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KRUUSH isn't medical advice. Every claim is sourced. Always talk to your healthcare provider.

The Hormones Page

Three hormones
run everything.

Estrogen. Progesterone. Testosterone. They regulate over 400 functions in your body. During perimenopause, all three shift. But here's what nobody tells you: the research on what to do about it has changed dramatically in the last two years. You have more options than you think. Let's walk through them.

Every claim sourced. Tap any source to verify it yourself.

See Your Options
01

What we wish our doctors had told us.

90%

Estrogen drops by up to 90% by menopause. That's not a subtle shift. That's a system overhaul.

Jean Hailes for Women's Health
50%

Your testosterone is already half of its peak by age 40. Most women have no idea they even produce it.

Davis et al., 2000
80%

of women get hot flashes during menopause. The average is 4 to 5 per day. For up to 7 years.

Cleveland Clinic; JAMA
30%

of your skin collagen disappears in the first five years after menopause.

Brincat et al., 1985; Thornton, Dermato-Endocrinology, 2013

Real data on hormones and perimenopause barely exists. Help us change that.

Add My Voice

Hormone Levels by Age

Progesterone (first to decline, starts around 35)

30
35
40
45
50
55

Estrogen (spikes then crashes, drops up to 90%)

30
35
40
45
50
55

Testosterone (gradual decline, half by age 40)

30
35
40
45
50
55

Sources: Jean Hailes for Women's Health; Davis et al., 2000; Cleveland Clinic; London Hormone Clinic, 2025

Estrogen runs 400+ functions.

Temperature regulation. Heart protection. Brain function. Bone density. Skin elasticity. Joint lubrication. Serotonin production. When estrogen drops, it's not one thing that changes. It's everything.

During early perimenopause, estrogen can spike 30% higher than normal before it crashes. Most symptoms come from the swings, not just the decline.

Hot flashes

Brain fog

Vaginal dryness

Joint pain

Skin thinning

Mood shifts

BCMJ; Cleveland Clinic; Jean Hailes

Progesterone is the calm one. It left first.

Progesterone helps your brain produce GABA, your nervous system's calming signal. It's the first hormone to decline. When it drops, your brain loses that signal.

That new anxiety at 42? The racing thoughts at 3am? The irritability that came out of nowhere? That's not you losing it. That's progesterone leaving. And it's biochemistry, not weakness.

Anxiety out of nowhere

3am wakeups

Irritability and rage

Heavy periods

Johns Hopkins; Jean Hailes

Testosterone belongs to you too.

Women produce testosterone. It drives desire, energy, motivation, and muscle maintenance. It peaks in your 20s and declines steadily. By 40, you're at about half. There is no FDA approved testosterone product for women. That is a funding problem, not a safety one.

The Lancet (2025) supports testosterone therapy for low desire in postmenopausal women. If your energy vanished and your libido went with it, this is worth a conversation with your doctor.

Low libido

Fatigue sleep won't fix

Muscle loss

Low motivation

Davis et al., 2000; The Lancet, 2025

BreakingFebruary 2026

FDA removed black box warnings from 6 HRT products.

For the first time in over 20 years, the FDA removed cardiovascular disease and breast cancer warnings from select menopausal hormone therapy products. These are the first six of 29 companies the FDA asked to submit updated labeling. More approvals are expected. This is the biggest regulatory shift in menopause care since the WHI study scared an entire generation off HRT in 2002.

Prometrium

Micronized progesterone

Bijuva

Estradiol + progesterone

Divigel

Estradiol gel

Cenestin

Synthetic conjugated estrogens

Enjuvia

Synthetic conjugated estrogens

Estring

Estradiol vaginal ring

Source: FDA.gov, February 12 to 13, 2026

Hormone Replacement Therapy

In 2002, the WHI study used synthetic progestin on women averaging age 63 and scared an entire generation. The actual increased risk was approximately 8 additional invasive breast cancer cases per 10,000 women per year in the combined estrogen plus progestin group. The estrogen only group had lower breast cancer rates. The benefits, including 34% fewer hip fractures and 37% less colon cancer during treatment, were buried in the headlines.

