The decision to suppress ovulation in perimenopausal women is a key starting point for hormone management based on individual preferences and symptoms.

“The first question that I try to answer in my interview with my permenopausal patients is do you like ovulating or not? And that's the sort of first branch point at which I sort of decide how I'm going to approach this patient.”

Perimenopause and menopause symptoms like brain fog and physical changes should be proactively treated with hormone replacement therapy rather than ignored.

“And all these things are happening and no one's diagnosing them. No one's treating them with hormone replacement until they go through menopause.”

During perimenopause and menopause, testosterone and progesterone are typically the first hormones to decline before estrogen levels drop.

“So that progesterone and testosterone kind of share the the race to the finish line of being the first hormone to go to drop. Estrogen really comes later.”