Hormone Replacement Therapy for Perimenopause

Hormone Replacement Therapy for Perimenopause at The Lee Clinic

The Lee Clinic has been a leader in hormone replacement therapy in Northern Virginia for over 40 years. Founded by Dr. William Lee, MD — a pioneer in hormone medicine since the early 1990s — the clinic is now led by his daughter, Dr. Megan Lee, DO, who brings that same philosophy into a modern, evidence-based practice: that hormones matter, and that feeling like yourself again is not too much to ask.

What Is Perimenopause?

Perimenopause is not simply the lead-up to menopause — it is its own distinct biological transition, and for many women, it is actually the most symptomatic chapter of their entire hormonal journey.

Menopause — defined as 12 consecutive months without a period — is often thought of as the hard part. But once cycles have stopped, hormone levels tend to settle into a new (lower) baseline. It is the transition — the years of unpredictable hormonal swings before that point — that many women find most disruptive to their daily lives.

A perimenopausal woman's hormones fluctuate unpredictably, making it both difficult to test for and difficult to treat — one day, levels might appear completely normal on a blood test, while the next they might show significant imbalances. It is this volatility, not simply the decline, that drives symptoms. Think of it less like a dimmer switch slowly turning down, and more like the lights flickering erratically before they settle.

Perimenopause typically begins in a woman's mid-forties and can last four to eight years, meaning many women spend nearly a decade in this state — often without anyone connecting the dots.

How Do I Know If I Am in Perimenopause?

There is no single test that definitively diagnoses perimenopause — and that is part of what makes it so frequently missed. Because hormone levels fluctuate day to day, a single blood draw can look completely normal even when you are clearly symptomatic. Diagnosis is based on a combination of your age, your symptoms, your menstrual pattern, and laboratory trends over time.

You may be in perimenopause if you are in your late 30s or 40s and experiencing any of the following — even with regular cycles:

Worsening PMS · New or worsening anxiety or irritability · Sleep disruption · Brain fog · Heavier, longer, or more irregular periods · Migraines, especially around your period · Low libido · Unexplained weight gain · Mood swings that feel out of proportion · Breast tenderness · Heart palpitations

If several of these feel familiar, it is worth having a conversation — regardless of what a previous blood test may have shown.

Can I Have Regular Periods and Still Be in Perimenopause?

Yes — and this is one of the most common misconceptions we encounter. A woman can be cycling regularly every month and still be in the thick of perimenopause. Progesterone is typically the first hormone to decline, often years before estrogen follows. The hormonal imbalance that results can cause very real symptoms even when cycles appear normal on the surface.

Healthcare providers often miss this connection. A woman might be referred to a psychiatrist for mood changes, a sleep specialist for insomnia, or a neurologist for migraines — when addressing the underlying hormonal shift could help with all of these at once. If something feels off, trust that instinct.

How Hormone Therapy Can Help

You do not need to wait until your periods stop to seek hormonal support. Hormone therapy provides the greatest benefit when started during the perimenopausal period — getting ahead of the decline rather than catching up to it.

Estradiol, progesterone, and testosterone are our primary tools. Estradiol addresses vasomotor symptoms and supports brain, bone, and cardiovascular health. Progesterone — used in its bioidentical micronized form — supports sleep, mood, and uterine protection. Testosterone addresses energy, libido, and muscle tone. Treatment is carefully tailored to work with your body's existing rhythm, not against it.

Research has shown that transdermal estradiol combined with micronized progesterone helps prevent the onset of clinically significant depressive symptoms in perimenopausal women. Hormone therapy also prevents bone loss, improves lean body mass, and reduces fracture risk.

At The Lee Clinic, we do not rely on a single lab value or wait for cycles to stop before taking your symptoms seriously. Perimenopause is often where the conversation should begin, not end.

What Hormones Do You Use?

Our first-line approach centers on estradiol, progesterone, and testosterone — hormones that most closely match what your body naturally produces. These are available through standard pharmacies and are often covered by insurance, making treatment accessible for most patients. Compounding is available when clinically necessary, but it is not our default approach.

Is Hormone Therapy Safe?

Yes — when initiated in the right candidate, at the right time, using the right formulation and route. In February 2026, the FDA removed the longstanding black box warnings on hormone therapy products, acknowledging that the risks had been overstated for decades based on flawed research. Women who begin hormone therapy within 10 years of the onset of menopause have been shown to have a reduction in all-cause mortality and fractures. We have always practiced with this individualized, evidence-based approach.

Cost of Hormone Replacement Therapy

We believe hormone replacement therapy should be accessible. Our approach is designed with that in mind:

Most of the hormones we prescribe — including estradiol and progesterone — are FDA-approved medications available at standard pharmacies and are covered by most insurance plans, meaning your out-of-pocket cost is often no more than a standard prescription copay.

Testosterone for women, while widely used, is prescribed off-label and may not be covered by all insurance plans, though it is available at low cost through many pharmacies.

Compounding is used only when a patient's clinical needs cannot be met by a commercially available product. Compounded medications are not covered by insurance, and we will always discuss cost and options with you before going that route.

Want to Learn More?

The New Menopause — Dr. Mary Claire Haver, MD

Estrogen Matters — Dr. Avrum Bluming & Carol Tavris

Think you may have already crossed into menopause? Click here to learn more about what that transition looks like and how we can help.

Ready to talk? Fill out the form below and we will be in touch shortly. You can also call us directly at 540-542-1700.