What should you know about estrogen for perimenopause?

During perimenopause, ovarian hormone production fluctuates before it becomes consistently lower. Periods may become irregular, heavier, lighter, or occasionally absent. Hot flushes, night sweats, mood changes, sleep problems, and reduced sexual desire may appear alongside the cycle changes. Pregnancy can still occur while periods are happening, so a missed period should not automatically be attributed to perimenopause. Bleeding patterns that are unusual for you deserve attention.

Discuss the main symptom you want to treat, your bleeding pattern, contraception needs, and relevant medical history. Estrogen can be delivered through the skin, by mouth, or locally, and the choice depends on symptoms and risk factors. If you have a womb, systemic estrogen usually needs protection for the womb lining with a progestogen. A clinician may suggest non-hormonal options when estrogen is unsuitable, and should review unexplained heavy bleeding before treatment begins.

Book a clinical review for bleeding that is very heavy, lasts longer than expected, happens after sex, or leaves you tired or short of breath. Seek urgent help for soaking bleeding with dizziness, severe pelvic pain, fainting, or a possible pregnancy with pain or bleeding. Contact a clinician if hot flushes, night sweats, or mood symptoms are affecting daily function.

Could my bleeding pattern have another cause? Which estrogen route fits my symptoms and risk factors? Do I need contraception or a progestogen, and how will we review the treatment?