Slowed

atherosclerosis progression when estrogen was started within 6 years of menopause, per the ELITE trial imaging endpoint

Hodis et al., NEJM 2016

50 to 60%

reduction in bone fractures

WHI, JAMA 2002

41%

reduced Alzheimer's risk in prior HRT users in observational data, though other studies show conflicting results

Zandi et al., JAMA 2002 (Cache County Study)

35%

decreased Alzheimer risk in observational studies, not yet confirmed by large randomized controlled trials

Shao et al., 2012

"For women aged less than 60 years or within 10 years of menopause onset, the benefit to risk ratio is favorable."

The Menopause Society Position Statement, 2022

How to take it

Transdermal options like patches, gels, and sprays bypass the liver, which means lower blood clot risk. Oral is more studied but carries higher clot risk. Vaginal products target local symptoms. Bioidentical does NOT mean compounded. FDA approved bioidentical options exist.

Patches

FDA Approved

Bypasses the liver so clot risk is lower. Changed once a week.

Gels and Sprays

FDA Approved

Also bypasses the liver. Bioidentical estradiol. Applied daily.

Oral Pills

FDA Approved

The most studied form. Inexpensive generics available. Higher clot risk than transdermal.

Vaginal Products

FDA Approved

Low dose and targets dryness and pain directly where it matters.

IUDs (Progestin)

FDA Approved

Lasts up to eight years. Pair it with an estrogen patch for full coverage.

Pellets

NOT FDA Approved

Cannot be removed if side effects happen. The Menopause Society does not recommend them.

CU Anschutz Medical Campus; FDA.gov; The Menopause Society

Talk to Your Doctor First If You Have

HRT isn't for everyone. The following conditions require a conversation with your healthcare provider before starting any hormone therapy. This isn't optional.

History of breast cancer

Estrogen can stimulate hormone receptor positive tumors. The WHI estrogen plus progestin arm showed increased risk.

History of blood clots or stroke

Oral estrogen increases clotting risk. Transdermal may be safer but still requires evaluation.

Active liver disease

Oral hormones are metabolized by the liver. Impaired liver function changes how your body processes them.

Unexplained vaginal bleeding

Must be evaluated before starting HRT to rule out endometrial pathology.

Known clotting disorders like Factor V Leiden

Genetic clotting disorders significantly increase thrombosis risk with oral estrogen.

Heart disease or recent heart attack

The timing hypothesis matters. HRT started more than ten years after menopause may increase cardiovascular risk.

The Menopause Society 2022 Position Statement; ACOG Practice Bulletin; FDA Prescribing Information

Options without hormones that have clinical evidence.

Breast cancer survivors. Women with clotting disorders. Women who simply don't want HRT. These are the alternatives with published trial data.

Veozah (fezolinetant)

Completely hormone free. FDA approved in 2023. Works by targeting the brain's temperature control center and reduced hot flashes by 60% in trials.

FDA 2023; Astellas Phase 3 trial

Elinzanetant (Lynkuet)

The newest option on the market. FDA approved November 2025. Treats both hot flashes and sleep disturbances.

JAMA 2025; FDA

Gabapentin

Reduces hot flashes and improves sleep, especially night sweats. Originally developed for nerve pain but works well here too.

Cochrane Review

SSRIs and SNRIs

Low dose paroxetine, sold as Brisdelle, is FDA approved specifically for hot flashes. Also helps with mood symptoms.

FDA; Menopause Society

CBT for Insomnia

Cognitive behavioral therapy for insomnia is recommended as the first line treatment for menopausal sleep disruption.

Menopause Society; AASM

Strength Training

Three times per week. Protects bone density, improves insulin sensitivity, and supports mood. One of the most evidence backed interventions for perimenopause.

ACSM; Menopause Society

Telehealth Access

Ready to talk to a doctor? You can do it from your couch.

You've read the data. You know the options. The next step is a doctor who specializes in this. If your current provider doesn't take menopause seriously, or if you don't have one, telehealth platforms now connect you with board certified physicians who prescribe FDA approved bioidentical HRT without leaving your house.

Why we chose to feature Winona.

We looked at six major telehealth HRT platforms (Midi Health, Evernow, Alloy, Gennev, PlushCare, and Winona). They all have board certified doctors. They all prescribe real HRT. But they work differently, and different ones fit different women. Here's why Winona is the one we feature:

1.

They own their own compounding pharmacies. Winona operates 503-A regulated pharmacies. Most platforms prescribe standard doses to your local CVS. Winona compounds personalized formulations (hormone type, dose, and delivery method) for each patient. That aligns with our philosophy that no single approach works for everyone.

