When we launched this blog, we’d share any article about perimenopause or menopause — there were so few. Now there are too many and we are picky. This article is one worth sharing.
Many of us who struggle through hot flashes, brain fog, disrupted sleep and mood changes are experiencing perimenopause — the turbulent transition before menopause. Perimenopause and menopause are distinctly different phases hormonally — in perimenopause estrogen is fluctuating, sometimes higher than before, and progesterone is declining.
Yet most of the research, and most of the clinical guidance healthcare providers rely on, focus on what happens after periods stop. At the same time, the growing attention on perimenopause and menopause includes misinformation on social media and the FDA has made claims about hormone therapy that leading researchers have called misleading. In the middle of all this noise, what does the science actually say?
In this article in Nature, Linda Nordling explores why the knowledge gap around perimenopause exists, what it means for those seeking treatment, and how researchers are now trying to fill it.
“We’re not good at treating perimenopause because we don’t completely understand it,” says Susan Davis, an endocrinologist at Monash University in Melbourne, Australia, who has studied menopause for decades.
Treatment of perimenopause, for example, tends to focus on stabilizing hormone levels using either menopausal hormone therapy (MHT) or hormonal contraceptives to supplement the body’s drop-off in oestrogen and progesterone. But these approaches are mostly informed by postmenopausal studies, and have not been optimized for perimenopause, when people might respond differently.
Indeed, says Davis, in some cases “giving more oestrogen can make things worse”, because women who are perimenopausal still produce variable amounts of hormones; adding more can cause them to “bleed all over the place”.
The FDA’s announcement in November trumpeted that MHT reduces Alzheimer’s disease risk by 35% and cardiovascular disease risk by 50% — claims refuted by menopause scientists.
Pauline Maki, a neuroscientist at the University of Illinois Chicago, called the claim of a 35% reduction in Alzheimer’s risk “misleading and inaccurate in light of what we now understand,” and told Nature that the data seemed to be taken from a single 1996 study. In December 2025, a systematic review of ten studies surveying more than one million participants found no evidence that hormone treatments affect dementia risk.
“There’s a fundamental gap of information on the perimenopause. We don’t yet understand how treating menopause symptoms, regardless of whether it’s hormonal or non-hormonal, benefits women or not.”— Pauline Maki, neuroscientist, University of Illinois Chicago
