What Happens During Perimenopause and Menopause? (podcast)

Hormone replacement therapy can help ease severe symptoms

Dr. Katrina Kelly, OB-GYN, discusses perimenopause and menopause on San Diego Health podcast.

Dr. Katrina Kelly, OB-GYN, Scripps Clinic

Hormone replacement therapy can help ease severe symptoms

Hot flashes, fatigue, mood swings, and irregular menstrual cycles can all indicate you may be heading toward menopause. This leadup period to menopause is called perimenopause and can start as early as your late 30s and last a whopping 10 years before the actual onset of menopause.

For some, the transition from perimenopause to menopause can be smooth, but for others, the symptoms that come along with the change can be quite severe.


In this episode of San Diego Health, host Susan Taylor and guest Katrina Kelly, MD, an OB-GYN at Scripps Clinic Rancho Bernardo, discuss menopause, perimenopause, and how hormone replacement therapy help ease some of the discomfort. Traditional hormone replacement therapy and plant-derived bioidentical hormone replacement therapy can also help protect your bones from osteoporosis, prevent heart disease, and ward off dementia as you age.

Some types of hormone replacement therapy have been linked to a slightly higher incidence of breast cancer, but experts believe the benefits outweigh the risks. Lifestyle changes like eating healthy, exercising, and losing weight can also help during perimenopause and menopause.


Your doctor can help craft and individualized plan to treat perimenopause and menopause-related symptoms.

Listen to the episode on symptoms of perimenopause and menopause

Listen to the episode on symptoms of perimenopause and menopause

Podcast highlights

What is perimenopause? (0:48)

Perimenopause is a frame of time which could even last 10 years before menopause, where women start noticing that their menstrual periods become somewhat irregular. They may come closer for a while, every 21 days instead of the usual 28 days. Eventually, they may start missing periods where they have a period every one to three months. Eventually they stop having periods.

What age do women start experiencing perimenopause? (1:15)

It can be late 30s, early 40s. That’s pretty typical.

What is menopause? (1:25)

Menopause is technically not having a period for one year (12 months).

What are the signs of menopause aside from no longer getting your period? (1:33)

Symptoms can vary from woman to woman. Some women go through a smooth transition where that’s the only thing that they notice while it can be quite severe in other women. They may have hot flashes, night sweats, insomnia and mood changes. They may notice vaginal dryness. They may be having pain with intercourse. They may have heart palpitations. There is a whole host of symptoms that women may have.

What are the long-term effects of menopause-related hormone reduction? (2:09)

Over the course of the 30 years that a woman may live beyond menopause, she may develop osteoporosis, which is a thinning and inflexibility of the bones and can lead to fracture and disability. In addition, it could lead to heart disease, stroke, heart attack and dementia.

What is hormone replacement therapy? (2:50)

The idea behind hormone replacement therapy is to replace the hormones that a woman makes in her reproductive years, which are estrogen, progesterone and testosterone.

What are the benefits of hormone replacement therapy? (3:07)

Hormone therapy can help protect the bones from osteoporosis. It can also help protect against heart disease and protect against all different types of dementia, including Alzheimer’s.

What are the risks of hormone replacement therapy? (3:46)

Hormone therapy does, depending on the type you’re using, carry a small increase in the risk of breast cancer. But if you look at the North American Menopause Society’s statement in 2017, they stated that they felt the benefits outweighed the risks in terms of hormone therapy.

What is bioidentical hormone replacement? (4:10)

It’s a product that’s synthesized from plant sources. It is synthesized to look like your natural hormones. For example, your main estrogen that you make is estrodiol. It is going to look like the chemical structure of your estrodiol and be absorbed in a way that your natural estrodiol would be into your system.

What are the benefits and risks of bioidentical hormone replacement therapy? (4:40)

Bioidentical hormone therapy can help keep your bones strong, prevent osteoporosis, heart disease and dementia. In addition to helping with quality of life issues, it can help with vaginal and bladder tissues. The risks are a slight increase in the risk of breast cancer.

Why would someone choose bioidentical over traditional hormone replacement therapy? (5:25)

Bioidentical hormone therapy, because it looks like the hormones that your body produces, is going to bind to the receptors in your body the way it should. Women tend to feel better on it. We believe there are less risks involved with bioidentical hormone therapy.

What kind of lifestyle changes also help reduce your symptoms? (5:53)

In terms of hot flashes and night sweats, we know that women who weigh less tend to have less hot flashes and night sweats. Weight reduction can be helpful. Eating a healthy diet, avoiding alcohol, too much caffeine, too many sugar products can be helpful. Regular exercise can be helpful. Some products can be helpful in terms of tolerating symptoms. For example, a lot of women are woken up by night sweats. Wearing breathable clothing at night or a cool pad underneath your sheets on your mattress can be helpful. There are pillows that are made now where you can have coolness on your head, so if you’re experiencing a night, sweat, you sleep a little bit better.

Some women get a little benefit from over-the-counter supplements, non-prescription, such as soy products or black cohosh-based products.

There are some prescription medications that we give to women that are non-hormonal that can be helpful with some of the symptoms that women experience.

What is the benefit of discussing menopause with your doctor? (7:22)

Whether you’re a woman and you’re going through your late 30s and starting to have symptoms or into your 50s or beyond, it’s important to talk to your gynecologist about what you may be experiencing.

We can help you to figure out an individualized plan, whether it be hormone therapy or something else to help you through this transition.

Watch the San Diego Health video on perimenopause and menopause

Watch the San Diego Health video with Susan Taylor and Dr. Kelly where they discuss what to expect during perimenopause and menopause.

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