2.

No consult fee. No subscription. No required appointment. You pay for the medication. That's it. No $250 initial visit. No monthly membership. No scheduling a video call and waiting two weeks. For a woman reading this page at midnight who is done waiting, she can start the process right now.

3.

Transparent pricing. Every product and its price is listed upfront. Estrogen cream: $89/mo. Progesterone capsule: $39/mo. DHEA: $27 for three months. No "we'll tell you after insurance processes." For women paying out of pocket, that matters.

4.

100,000+ patients. 4.6 stars across 5,700+ reviews. This is not a startup experiment. Board certified physicians, primarily OB/GYNs, prescribe everything. HSA and FSA accepted.

When Winona might not be your best fit.

We're not here to pretend one platform works for everyone. Here's when to look elsewhere:

If you have good insurance: Midi Health accepts PPO plans (BlueCross, Aetna, United, Cigna). Your cost could be lower. They also do video consultations with menopause specialists.

If you have a breast cancer history: Midi Health specifically treats women with breast cancer history or family risk. Winona doesn't highlight this as a specialty.

If you want testosterone: Neither Winona nor Midi currently offer testosterone. Look into Joi Women's Wellness for that.

If you want your local pharmacy: Midi and Evernow prescribe to your local pharmacy for faster pickup. Winona ships from their own pharmacy.

Personalized Compounding

Own 503-A pharmacy. Custom dose, format, and hormone ratio for each patient.

$0 to Start

No consult fee. No subscription. Pay only for your medication. HSA and FSA accepted.

Board Certified MDs

OB/GYNs who specialize in menopause. Not a chatbot. Unlimited consultations.

Start Your Free Consultation

Affiliate Disclosure: This is an affiliate link. If you start treatment through Winona via our link, KRUUSH earns a commission at no extra cost to you. We feature Winona because they prescribe the same FDA approved bioidentical hormones backed by the clinical evidence on this page, with the lowest barrier to entry we found. Compounded medications use FDA approved ingredients but the combinations themselves are not FDA approved. We're not doctors. This isn't medical advice.

Thyroid disease is 5 to 8 times more common in women. Risk increases as estrogen drops. Many women get told "it's just menopause" when their thyroid is struggling. If your doctor only runs TSH, ask about the full panel.

TSH

The baseline test, but not enough on its own.

Free T3 and Free T4

Shows what your thyroid is actually producing right now.

Thyroid Antibodies (TPO and TgAb)

Detects Hashimoto's, the most common cause of thyroid issues. Often goes undiagnosed for years.

British Thyroid Foundation; Usha et al., PMC 2023

We rejected 4 popular products. Here's why.

Every product we recommend has to pass our evidence standard. These didn't.

What the data says to try.

The supplement that shows up most consistently across hormonal health research. Not a replacement for HRT. A starting point.

KRUUSH Pick

Pure Encapsulations Magnesium Bisglycinate

$24 to $47

Magnesium is involved in over 300 enzymatic reactions including hormone production. Schuster et al. 2025 published in Nature and Science of Sleep ran an RCT with 155 adults and found magnesium bisglycinate significantly improved sleep quality versus placebo. NSF GMP Registered facility. Most women are deficient, and it is the one supplement that shows up across sleep, mood, and hormonal health research.

Vibe Check

No vibes yet. Your experience could help another woman decide.

See all picks in What Works

Every product is selected based on published clinical data, not sponsorship. See the full evidence on our What Works page.

Some links on this page are affiliate links. We may earn a small commission at no extra cost to you.

The bottom line.

Your hormones are changing. That's a fact. But the science has changed too. The options are better than they've ever been. Get your levels tested. Find a doctor who actually understands perimenopause. Talk to them about what's right for your body.

This page gives you the data. Your doctor gives you the plan.

Track your symptoms. Build your case.

Hormones affect everything. Track mood, sleep, hot flashes, and energy. Then walk into your next appointment with 30 days of evidence.

Free. Private. Your personal data is never sold.

Last reviewed: March 2026

Health Notice: KRUUSH is a wellness content platform, not a healthcare provider. The information on this page is for educational and informational purposes only and isn't a substitute for professional medical advice, diagnosis, or treatment. Always talk to your healthcare provider before making health decisions. Full terms.