Hormone Healthcare for Women: Providing therapy, and healthy living for women.

Velkomin Health & Wellness
Helping you navigate this next chapter with knowledge, strength & wellness. Providing hormone healthcare for women.

What is perimenopause?

Perimenopause is the transitional phase before the last menstrual period, when the ovaries gradually produce less regular amounts of estrogen and progesterone. Women often experience symptoms such as:

• Hot flashes and night sweats (vasomotor symptoms)
• Sleep disturbances
• Mood changes (irritability, anxiety, low mood)
• Irregular menstrual bleeding
• Vaginal dryness or discomfort (genitourinary syndrome of menopause, GSM)
• Decreased libido, energy or muscle strength

Because hormone levels fluctuate widely during this phase, diagnosis is primarily based on symptoms and menstrual history rather than relying solely on blood hormone tests.

Why consider hormone therapy (HT/HRT)?

Hormone therapy remains the most effective treatment for many of the bothersome symptoms of perimenopause. Here’s what the research shows:

• Systemic estrogen (with progestogen if the uterus is intact) is the most reliable way to relieve hot flashes and improve sleep and overall quality of life.
• Local vaginal treatments (low-dose vaginal estrogen or vaginal DHEA/prasterone) are highly effective for vaginal dryness, pain with intercourse, and related symptoms, with minimal systemic hormone exposure.
• In select cases with hypoactive sexual desire disorder (HSDD), low-dose testosterone may be considered after non-hormonal options.

What kinds of hormones are used — and how do they differ?

Estrogen (systemic)

• 17β-estradiol is the human estrogen most often used in treatment.
• Available in oral form, and in transdermal (patch, gel) forms.
• The transdermal route can be preferable for women with higher risk of metabolic issues or blood-clot risk because it avoids first-pass metabolism in the liver.

Progestogens (if uterus intact)

• Essential to protect the endometrium when systemic estrogen is given to a woman who still has a uterus.
• Progestogens include micronized progesterone (a “bio-identical” form) and synthetic progestins (e.g., medroxyprogesterone acetate). The choice impacts bleeding patterns, side effects and possibly risk profiles.

Local vaginal therapies

• Low-dose vaginal estrogen cream, tablet, or ring: excellent for vaginal dryness, irritation, urinary symptoms without significant systemic exposure.
• Vaginal DHEA (prasterone/Intrarosa): converts locally to estrogens and androgens; good option for dyspareunia in women who prefer minimal systemic hormones.

Testosterone

• When symptoms such as low libido, energy loss or sexual dysfunction persist despite other treatments, low-dose physiologic testosterone may be considered. However, long-term safety remains less well-established and requires monitoring.

What testing and work-up should we do before starting therapy?

Before initiating hormone therapy (or even when just evaluating symptoms), consider:

• TSH to rule out thyroid disease (symptoms overlap).
• Pregnancy test if pregnancy remains possible (even if irregular bleeding).
• Routine baseline labs if starting systemic therapy: blood pressure, lipid panel, glucose/A1c, liver function tests (especially if oral estrogen).
• Bone density scan (DXA) if the patient has risk factors for osteoporosis (since HT may also provide bone-protection).
• Mammogram and breast/cervical screening up to date (as hormone therapy discussions include breast and uterine risk/benefit).
• FSH/estradiol levels aren’t usually necessary in perimenopause because of high variability — but may be used in special cases (e.g., younger than 45, suspicion of premature ovarian insufficiency).

Lifestyle & exercise: essential partners to hormone therapy

Hormone therapy alone doesn’t replace the benefits of movement and healthy living — and in fact, combining therapy with good lifestyle choices gives the best outcomes. At Velkomin Health & Wellness, we encourage:

• Aerobic activity: aim for at least 150 minutes per week of moderate intensity (brisk walking, swimming, cycling) or 75 minutes vigorous.
• Strength / resistance training: at least 2 sessions per week targeting major muscle groups (free weights, resistance bands, bodyweight). This supports bone and muscle health.
• Impact / weight-bearing exercises (as tolerated): dancing, stair-climbing, light jogging — to stimulate bone density.
• Balance & pelvic-floor exercises: especially if urinary symptoms, pelvic pain, or risk of falls — yoga, tai chi, single-leg balance, pelvic-floor physical therapy.
• Healthy lifestyle habits: good sleep hygiene, avoid smoking, moderate alcohol (excess alcohol can worsen hot flashes), maintain a healthy weight and eat a nutrient-dense diet rich in calcium/vitamin D.

Monitoring and follow-up

Once therapy is initiated:

• First follow-up around 4–12 weeks to assess symptom relief, side effects (bleeding, mood changes, breast tenderness), and blood pressure.
• Ongoing visits every 6–12 months to review symptoms, change in health status, and update screening (breast, bone, cardiovascular).
• Monitor metabolic parameters (lipids, glucose) for those on systemic estrogen, especially oral.
• Advise patients on what bleeding patterns are expected, and when bleeding is abnormal (e.g., new heavy bleeding or post-menopause bleeding) — which triggers further evaluation (ultrasound, endometrial assessment).

Shared-decision making: risk vs benefit

It’s vital to tailor the plan — consider age, time since onset of menopause transition, personal and family history (breast cancer, blood clot, stroke, cardiovascular disease), and patient values. For most healthy women under ~60 and within 10 years of menopause onset, HT tends to have a favorable benefit–to–risk for vasomotor symptoms and bone health. The route (transdermal vs oral), type of progestogen, and duration should all be individualized.

Take-home message

Suppose you’re experiencing perimenopausal symptoms that are interfering with your quality of life. In that case, the combination of hormone therapy (systemic or local) plus a proactive lifestyle plan offers the strongest evidence for relief and long-term wellness. At Velkomin Health & Wellness, we specialize in hormone healthcare for women—working with you to evaluate your risk profile, choose the best therapy route and dose, set up monitoring, and support your exercise and healthy-living plan.