There is no blood test for perimenopause. Estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone all fluctuate so unpredictably during this stage that lab results are clinically uninterpretable. Mary Ann Lumsden, former president of the International Menopause Society, is direct: 'You can't interpret hormone [measures] because they change so much.' Perimenopause typically begins around age 46 or 47, and symptoms like hot flashes, irregular periods, and anxiety are real. But the social media ecosystem built around diagnosing and treating it is not.
HRT is not the universal fix being promoted online. The drugs were trialed on menopausal women, not perimenopausal ones, and in perimenopausal patients the treatment can be overwhelmed by the body's own still-cycling hormones or cause abnormal bleeding. Paula Briggs, who leads the menopause service at Liverpool Women's Hospital, calls the social media push to get every symptomatic woman on HRT 'almost cult-like.' Supplements marketed to midlife women fare no worse: Lumsden tested patients self-reporting testosterone supplementation and found no measurable increase in testosterone levels. 'Whatever they're getting, it's not testosterone,' she says.
The deeper problem is attribution. Nanette Santoro, professor of obstetrics and gynecology at the University of Colorado Anschutz, says fatigue, brain fog, and aches do not track closely with hormonal changes across the menstrual cycle or menopause transition. Symptoms in midlife women can come from unrelated conditions entirely. The article's author discovered her own pelvic pain is almost certainly endometriosis, a condition HRT can worsen. Read the full piece for Santoro's precise framing of what the science does and does not support, and for Briggs's account of how younger women are being pulled into treatment pipelines built for a different patient population.
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