Symptoms & Patterns

Some women notice changes in focus, emotional resilience, or anxiety before physical symptoms appear. These experiences can feel confusing because they are rarely discussed as early signs of hormonal transition.

What research suggests:
Research suggests that brain systems sensitive to estrogen may respond earlier to hormonal variability, which can surface as cognitive or emotional symptoms during perimenopause.

References (APA):
Mosconi, L., et al. (2021). Menopause impacts human brain structure, connectivity, and energy metabolism. Scientific Reports, 11, 10867. https://www.nature.com/articles/s41598-021-90084-y
Mosconi, L. (2022). The XX Brain. New York: Avery.
Weill Cornell Medicine. (2024). Brain estrogen activity changes during menopause. https://news.weill.cornell.edu/news/2024/06/scans-show-brains-estrogen-activity-changes-during- 

Hormonal shifts can influence neurotransmitters involved in mood regulation. During perimenopause, rapid fluctuations—not just low hormone levels—may contribute to increased anxiety or emotional sensitivity.

These experiences are biologically grounded and do not reflect personal weakness.

What research suggests:
Mood symptoms during the menopause transition are associated with hormonal variability.

References (APA):
Freeman, E. W. (2010). Menopause, 17(4), 823–827. https://doi.org/10.1097/gme.0b013e3181dbf1f9

Hormonal fluctuations can affect temperature regulation and circadian rhythm, which play a role in sleep quality. Difficulty staying asleep or waking earlier than usual is common.

These changes may occur even without hot flashes and are often misattributed to stress alone.

What research suggests:
Sleep disruption is one of the most frequently reported symptoms during midlife hormonal transitions.

References (APA):
Kravitz, H. M., et al. (2008). Menopause, 15(4), 621–629. https://doi.org/10.1097/gme.0b013e318160dafa

For women with moderate to severe symptoms, hormone therapy can improve daily functioning—particularly when symptoms interfere with sleep, temperature regulation, or comfort. Improved sleep alone can have downstream effects on mood, focus, and resilience.

Hormone therapy is not a single treatment but a category of approaches that vary by formulation, dose, route, and timing. Individualization is essential.

What research suggests:
Large clinical reviews and position statements consistently identify hormone therapy as the most effective treatment for vasomotor symptoms and note improvements in sleep quality and overall wellbeing for appropriately selected patients.

References (APA):
The North American Menopause Society. (2022). Hormone therapy position statement. Menopause. https://pubmed.ncbi.nlm.nih.gov/35797481/
ACOG. Hormone therapy for menopause. https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause

The clearest, most consistently supported benefits of hormone therapy include relief of hot flashes and night sweats, improvement in genitourinary symptoms*, and prevention of bone loss in appropriate candidates.

Other potential benefits—such as effects on mood or cognition—are more variable and depend on individual factors and timing.

What research suggests:
Major medical societies emphasize that when hormone therapy is initiated in appropriate patients—often earlier in the menopause transition—the benefit–risk profile is favorable for symptom control and bone health.

References (APA):
The North American Menopause Society. (2022). Hormone therapy position statement. Menopause. https://menopause.org
NAMS Press Release. https://menopause.org/wp-content/uploads/press-release/ht-position-statement-release.pdf

*  Genitourinary symptoms are  changes or discomfort in the vagina, bladder, or urinary tract—such as dryness, irritation, pain during sex, frequent urination, or urinary leaks—often linked to hormonal changes, especially during midlife