MONDAY— Research Monday

This week’s GOATGETheR lane:

Perimenopause — before we even get to menopause

After PCOS and endometriosis, I’d make this week about perimenopause specifically, rather than combining it with menopause immediately. There is enough here for its own week, and the strongest angle connects directly to what women are already telling us: “Something is happening to me, but I’m being told everything is normal.”

Teach yourself first: What → Why → So What → What Now

WHAT: Perimenopause is the transition leading up to menopause. Menopause itself is reached after 12 months without menstruation, assuming another cause isn’t responsible. During the transition, ovarian hormone production becomes increasingly variable rather than simply declining in a neat straight line.

WHY: That variability helps explain why women can experience changing periods, hot flashes, night sweats, sleep problems, mood symptoms and other changes while a single hormone measurement may not neatly explain what they are experiencing.

SO WHAT: A woman can make the mistake of thinking, “My bloodwork was normal, therefore this can’t be perimenopause.” That’s not how major clinical guidance approaches routine diagnosis. NICE guidance does not recommend routinely using biochemical/hormonal testing to identify perimenopause or menopause in otherwise healthy women aged 45+ when the clinical picture is clear.

WHAT NOW: This is exactly where symptom and menstrual-pattern tracking becomes useful. Not because a tracker diagnoses anything, but because “I haven’t felt right lately” is much harder to investigate than “I’ve had 14 night-sweat episodes this month, my cycles changed from 28–30 days to 19–45 days, and I’m waking three nights per week.”

That’s the education opportunity behind the tracker we just built.

MONDAY— Research Monday

The Perimenopause Myth: “My Hormones Were Normal, So It Can’t Be Perimenopause.”

Here’s something I think more women should know:

Perimenopause isn’t necessarily something you can capture with one hormone test.

Hormones during the menopause transition can fluctuate.

That means the story isn’t always:

Estrogen normal → estrogen normal → estrogen normal → estrogen suddenly low → menopause.

The transition can be much messier.

And that’s one reason major clinical guidelines don’t recommend routinely diagnosing perimenopause in healthy women over 45 by ordering a giant panel of hormone tests.

Think of it like weather versus climate.

One hormone test is a little like checking the temperature at 2:13 PM on Tuesday.

Useful information?

Sure.

But it doesn’t necessarily tell you what the weather has been doing for the last six months.

Your menstrual history + symptoms over time provide a different type of information.

This does NOT mean bloodwork is useless.

There are situations where testing can be appropriate—particularly when age, symptoms, medications, medical conditions or other possible diagnoses complicate the picture.

The point isn’t:

“Doctors shouldn’t test hormones.”

It’s:

“One normal hormone result doesn’t necessarily settle the entire perimenopause question.”

Evidence tier: 🟢 HIGH

This is established clinical-guideline territory rather than an emerging TikTok theory.

Research Deep Dive — The bigger menopause conversation we’re missing

Here’s where I want GOATGETheR to go beyond hot flashes.

The menopause transition isn’t solely a symptom-management conversation.

We’re also talking about:

muscle.

bone.

cardiovascular health.

metabolic health.

sleep.

sexual and urinary health.

mental health.

long-term physical function.

And one of the most interesting areas is resistance training.

A 2024 systematic review/meta-analysis of randomized trials in healthy postmenopausal women found resistance training significantly improved upper- and lower-body strength and cardiorespiratory fitness.

Then a 2025 meta-analysis went deeper into bone health.

Researchers analyzed 17 randomized controlled trials involving 690 postmenopausal women.

Resistance training improved bone mineral density at the:

lumbar spine
femoral neck
total hip

The authors found particularly encouraging results with higher-intensity resistance training and programs performed around three times per week.

But here’s where research literacy matters.

There was very high heterogeneity for lumbar-spine and femoral-neck results.

So we shouldn’t turn this into:

“Scientists proved every menopausal woman needs ≥70% 1RM three days per week.”

They didn’t.

A 2025 scoping review explicitly concluded that there still aren’t evidence-based resistance-training prescriptions specifically tailored to postmenopausal women, despite many studies following conventional strength-training principles.

And an especially important 2025 Canadian systematic review looked specifically at peri- and early-postmenopausal women aged 45–60.

Only six trials met the criteria.

The evidence was low quality, and researchers concluded we still cannot determine which training method best prevents muscle and bone loss during the actual menopause transition.

That’s a huge research gap.

Evidence tier

Resistance training improves strength/function after menopause: 🟢 STRONG

Resistance training supports bone health: 🟢 MODERATE–STRONG

Exact optimal menopause-specific program: 🟡 UNCERTAIN

Exercise prescription specifically during perimenopause: 🟡 UNDERSTUDIED

Confidence:

8.5/10

High confidence that resistance training matters.

Much lower confidence that science has identified the perfect menopause-specific protocol.

Emerging Therapy Spotlight — Menopausal Hormone Therapy

Few areas of women’s health have generated as much confusion as menopausal hormone therapy (MHT).

For years, many women heard some version of:

“Hormone therapy is dangerous.”

The actual evidence is much more nuanced.

