From hormone therapy to lifestyle changes, experts share 7 tips for managing perimenopause symptoms
Hot flashes, brain fog, mood shifts, and irregular menstrual cycles — these symptoms likely sound familiar to many women in the throes of perimenopause.
Anna B. Shannahan, MD, a family medicine and integrative medicine specialist with Northwestern Medicine, describes this life phase as “a little like puberty in reverse. Your body is transitioning out of reproductive years. Just like puberty, there are a lot of hormone fluctuations.”
Shannahan says the average length of perimenopause is about four years before menopause — defined as 12 months without a menstrual cycle — fully sets in. The average age for menopause in the U.S. is 51, with menopause before age 45 considered early.
If someone is noticing signs of perimenopause, Suzie Carroll, a family nurse practitioner and co-founder of The Fitz Aesthetic Club, a medical spa with locations in Chicago and Kenilworth, recommends a comprehensive blood panel. The panel includes vitamin levels, sex hormones, DHEA (a naturally produced steroid hormone precursor), and thyroid function in order to provide a complete picture. Shannahan also reviews blood work but cautions that, because hormone levels fluctuate, changes may not always appear right away.
Here are seven treatments that can help people manage perimenopause symptoms.
1) Estradiol
“Estradiol replacement helps stabilize hormonal signaling, improve temperature regulation, support cognition, and maintain skin hydration and elasticity,” says Tatiana Batista, DO, medical director at The Fitz.
Batista and Shannahan recommend transdermal estradiol, delivered via a patch or gel, for a steady estrogen delivery. Shannahan says oral estrogen carries a higher risk of blood clots. She also notes that hormonal pellets — tiny, rice-sized implants inserted under the skin — can have less predictable release and are difficult to remove, although Batista says these may be a better option for patients who struggle to remember daily application or patch changes.
2) Progesterone
For women taking estradiol, progesterone is important to protect the uterine lining. Without progesterone, estrogen can cause the lining to build up unchecked, increasing the risk of uterine cancer.
“Supplementing progesterone helps support more restful sleep, reduce night sweats, and improve mood stability too,” Batista says. People can take progesterone orally, and it does not carry the same risk of blood clots as estrogen.
3) Testosterone
Testosterone clinics have proliferated nationwide, and Batista notes that testosterone is often the first hormone to decline with age. While testosterone therapy is not FDA-approved for women, many report improved muscle tone, increased energy, and higher libido.
Experts stress the importance of working closely with a clinician to customize dosage, as excessive levels can cause side effects, such as unwanted hair growth, hair loss, and acne. “Creams allow for precise dose adjustments while pellets provide long-acting, steady delivery,” Batista says. “The goal is not to masculinize, but to restore physiologic levels that enhance well-being and resilience.”
4) Lifestyle consulting
Whether or not women use hormone therapy, lifestyle factors play a critical role in navigating perimenopause. A healthy routine includes strength training, a balanced diet with adequate protein, sufficient sleep, and stress management.
Carroll emphasizes strength training to preserve muscle mass, boost metabolism, and maintain bone density. “Nutrition stabilizes blood sugar and supports energy, while sleep and managing stress help regulate cortisol and mood,” she says. “Thoughtful, individualized lifestyle support makes hormonal therapies work better and helps results stay sustainable.”
5) GLP-1s
“Perimenopause can significantly impact metabolism, leading to weight gain, especially around the midsection, due to shifting estrogen levels and increased insulin resistance,” Carroll says. GLP-1 medications improve satiety, stabilize blood sugar, and reduce cravings, helping people regain metabolic control. Carroll recommends pairing GLP-1s with nutrition counseling and resistance training to support sustainable weight loss, improved cardiovascular markers, and increased energy.
6) Biostimulators
As collagen production slows, many women notice changes in facial fullness, lift, and luminosity. Biostimulators — a very new injectable compound — may rebuild the internal structure of the skin by stimulating collagen and elastin over time, Carroll says. The result is natural-looking volume, improved tone, and a subtle, healthy radiance. “It is rejuvenation that looks like you, simply well-rested and supported,” Carroll adds.
7) Ultrasound technology
As estrogen levels shift during perimenopause, skin can become thinner and less elastic. “The supportive scaffolding of the mid-face, jawline, and neck begins to soften,” Carroll says. She recommends Sofwave, which uses ultrasound technology to tighten existing collagen and stimulate the growth of new collagen and elastin in the deeper dermal layers. “This helps improve jawline definition, neck firmness, and overall skin smoothness without downtime,” she says. “It’s an excellent option for patients noticing sagging or early jowl formation in perimenopause.”
While no single treatment works for everyone, most women benefit from a tailored approach that evolves. Hormone levels shift throughout perimenopause, symptoms change from month to month, and treatments that help at one stage may need adjustment later.
“I tell women that you know your body better than anyone else,” Shannahan says. “Your symptoms and what you are experiencing are valid.”
Start conversations early, track symptoms, and work with qualified providers who can weigh benefits, risks, and personal health history. As research and treatment options continue to expand, experts say informed decision-making — grounded in evidence and individualized care — remains the most effective tool for managing the perimenopause transition.
Amber Gibson is a freelance journalist with more than a decade of experience specializing in travel, food, drink and wellness topics. Her stories have appeared on the cover of The Wall Street Journal, The Telegraph, TIME, Travel + Leisure, Conde Nast Traveler, National Geographic, Robb Report, Chicago Tribune, USA Today, Artful Living, Medscape and many more.
