There is RARELY a need to start estrogen during perimenopause. Doing so results in adverse effects more often than not and I have seen far too many women stop hormone therapy completely because of an uninformed "menopause specialist" cluelessly creating an environment of estrogen excess.

Many practitioners, even self-proclaimed "menopause specialists", fail to understand the fundamental physiology of the perimenopausal transition. They operate under the false assumption that because a woman is experiencing hot flashes or night sweats, she must be estrogen deficient. In perimenopause, the reality is often the exact opposite.

Women's health matters. By understanding the physiology of perimenopause, we can save women from unnecessary suffering and keep them on a path to optimal health.