Perimenopause or “Am I Going Crazy?” Understanding Complex Symptoms and Hormone Fluctuations

Duncan Turner, MD discusses how perimenopause symptoms can be complex, obscure, and easily confused with other conditions, leading some patients to be prescribed medications like Xanax or antidepressants that may not address the underlying hormonal changes. He explains that perimenopause is marked by unreliable, inconsistent shifts as the ovaries “misfire,” with intermittent ovulation and fluctuating estrogen and progesterone levels that cause symptoms to change over time. Turner emphasizes evaluating the big picture and using lab work to better determine where a patient is in the transition, often starting slowly with small amounts of estrogen and/or progesterone to manage symptoms. He notes this is not a quick fix and typically requires ongoing care and patience over four to ten years as symptoms evolve.

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Non-Hormonal Options for Menopausal Symptoms

On the Vagina Doctor Podcast, nurse practitioner Sophie Mengele discuss non-hormonal options for managing menopausal symptoms such as hot flashes, night sweats, and mood irregularities. Sophie reviews several medication choices used when hormone therapy isn’t desired or isn’t an option, including SSRIs (noting Lexapro as a preferred option) and SNRIs for anxiety and mood stabilization. She highlights Veozah, which works on brain pathways involved in thermoregulation to reduce hot flashes and night sweats, emphasizing that it should be prescribed with ongoing monitoring and liver enzyme labs. She also mentions gabapentin and pregabalin as additional options that can help with uncomfortable symptoms and encourages listeners to speak with their healthcare provider about which approach may fit.

00:00 Non-Hormonal Menopause Treatment Options

01:09 SSRIs & SNRIs

02:05 Gabapentin & Pregabalin

02:33 Talk to Your Provider

https://www.turnermedicalarts.com

https://www.youtube.com/@thevaginadoctor

Perimenopause, Sleep Disruption, and Hormone Therapy Options (Estrogen vs Progesterone) | The Vagina Doctor Podcast

Duncan Turner MD and Sophie Mengele NP role-play a gynecologist visit with a 45-year-old patient who suspects perimenopause due to irregular heavier periods, mood changes, hot flashes, and especially disrupted sleep. The clinician explains that perimenopause is challenging because ovarian hormone output becomes unpredictable, with fluctuating estrogen and inconsistent progesterone depending on irregular ovulation, making random blood tests less useful; checking FSH early in the cycle can provide a clue. They discuss trying estrogen to address low-estrogen symptoms like hot flashes, night sweats, and insomnia, and consider nightly progesterone for its sedating effect and potential sleep benefits. They cover dosing approaches, the need for progesterone to protect the uterus if estrogen is used due to uterine cancer risk, and suggest baseline labs, an ultrasound, and trial-and-error experimentation.

00:00 Role Play Setup

00:23 Patient Symptoms Overview

01:09 Why Perimenopause Is Tricky

02:12 Estrogen Testing and Trial

02:55 Progesterone for Sleep

03:57 Dosing and Uterus Protection

05:20 Next Steps Labs and Ultrasound

05:39 Wrap Up and Follow Up