. Research in this area is still developing, and well-designed clinical trials are needed to confirm the full picture. For women experiencing brain fog or mood instability during perimenopause, this emerging evidence is worth discussing with your provider.
Transdermal delivery has advantages. A 2024 non-interventional observational study published in Climacteric found that transdermal estradiol effectively managed menopausal symptoms, with more than 81% of participants reporting improvement in hot flashes at 12 months. Compared to oral estradiol, transdermal delivery is generally associated with more stable hormone levels, fewer side effects, and a lower risk of blood clots — because it absorbs through the skin rather than passing through the liver. This delivery method is something we discuss with patients regularly.
Regulatory bodies are updating their stance. In late 2025 and into 2026, the FDA began removing longstanding "black box" warnings from many hormone therapy products, reflecting contemporary evidence showing that timely initiation significantly reduces risk of heart attack and all-cause mortality for appropriate candidates. This is a major shift in the regulatory landscape.
Who May Be a Good Candidate?
Hormone therapy is not right for everyone. Factors that your provider will consider include your age, how long ago your periods became irregular, your personal and family medical history, and the specific symptoms you are experiencing. Women with certain histories — such as hormone-sensitive cancers, uncontrolled blood pressure, or a history of blood clots — may not be candidates, or may need a carefully modified approach.
The conversation is worth having. Many women spend years managing symptoms they don't realize are treatable.
When to Reach Out to a Professional
If you are experiencing two or more of the symptoms listed above — and especially if they are affecting your sleep, your mood, or your ability to function the way you want to — it is a good time to speak with a provider who specializes in hormonal health. A thorough evaluation includes looking at your labs, your symptom picture, and your full medical history. An internet article, including this one, cannot replace that.
Please do not make any medication decisions based on this content. Use it as a starting point for a real conversation.
¿Quieres hablar sobre lo que estás sintiendo? (Want to talk about what you’re experiencing?) Whether you prefer to speak in English or Spanish, we’re here. At OptimaVida Telehealth, Ana Noriega, APRN, FNP-BC, offers a free consultation to discuss your hormonal health — no insurance required, available throughout Florida, on your schedule. Book your free consult.
This content is for educational purposes only and does not constitute medical advice. Results vary by individual. Always consult a qualified healthcare professional before beginning any treatment.
References
El Khoudary SR, et al. "Menopausal Hormone Therapy and Cardiovascular Risk in Midlife Women With Vasomotor Symptoms." JAMA Internal Medicine. Published September 8, 2026. doi: https://doi.org/10.1001/jamainternmed (SWAN cohort; 20-year follow-up)
Bjelke M, et al. "Progestagens and progesterone receptor modulation: Effects on the brain, mood, stress, and cognition in females." Frontiers in Neuroendocrinology (published via Elsevier). 2024. PMID: 39515587. Available at: https://pubmed.ncbi.nlm.nih.gov/39515587/
Römer T, et al. "Use of an estradiol transdermal spray in women with menopausal symptoms: a non-interventional study." Climacteric. 2024 Oct;27(5):473–481. doi: https://doi.org/10.1080/13697137.2024.2376185 (451 postmenopausal women; 81.4% reported improvement in hot flushes)
U.S. Food and Drug Administration. "HHS Advances Women's Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy." FDA Press Announcement; November 10, 2025. Available at: https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy
National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: The National Academies Press; 2020. Available at: https://www.nationalacademies.org/projects/HMD-HSP-18-13
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