It might not be stress. It might be perimenopause.

What it can look like

Hot flashes are rarely the first sign.

Perimenopause is the years of hormone swings before your periods stop. It usually starts in your 40s, sometimes the late 30s, and you can be in it while your cycle still looks regular.

• Waking at 2 or 3 a.m. and staying awake
• Brain fog and losing words mid-sentence
• New anxiety or a shorter temper
• Periods that are heavier, closer together or unpredictable
• Hot flashes and night sweats
• Low desire
• Vaginal dryness or pain with sex
• Joint aches with normal imaging
• Weight shifting to your midsection
• Tired even after a full night

These symptoms overlap with thyroid problems, anemia, depression and sleep apnea, so they deserve a real evaluation and not a guess.

Free guide

The Perimenopause Starter Guide.

A short guide to bring to your appointment: what's happening, a 4-week symptom tracker, which labs help, hormone therapy in plain English, vaginal and bladder symptoms, skin changes, and the questions to ask.

Why this is on a GLP-1 site

Many of you are in this window right now.

Most of the people I talk with about GLP-1 medications are women between 35 and 60. That is the same stretch of life when estrogen and progesterone start to change, and when sleep, mood, muscle and where your body stores fat can all shift at once.

Hormone therapy is not a weight loss treatment, and it doesn't replace a GLP-1. But if the scale is only part of what feels off, hormones are worth asking about.

A telehealth option

What Belle offers.

Belle is one of the two telehealth companies I already recommend for GLP-1 care. They now run a perimenopause and menopause program, designed by their Chief Medical Officer, a Menopause Society Certified Practitioner.

• Bioidentical estradiol as a nightly cream or a weekly injection
• Progesterone as a nightly capsule, when it's part of your plan
• Vaginal estradiol cream and testosterone, as add-ons or on their own
• Diagnosis based on your symptoms and cycle history, with no blood work required to start
• Free 20-minute consultations with a menopause-trained provider
• Check-ins at weeks 6, 12, 18 and 24, with dose changes included
• Available in all 50 states, shipped from a licensed US pharmacy
• No membership fee. HSA and FSA eligible. Not billed to insurance.

The process

How it works.

1. Symptom check and health history. A short quiz, then screening questions so a provider can confirm hormone therapy is safe for you.

2. Optional free consultation. Twenty minutes with a menopause-trained provider. You can skip it if you already know what you want.

3. Your treatment plan. If you're a candidate, the provider chooses the form and dose with you.

4. Delivery and follow-up. Medication ships to your door. Belle says it takes about 4 to 6 weeks on a dose to judge how it's working, and they check in at week 6 to adjust.

Skin

Your skin on low estrogen.

Estrogen helps skin make collagen. Skin can lose about 30% of its collagen in the first five years after menopause, which shows up as dryness, thinning, itch and new fine lines.

Daily sunscreen, a retinoid and a good moisturizer do the most. Belle also offers prescription skin care, including a daily cream with estriol and a copper peptide cream. These are compounded, not FDA-approved, and the studies behind them are small, so a licensed provider reviews your skin history first.