Menopausal hormone therapy can include estrogen alone or estrogen combined with a progestogen, depending partly on whether a woman has a uterus. Different formulations and routes—such as oral versus transdermal estrogen—also matter when evaluating benefits and risks.

MHT remains the most effective treatment for vasomotor symptoms, including hot flashes and night sweats, and it can help prevent bone loss and fractures.

But that does not mean:

“Every woman should take hormones.”

And it also does not mean:

“Hormones are inherently dangerous.”

Timing matters.

Major menopause guidance emphasizes that the benefit-risk profile is generally most favorable for women who:

* are younger than 60, or

* are within approximately 10 years of menopause onset,

when they have bothersome menopausal symptoms and do not have contraindications.

For women who begin therapy later—particularly more than 10 years after menopause onset or after age 60—the absolute risks of certain cardiovascular events, stroke, venous thromboembolism and dementia become more important in the decision.

That’s why the question shouldn’t simply be:

“Is hormone therapy safe?”

A better question is:

“For which woman, at what age, for which symptoms, using which formulation and route, and with what medical history?”

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Why did hormone therapy become so controversial?

A major turning point came from the Women’s Health Initiative (WHI).

The original WHI hormone-therapy trials fundamentally changed medical practice after findings raised concerns about outcomes including breast cancer and cardiovascular disease.

But there was an important limitation to how those results entered public conversation:

The women enrolled in the WHI hormone trials were, on average, substantially older than women who typically first experience menopausal symptoms.

The average participant was approximately 63 years old.

That matters because starting hormone therapy many years after menopause is not biologically identical to beginning treatment around the menopause transition.

Later analyses, longer follow-up and subsequent research have produced a much more individualized understanding of MHT than the simple message:

“Hormones = dangerous.”

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What does the evidence support?

Hot flashes + night sweats

🟢 STRONG EVIDENCE

Systemic menopausal hormone therapy remains the most effective treatment for moderate-to-severe vasomotor symptoms.

Bone

🟢 STRONG EVIDENCE

MHT prevents bone loss and reduces fracture risk while treatment continues.

Genitourinary symptoms

🟢 STRONG EVIDENCE

For vaginal dryness, painful sex and other symptoms of genitourinary syndrome of menopause, low-dose vaginal estrogen and other targeted therapies may be considered depending on the individual situation.

Preventing cardiovascular disease

🔴 NOT its primary indication

Hormone therapy should not be started solely for the purpose of preventing cardiovascular disease.

That’s an important distinction.

Something can influence cardiovascular biology without becoming a recommended cardiovascular-prevention drug.

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Myth Check

“Hormone therapy causes breast cancer.”

Too simplistic.

Breast-cancer risk depends on factors including the hormone regimen used and duration of treatment.

Estrogen-only therapy and estrogen-plus-progestogen therapy should not automatically be treated as identical exposures.

“Every menopausal woman should take estrogen.”

False.

Treatment should be individualized according to symptoms, age, time since menopause, personal risk factors, medical history and preferences.

“Nobody should take hormones after 60.”

Also too simplistic.

Age 60 isn’t a magical biological cutoff.

Starting therapy later changes the benefit-risk calculation, but continuation or treatment decisions require individualized assessment rather than one universal rule.

“Bioidentical means safer.”

Not necessarily.

The word bioidentical describes hormones that are chemically identical to hormones produced by the human body.

It does not automatically mean a product is safer, more effective or better regulated.

Major professional organizations distinguish regulated hormone products from custom-compounded preparations, which may have greater uncertainty around dosing, purity and consistency.

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So What?

The hormone-therapy conversation is a perfect example of why women’s health can’t be reduced to headlines.

The question isn’t:

HRT: good or bad?

It’s:

What treatment?

For whom?

At what point in the menopause transition?

For what goal?

At what dose?

Through what route?

With what individual risks?

That’s a completely different conversation.

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What Now?

If you’re approaching perimenopause or menopause, you don’t need to decide today whether you’re “for” or “against” hormone therapy.

Learn enough to ask better questions.

Document:

Your symptoms.

Your menstrual changes.

Your medical history.

Your family history.

Your medications.

What symptoms are affecting your quality of life.

And what you actually want treatment to accomplish.

Then those factors can become part of an individualized conversation with a qualified healthcare professional.

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Evidence Tier: 🟢 ESTABLISHED CLINICAL THERAPY

MHT is not an experimental longevity treatment or hormone “optimization” protocol.

It is an established medical therapy with decades of clinical research behind it.

What continues to evolve is our understanding of who benefits most, which formulations and routes are preferable for different women, how timing affects risk, and how treatment should be individualized.

Confidence: 9/10

High confidence: effectiveness for vasomotor symptoms and prevention of bone loss.

More individualized: long-term benefit-risk profile, cardiovascular outcomes, breast-cancer risk and the optimal formulation/route for a particular woman.

Key research base: The Menopause Society Hormone Therapy Position Statement; Women’s Health Initiative randomized trials and long-term follow-up; NICE menopause guidance; International Menopause Society recommendations.

Bottom line:

Hormone therapy deserves neither fearmongering nor hype.

It deserves context.

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MONDAY— Research Monday