"Perimenopause wasn't even on my radar, I thought I was losing it"
Midlife doesn’t come with a manual, but can HRT make it better?
Priya Malhotra, 39, a teacher in Noida, remembers feeling “off” for over a year. “First, my sleep went haywire. Then I started crying during ads. I thought I was losing it,” she laughs. At the time, she didn’t realise this was her welcome party to perimenopause. It’s the hormonal plot twist no one prepared us for. You’re suddenly waking up drenched in sweat. You’ve yelled at your partner for chewing too loudly. You’ve lost your keys three times this week, and cried about it twice.
“It’s like puberty in reverse,” says gynaecologist-obstetrician Dr Neha Bansal, who runs a private clinic in Lucknow. “Your hormones are fluctuating wildly, but because it happens slowly, many women don’t realise it’s a biological change, not a personal failing.”
“I didn’t expect to feel this kind of rage and exhaustion in my early 40s. I thought I was just stressed or maybe slipping into depression,” says Asha Negi, 41, a housewife in Ahmedabad.
If you are in your mid-30s to early 40s, and have been feeling off, tired, foggy, rage-y, sweaty, weepy, or maybe even all of it, this might be why. So, let’s break it down, one hormone-fuelled curveball at a time.
What is perimenopause?
Perimenopause is the phase before menopause, when your ovaries begin to wind down and your estrogen levels go from stable to erratic. It can last anywhere from a few months to up to 10 years, with symptoms like irregular periods, hot flashes, night sweats, mood swings, anxiety, brain fog, sleep disturbances, and fatigue, that wax and wane over time (wondering how perimenopause changes your body?). Some women breeze through it. Others feel like they’re quietly falling apart. For many, the mood swings, exhaustion, hot flashes and brain fog aren’t just physical, they chip away at their sense of self.
When Negi’s usually clockwork periods vanished for two months, she began to panic. It was only after her anxiety became unmanageable that she saw a psychologist, who suggested she consult a gynaecologist. “Perimenopause wasn’t even on my radar, even though I knew it was common in one’s 40s. It was a relief to have a name for what I was going through,” she adds.
The average age to enter perimenopause is early to mid-40s, but it can kick in as early as mid-30s. “There’s a growing awareness in India around perimenopause, thanks to more preventive checks and better diagnosis,” says Dr Swati Rai, senior consultant gynaecologist, obstetrician and laparoscopic surgeon at Motherhood Hospitals, Noida. “That’s why it’s important for women to act early and consult a gynaecologist who can guide them through this phase.”
Alas, there’s no definitive test to confirm it. It’s usually diagnosed based on symptoms—which can mimic or overlap with conditions like PCOS, thyroid disorders, or even depression. Blood tests, however, can help rule out the other causes.
This is quite empowering, since you don’t have to wait for a lab report to validate what your body’s already telling you. But once you’ve figured out what’s going on, the next question usually is, what now?
Enter HRT
Hormone replacement therapy, or HRT, isn’t new. But it is having a well-deserved rebrand. So what exactly is it?
Simply put, HRT replaces the hormones your body is no longer making enough of, mainly estrogen, sometimes progesterone, and occasionally testosterone (yes, women produce that too). When prescribed appropriately and started at the right time, HRT can offer real relief. “HRT can help women manage symptoms like hot flashes, night sweats, vaginal dryness, sleep problems, and mood swings, and may lower the risk of osteoporosis and, in some women, cardiovascular disease, especially when started early and under expert guidance,” says Dr Sonamm Tiwari, senior consultant, obstetrics and gynaecology, Gleneagles Hospital, Parel.
The treatment can be administered in different ways: pills, skin patches, daily gels, vaginal tablets, rings, even an IUD. Think of it as your hormone support squad during perimenopause. But it can take time to find the right dosage and method. Some women feel relief quickly, others need more adjustments. “I started with a gel and then moved on to a progesterone pill at night when I did not feel any change. That’s when I began sleeping better,” says Humaira Khan, 40, a housewife in Prayagraj.
But despite its effectiveness in reducing symptoms of perimenopause, HRT still isn’t widely talked about, or offered. “Many doctors avoid HRT due to outdated beliefs (like stereotypes about women being hormonal and prone to overreaction) or lack of training, while women often remain silent due to the stigma of menopause and misinformation,” says Dr Tiwari. Additionally, for many women outside metro cities or without private care, access remains a real challenge.
So, can anyone take it?
Short answer: No. Long answer: HRT works best for women under 60 or within 10 years of their last menstrual period. That’s when benefits are maximised and risks are minimised, according to the most current research.
If you’ve got severe symptoms, think hot flashes that could melt steel or sleep so broken you’ve turned into a gremlin, it could be very beneficial. “Women who’ve experienced premature menopause (before age 40) or early menopause (before age 45) should also consider it,” says Dr Rai. Unlike perimenopause, where hormones fluctuate and periods come and go unpredictably, premature and early menopause mark a permanent stop to menstruation and consistently low hormone levels.
That said, it’s not a one-size-fits-all. HRT is not suitable for all women. Tell your doctor if you have had breast cancer, endometrial cancer or other cancers that are dependent on hormones. Additionally, anyone with a history of blood clots, stroke, or liver disease, or those with untreated high blood pressure or other unmanaged cardiovascular risks may need to avoid or at least tweak the plan.
And, like any treatment, it’s not risk-free. “HRT can increase the risk of blood clots, stroke, and breast cancer, especially in older women or those with certain pre-existing medical conditions,” says Dr Tiwari. The exact risk depends on factors such as the type of therapy, how long you’re on it, and your personal and family history.
“Always consult your doctor about the risks, benefits, possible side effects, and personalised options before starting HRT. Take the therapy only when advised by your doctor, it’s not something to self-prescribe or experiment with,” Dr Rai adds.
Translation? Don’t DIY this. Your doctor’s guidance isn’t optional, it’s essential.
Still not sure?
Don’t stress. HRT is one piece of the puzzle, but it’s not the only one. There are non-hormonal medications, like certain antidepressants (SSRIs and SNRIs), that have been shown to ease hot flashes and mood swings during perimenopause.
“Some women are also exploring natural remedies like ashwagandha, soy isoflavones, or herbal teas. While these might offer mild relief for some symptoms, the science is still catching up. Talk to your doctor to understand what is safe and effective,” says Dr Bansal.
Lifestyle shifts can also move the needle in big ways. “Women with mild symptoms or those who can’t take HRT can benefit greatly from changes like eating a nutritious diet, exercising at least three times a week for 45 minutes, and practising stress reduction through yoga, mindfulness and meditation,” says Dr Tiwari.
Here is Dr Bansal’s feel-better toolkit to get you started:
Food: Pack in calcium, protein, and anti-inflammatory foods. Cut down on sugar, caffeine, and alcohol (even wine, sorry!).
Movement: Strength training = stronger bones. Yoga = calmer mind. Walking = everything.
Sleep: Yes, it’s harder. Yes, it’s fixable. Try magnesium supplements, cut screen time before bed, and follow a wind-down routine. After all, women need more sleep than men.
Mental health: Therapy, journalling, mood-tracking apps can really help.
Community: Talk to your girlfriends. Read, share, listen. Don’t go through this in silence. You’re not alone.
In the end, this isn’t just about managing hormones. It’s about reclaiming your energy, your clarity, your sense of self. Perimenopause might feel like puberty’s crankier, more confusing cousin, but with the right support, whether it’s HRT, lifestyle changes, or simply knowing what’s going on, you can feel like you again.
A note of caution: This story is for educational purposes with inputs from trained experts. If you need help, please seek assistance from your healthcare provider.
