Navigating early perimenopause

I’m 43 and, and for about 6-9 months, I’ve been experiencing some symptoms of peri. My symptoms were mild enough that I was not sure if I should go on MHT just yet. I had classic luteal phase progesterone deficiency symptoms such as lighter sleep a week or ten days before my period, some spotting before my period, and lowered energy. I also experienced restless leg syndrome occasionally, and sometimes had trouble regulating my temperature at night (without yet experiencing hot flushes). All symptoms were concentrated in the luteal phase. I felt great during follicular phase and my period is regular, and my temperature trends as measured by my Oura ring suggested I was ovulating each month.

I have been keeping a concierge doctor’s number handy for whenever I felt like it was time to get hormones. But he costs $700 (for a year of managing hormones based on response) I wanted to be sure I was ready, hence the waffling. I’ve been watching my symptoms like a hawk for two years, waiting for the moment when I’d need to pull the trigger on MHT, not expecting that the symptoms could be this vague and borderline bothersome.

I could also go to Midi for $250 (with $150 for follow ups) but was hesitating for the same reason - I wanted to actually be ready.

Then I went for my annual physical with a new primary care doctor and mentioned my peri stage, and she said she’s happy to do menopause care and can prescribe hormones. This changed my outlook on it immediately. I asked her for progesterone for the luteal phase only. I was going to go with 100 mg but she suggested 200 mg if I wanted to be cyclical, so I did. She also floated estrogen but I felt like I have enough circulating estrogen of my own right now, plus there can be more side effects like bloating, etc.

30 pills cost me $5.

I started taking 200 mg Prometrium during the literal phase of my last cycle. I had read about its next day drowsiness, so I took it earlier in the evening around 7:30 pm. But although I experienced heavier sleep in the first part of the night, I would wake up at 3-4 am and have some trouble getting back to sleep. The issue was resolved when I took it at bedtime. Heavy sleep like old times and no next day drowsiness.

At the start of my cycle, I figured there is no harm in adding estrogen if that might even out my energy. I asked my doctor in a telehealth visit for the lowest dose patch, and she prescribed 0.025 mg estradiol. A month’s supply, 8 patches, cost me $5.

I have now been on estradiol for three weeks and am taking Prometrium for my second luteal phase since starting hormones.

From the estradiol, I think I am experiencing some bloating. I cannot say I have felt a whole lot different since starting it. The progesterone otoh has such a lovely soporific effect. I love the deep sleep. I also haven’t experienced my other symptoms - no spotting before my period, no RLS, no temperature regulating issues. My libido has improved slightly? Maybe my energy? So subtle it’s hard to say.

After I started progesterone, my resting heart went down by ten beats a minute for the first time in 14 months. But adding estradiol has made it go back up again.

I wanted to write about this because it ended up being really simple and cheap to try hormones. I was more willing to start it if I could stop if it didn’t feel right, and I would only be out the cost of a couple of $5 prescriptions.

Hormones for peri are straightforward and our primary care doctors should be able to prescribe for us. Why does Midi have to exist? Why are hormone specialists charging hundreds of dollars for this basic healthcare?

I should mention, I did put my symptoms and cycle info (from Oura) into AI to get advice. AI gave me excellent advice that was borne out by what I’d read about menopause in Dr Jen Gunter’s comprehensive book on the subject. I recommend doing that and running it by your doctor and asking for the scripts you need.

Hope this helps anyone with mild symptoms who is wondering how to proceed.