I’m now happily post menopausal and to be fair had a pretty easy peri menopause. I had a Mirena coil fitted at 40 after years of high blood loss during menstruation which result in chronic iron deficiency anaemia which had to be treated aggressively during pregnancy.
I started HRT in my early 50s, adding estrogen patches to the Mirena because I was having mood problems and muscle and joint pain.
The HRT had no impact on the physical symptoms so we had to go back to the drawing board and I started to take B12, Vit D and magnesium. I had a good response but somewhat annoyed that the default for skeletal problems during perimenopause is to throw HRT at the problem. Had I been advised to take the supplements I probably wouldn’t have bothered with HRT since the common symptoms were minimal and didn’t really impact seriously in day to day life.
A lot of women who have Mirena fitted have a “better” peri menopause. The possible reason for this is that cessation of menstruation means that you don’t develop the chronic problems associated with chronic blood loss. In peri, periods often become heavier, longer and your cycle varies, so the body often ends up in deficit. It can be difficult for the body to keep up and many of the symptoms associated with low iron, magnesium and vit D mirror those of peri.
If you aren’t sure about HRT I would start with addressing other potential causes of the symptoms you are experiencing.
I have a number of friends who have had the same experience and have been disappointed with HRT. Even when doses have been increased their underlying reason for seeking treatment has not been addressed. We hear so many women evangelising HRT it is often difficult to be luke warm about it.
Finally, as one of the “tiny” number who have developed hormone positive breast cancer after taking HRT I am a little uncomfortable with how much it is minimised. There are very few studies available on the risk for women taking HRT peri menopausally. Most of the data associated with peri menopause is from women who have had their ovaries removed or have had primary ovarian failure so replacement therapy is medically necessary. For women who have normal ovarian function function, ovulating and menstruating, the data is scant. I have managed to find a meta analysis study from 2025 worth a quick read. The big problem is that oestrogen only, which appears to reduce the risk, is not recommended to intact (still has ovaries and uterus) women because it significantly increases the risk of uterine cancer. Combined HRT significantly increases the risk of early breast cancer , particularly triple negative, in 16-54 age group.
Over the next 20 yrs we will be able to get a better idea of the effect of HRT on perimenopausal women who have not entered a premature or surgical full menopause. It is only very recently that HRT has been prescribed to peri menopausal women. Qualification was, until recently, evidence that menopause was complete ie cessation of periods.
We see so much positive information and experience of early HRT but as yet the practice can’t be fully evaluated because it’s too early to see the long term effects of taking pre meno HRT for symptoms only. Lots of data for those without ovaries but little for those with ovaries basically.
If I could turn back the clock I would still opt for HRT. My breast cancer was more advanced than it should have been because the breast screening service was suspended during covid so I had to wait an extra year between screening. My tumour would have been picked up at a much earlier stage but treatment & outcome would have been the same. I have the common as muck post meno form of BC that is easy to treat.
I wouldn’t deter a woman from HRT but I would strongly advise attending regular screening when offered. Stick to the recommended dose and address any mineral or vitamin deficiencies commonly associated with chronic blood loss. Don't rule out other causes if your symptoms, it’s easy to accept they are peri menopause symptoms but as Davina McCall has discovered her menopause was disguising a condition that was far more serious. In addition the high doses of HRT she was using may have contributed to her recent breast cancer diagnosis.
https://oicr.on.ca/study-reveals-young-onset-breast-cancer-risk-for-women-taking-hormone-therapy/