Sep 17, 2026 · 19 min
New evidence reframes hormone therapy for perimenopause
Hot flashes, hormone therapy, and the science of perimenopause
Perimenopause symptoms vary widely, and hormone therapy decisions depend on individualized risks, benefits, and the limits of current evidence.
- 1Perimenopause reflects fluctuating hormones and neurological changes, but symptom severity also tracks pain, stress, finances, and social conditions.
- 2Hot flashes arise when changing estrogen affects temperature-regulating brain circuits, with neurokinin helping explain why symptoms eventually improve for many.
- 3Updated evidence supports individualized hormone therapy decisions while challenging broad fears and unsupported commercial claims about midlife hormones.
Don't miss
Genevieve Scott Neal-Perry and Nanette Santoro explain how results from older women in the Women's Health Initiative were generalized to younger women, reshaping hormone therapy fears.
The brief
Perimenopause can bring hot flashes, mood changes, and brain fog, but experiences range from severe disruption to barely noticeable symptoms.
Genevieve Scott Neal-Perry and Nanette Santoro explain how fluctuating hormones affect the body and brain, including temperature-regulating neurons involved in hot flashes.
The episode revisits the Women's Health Initiative, whose findings in older women were broadly applied to younger patients and helped create widespread fear of estrogen therapy.
Updated follow-up suggests risks such as breast cancer and blood clots remain small but must be weighed against symptom relief and individual circumstances.
The guests also challenge commercialized hormone messaging, compounded and 'bioidentical' claims, peptide treatments, and testosterone as a general solution to midlife concerns.
Nanette Santoro
University of Colorado AnschutzListen to the full episode and explore every guest, topic, and moment on PodLume.