Perimenopause 101: What It Is and How to Treat Its Many Symptoms

While Midi provides services for women in menopause and perimenopause, its founder was inspired by the gap in care for perimenopause and menopause, and that focus is evident. Symptoms like hair loss, hot flashes, low sex drive, and skin changes get special callouts on the site, so you know you’re in the right place. After you fill out an intake form describing your symptoms, you’ll be set up with a half-hour virtual appointment with a clinician who will develop a care plan for you.

You might need to undergo some testing to make sure your symptoms aren’t caused by a thyroid condition, and Midi will help coordinate it with a lab near you. Depending on what you need, your clinician may prescribe hormonal or nonhormonal medications, which will be sent to your local pharmacy. The site sells its own supplements (such as fiber, omega-3s, berberine, and cortisol support), so don’t be surprised if those are included in your regimen. It also provides coaching on various lifestyle changes that may help with symptoms like insomnia. Best of all, Midi has no subscription cost, and visits are covered by many insurance plans. Without insurance, it’s $250 for the first visit, $150 for follow-ups (medicines and lab work not included).

Alloy skips lab tests and video visits and gets straight down to business. After filling out your intake form, the site promises that a doctor will have a personalized treatment plan ready for you within 12 hours. That may include hormone therapy, as well as prescriptions for skin care, sexual wellness, weight loss, hair loss, and gut health. If you have questions for your clinician, you have unlimited access to them via messaging. After the $49 fee for your initial consultation, you’ll only pay for medications mailed directly to you. The service does not take insurance, but you may be able to submit medication receipts to your insurance provider for reimbursement.

Winona is another platform that offers an efficient way to get hormone therapy without a visit to the doctor. The site is specifically for perimenopause and menopause treatments. The brand sells its own bioidentical hormone medications (tablets, creams, patches, capsules), dehydroepiandrosterone (DHEA, a hormone that promotes the production of estrogen and testosterone), estriol face cream, a minoxidil serum for hair loss, and a sleep medication. It also offers its own supplements. You will have your own assigned clinician, but your communication with them is solely through messaging via the patient portal. There’s no subscription fee or charge for doctor communications; the only cost is for the medications. Winona does not take insurance, however.

One thing that distinguishes Winona is the site’s community emphasis. There’s an active message board for discussions about perimenopause and menopause, a regular book club, live Q&A sessions with doctors, and opportunities to meet in person with other members of the community. The site even helps people organize their own meetups if they’d like.

For more providers, read our list of the best places to get HRT online.

This site offers a streamlined approach to getting birth control (whether for contraception or perimenopause treatment), hormone therapy, and nonhormone medications like Veozah (for hot flashes) mailed directly to you. After you fill out your intake form, a Pandia doctor will use the company’s AI technology to determine the right prescriptions for you. You won’t need to do any additional lab testing or virtual visits with these doctors (although they may recommend independent testing for specific health concerns that require further investigation). There’s a subscription cost (from $34.99 a month to $69 a month), plus the cost of your meds, which may be covered by your insurance. The catch is that Pandia can only prescribe in 14 states.

“In the Northeast, it’s very hard to get enough vitamin D from the sun, and vitamin D is not found in tons of foods,” says DeLorenzo.

Not everyone needs an iron supplement, but a deficiency of this mineral can cause symptoms similar to those associated with perimenopause — namely fatigue, difficulty focusing, and inflammation.

“People with heavy periods sometimes can become iron deficient, and interestingly, iron deficiency symptoms are very similar to a lot of the perimenopausal symptoms,” Kassis shares. “I had one patient who’s had a lot of these kinds of ‘brain zap’ symptoms: disequilibrium or dizziness. It turned out she was super iron deficient, and when we fixed that, those went away.”

Though DeLorenzo believes that today’s protein-maxxers have gone a little overboard with their daily intake recommendations, it is a good idea to increase your protein intake as you age. “In perimenopause, because lean body mass is decreasing, it is helpful to go toward 20 to 30 percent of your diet,” she says, or around 1.5 grams of protein per kilogram (2.2 pounds) of body weight. This protein powder contains 22 grams of protein from grass-fed cows and 0 grams of added sugar. It’s sweetened with stevia and comes in delicious flavors like Dutch Chocolate, Birthday Cake, Orange Cream, and S’mores (also available in unflavored).

Magnesium is easily depleted in our bodies, DeLorenzo says, but you can boost your level with some simple dietary tweaks: “Foods you can eat that help to increase your magnesium intake are things like beans, chickpeas, cannellini beans, kidney beans, walnuts, almonds, cashews, peanut butter, almond butter, avocados, and chocolate,” she notes. Still, many of us aren’t getting enough of this mineral, and that may actually be impacting our sleep.

Read about more dietitian-recommended supplements for perimenopause.

I’ve been using BUBS Naturals brand for a few months, and I like that it’s completely tasteless and blends well into my smoothies. It’s NSF Certified for Sport, third-party tested, and the company donates 10 percent of its profits to veteran-focused charities.

“Since drinking a glass of soy milk every day, and then [eating] occasional tofu on top of that, I have no more night sweats and hot flashes at all,” DeLorenzo says.
”And if I slip, I notice it.” While this won’t necessarily work for everyone, she says that it’s a good place to start.

Sometimes the problem isn’t you, it’s your surroundings. Loop’s reusable silicone earplugs seal out whatever noises might be keeping you up, and they are truly comfortable as well. They come with four ear-tip sizes, and once you get the right fit, they really stay in. I use mine at night when my husband’s snoring gets unbearable, as well as when I’m on vacation in a place with noises I’m not used to. Loop also has a new Dream earplug that’s meant for side sleepers, but I have yet to try them.

These sheets helped editor Olivia Campbell get a good night’s sleep, by helping her combat the tossing and turning she was doing due to overheating and night sweats. They’re made from a wood-based Tencel lyocell and patented Outlast viscose blend that wicks moisture while remaining breathable to help regulate temperature. They also get softer with every wash.

While attending to your body’s needs will go a long way toward improving your sleep, it also helps to introduce some good habits for your mind. The Hatch Sleep Clock can play meditations, sleep stories, soothing sounds, or music — and accompany it with dimming, colored lights — at a set time each night to ease you into a bedtime routine without your phone. It also tracks your sleep patterns nightly without a wearable device, using low-power radio signals. The results will help you learn what habits help you get the best sleep.

Water-based lubricant is best to use with condoms or sex toys — and by the way, vibrators are a great tool for improving sexual function in women. This lube has moisturizing aloe vera and no potentially irritating glycerin, parabens, or petrochemicals. The brand claims that this formula also lowers pH levels and encourages healthy bacteria to grow, which is great news for women who tend to suffer from yeast infections or other microbiome imbalances.

This particular estriol cream formula includes hyaluronic acid and niacinamide to support hydration and protect the skin barrier.

Itchy ears are one of the weirdest potential perimenopause symptoms — and even Coleman was tempted to dismiss it as a social media phenomenon until she experienced it herself. The most likely culprit is dry skin and very sensitive nerve receptors in the ear canal, she says. And while you may be able to cure it with olive oil or coconut oil, that can get messy. These easy-to-use drops from Hyland’s have hemp seed oil, argan oil, jojoba oil, camellia oil, avocado oil, coconut oil, and apricot kernel oil to moisturize and eventually ease the itch.