Hormone Therapy for Perimenopausal and Menopausal Women: A Holistic Approach

randrson
Jul 4, 2025
5 min read

At Cascade Mind and Body Clinic, we recognize that the journey through perimenopause and menopause can be deeply transformative, yet often challenging. Hormonal shifts during this time can significantly impact a woman’s mood, sleep, energy, cognition, sexual function, and long-term health. Fortunately, individualized hormone therapy (HT) and strategic supplementation can help restore balance, vitality, and well-being.

Understanding Perimenopause and Menopause

Perimenopause usually begins in a woman's 40s and may last 4 to 10 years. Hormone levels fluctuate, leading to symptoms such as insomnia, anxiety, and irregular periods. Menopause is defined as the absence of menstrual periods for 12 consecutive months, typically occurring between ages 45 and 55.

How We Test Hormones at Cascade Mind and Body Clinic

We use comprehensive testing to evaluate hormone status and guide therapy:

Serum blood testing for estradiol, FSH, LH, progesterone, free and total testosterone, DHEA, SHBG, and TSH.
DUTCH testing for advanced hormone metabolite and adrenal assessment.
Salivary testing in select cases to assess circadian rhythm or adrenal status.

What Each Hormone Tells Us

Hormone	Why It Matters	Symptoms of Imbalance	References
Estradiol (E2)	Regulates thermoregulation, bone remodeling, cognition, cardiovascular health, urogenital tissue, and skin.	Hot flashes, night sweats, vaginal dryness, memory issues, mood swings, bone loss.	NAMS, 2022; Manson et al., 2017; Rocca et al., 2011
Progesterone	Balances estrogen, supports mood, reduces anxiety, promotes GABA activity for sleep, regulates the uterine lining.	Anxiety, insomnia, mood swings, irritability, irregular bleeding.	Prior, 2018; Hitchcock & Prior, 2023; Genazzani et al., 2018
Testosterone	Supports libido, energy, cognition, muscle mass, mood, and bone strength.	Low libido, fatigue, depression, brain fog, muscle loss.	Davis et al., 2019; Nappi et al., 2020; Islam et al., 2019
FSH	Increases as ovarian function declines. Marker of menopause, not a direct cause of symptoms.	Often associated with severe hot flashes, irritability, and brain fog.	Burger et al., 2007
DHEA	Precursor to estrogen/testosterone; supports mood, libido, immune function, and energy.	Fatigue, low libido, depression, poor stress tolerance.	Labrie et al., 2005

Hormone Therapy Benefits

When hormone therapy is tailored to an individual's biology and timing, it can:

Alleviate vasomotor symptoms (hot flashes, night sweats)
Improve sleep, mood, and energy
Enhance sexual function and vaginal health
Support cognitive clarity
Prevent osteoporosis and maintain bone density (NAMS, 2022)

When to Start Hormone Therapy: The Therapeutic Window

The ideal time to begin HT is within 10 years of menopause onset or before age 60. This is known as the therapeutic window, when estrogen receptors are most responsive, and vascular risk is lowest (Hodis & Sarrel, 2018).

Outside this window, particularly >10 years post-menopause, estrogen therapy may slightly increase the risk of stroke or heart attack if not managed carefully due to pre-existing vascular changes (Manson et al., 2017).

Can Women Over 70 or 15+ Years Post-Menopause Use HT?

Yes—with caution and personalization. While systemic estrogen may pose cardiovascular risks in this group, testosterone and progesterone can still be beneficial:

Micronized progesterone improves sleep and anxiety without increasing cardiovascular or breast cancer risk (Hitchcock & Prior, 2023; Prior, 2018; Fournier et al., 2005).
Testosterone improves libido, energy, mood, and cognition even in late postmenopause, with no increase in cardiovascular or breast cancer risk when dosed physiologically (Davis et al., 2019; Islam et al., 2019).

Delivery Methods

Method	Pros	Notes
Patch	Stable blood levels, bypasses liver	Ideal for estradiol
Gel/Cream	Flexible, bioidentical	May transfer with contact
Oral	Convenient (esp. for progesterone)	Higher clot risk for estrogen
Troche/Sublingual	Fast absorption, avoids digestion	Common for testosterone, DHEA
Vaginal (local)	Targets dryness, UTIs	Minimal systemic effects

Bioidentical vs. Synthetic Hormones

Type	Source	Pros	Common Examples
Bioidentical	Plant-derived; identical to human hormones	Safer, better tolerated	Estradiol patch/gel, Prometrium, compounded testosterone
Synthetic	Not structurally identical	More side effects	Medroxyprogesterone, Premarin

At Cascade Mind and Body Clinic, we prioritize bioidentical hormones supported by safety and efficacy data.

Supplements to Support Hormonal Balance

Supplement	Use	Thorne Product
Magnesium bisglycinate	Sleep, anxiety, cramps	Magnesium Bisglycinate
Vitamin D3 + K2	Bone, cardiovascular health	D/K2 Liquid
DIM	Estrogen metabolism	DIM Advantage
Omega-3s	Mood, cognition, inflammation	Super EPA
Rhodiola, Ashwagandha	Stress, energy, libido	Phytisone

Symptoms Hormone Therapy Can Relieve

Hot flashes, night sweats
Anxiety, depression, mood swings
Poor sleep or early morning awakening
Brain fog, forgetfulness
Vaginal dryness, painful intercourse
Fatigue, apathy
Muscle or bone loss
Low libido, weight gain
Urinary urgency or recurrent UTIs

Long-Term Consequences of Hormonal Depletion

Without appropriate support, long-term hormone deficiencies can increase the risk for:

Osteoporosis and fractures
Cardiovascular disease
Cognitive decline and dementia
Skin aging and muscle loss
Chronic fatigue and mood disorders
Urinary incontinence and prolapse

Final Thoughts

Hormone therapy is about more than symptom relief—it’s about restoring your foundation of health and vitality. At Cascade Mind and Body Clinic, we believe in empowering women with evidence-based options, advanced diagnostics, and individualized care. Whether you're navigating early perimenopause or have been postmenopausal for over a decade, we're here to help you feel like yourself again.