Husbands, boyfriends, partners, sons, uncles, fathers and friends may have the best of intentions, but still struggle to support the women in their lives during the delicate phase of life that perimenopause is. As societal taboos and healthcare industry denial fuel a tacit code of silence around all things menopausal, a shift is slowly occurring. More books are being published about perimenopause; online communities are growing; more women are testifying in podcasts and videos about their experiences; and new companies are popping up, intent on filling a void and capitalizing on an underserved, growing and economically viable market.
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Still, men in everyday life may not know how to help their loved ones navigate perimenopause. Often, they are just as confused as the women who are shocked and befuddled by their new symptoms – and their new selves.

Financial Support. Money matters when it comes to accessing and acquiring quality treatment for perimenopausal symptoms. While insurance can help pick up the tab for those fortunate to have better-than-average coverage, in some cases insurance won’t pay for hormone replacement therapy (HRT) at all – leaving women to pay the full cost out of pocket with conventional doctors, or sourcing care (out of pocket again) at boutique HRT and anti-aging providers. While money isn’t everything, especially in relationships, if you are able to contribute financial resources to the pursuit and acquisition of ongoing perimenopausal care, it’s priceless. Also, if you can allay any guilt the woman in your life may feel about allocating resources to her perimenopausal healthcare, that is helpful, too.

At a minimum, expenses to anticipate include office visit co-pays, lab fees, prescriptions and follow-up visits. As many women also begin to supplement prescriptions with natural remedies and supplements during this phase of life, expect costs for those as well.

Fact-Based Knowledge. Perimenopause is a phase of life that our families, educational system, faith-based communities, media, pop culture and healthcare system do little to prepare women for. There is ample information and preparedness for adolescence and even “low T.” But even though menopause is described as “puberty in reverse,” it is met with eerie silence. When the woman in your life begins to experience perimenopausal symptoms (such as hot flashes, night sweats, changes in mood, motivation or attitude, hair thinning, weight gain, trouble sleeping), she may not at first know the cause. Once she connects the dots and realizes that she is in process of hormonal decline, she may begin doing oodles and boatloads of research. She may join online forums, start buying and checking out various books, saving news articles to her favorites and doing all she can to learn about what’s going on with her body – least of which is why no one told her!

You can be an ally in this process by doing your own research as well. Join support groups for menopause and perimenopause, if they are not gender exclusive (e.g. they allow men to join). Try to read up on the latest research and scan your library’s catalog for books on the topic. If you learn something you didn’t know, or find something that corroborates her research, chime in and share it with her. Sometimes women feel like learning about perimenopause is a one-woman job – and it often is. But having someone in her life that shows sincere interest in something affecting her well-being is a huge relief and reassurance.

Keep the Faith. A bad run of perimenopausal and menopausal symptoms is not for the faint of heart. The collective range of symptoms can be so disruptive and debilitating that it makes women question the quality of their very lives. This is a time ripe for faith, a time when people find resolve in a power and force greater than themselves. Whatever your believe system or faith practice, this is a prime time to serve as a spiritual friend to the woman in your life. Pray for and with her. Pray for your own ability to endure these storms, for the strength to be a pillar of support. Initiate or maintain spiritual practices that give her meaning, fortitude and optimism.

Hold Her Blameless. It’s hormonal; it’s really not her fault. Not the mood swings, the crying spells, the outbursts, the sweaty sheets . . . Perimenopause is really the beginning of a long-term hormone deficiency state. Hormones are pivotal messengers responsible for a multitude of functions and for various levels of other bodily signals, such as neurotransmitters. Once you realize that the responses and reactions she’s experiences are actual side effects of hormone fluctuations, the more you will understand the involuntary nature of it all.

Patience is Key. It may sound cliché, but this is a marathon, not a sprint. Did you know that perimenopause symptoms may occur for a decade before actual menopause (12 months without a period) happens? And then post-menopause, women may deal with new symptoms, other changes and, in best cases, a reduction in issues – any and all of which lead to a new normal. Realize that just because she’s now on HRT, an antidepressant or is making lifestyle changes that appear to be improving things, that doesn’t mean this phase is over. This is an era of inner-body flux, and your resilience through it all will not go unnoticed.

Chip In without Complaint. Being part of a couple or a family means there are more than two arms, two legs, two hands and two brains to figure things out and get things done. During this time, a woman’s energy and motivation may dip. So pitch in and do some of the tasks that she typically does. Notice you’re out of milk? Go to the store yourself and replenish the fridge. Hungry and dinnertime nearing? Order takeout or cook for the family – without her asking. See the bin of laundry piling up? Wash it, dry it, fold it and put it all up. Perimenopause is a time of change, and as a woman navigates its ups and downs, she needs to focus more on her new self and preserving her well-being, as stress-free as possible.

Go with Her to the Doctor(s). Yes, it may be inconvenient. Yes, you may have other places to be or things you’d rather be doing. But accompanying her to the doctor is a bold, subtle showing of incredible support. Not only can you witness and digest the information from medical professionals, you can also be an active contributor to ensuring she gets heard – and hopefully receives quality care. You need not be a passive bystander, either. During these visits, you can take notes, ask questions, bring up observations or symptoms, ask about prescriptions, side effects and dosages, and simply listen. Your very presence is a powerful visual statement that the woman in your life is not tackling this alone. She has people in her life who value and love her – and they should treat her as a whole person, not an isolated problem.

Give Her Space. How often does she get time to just be alone? If you have kids, elder relatives at the house, or even if you work from home, the answer is probably “rarely” or “never.” Just because a woman is a fantastic mom, wife or caregiver does not mean she doesn’t crave alone time. Take the kids for a multi-hour outing. Better yet, haul them away for the weekend and go visit your relatives. Arrange for someone to take over and do the things she usually does, just so she can get a break for a couple of hours on a regular basis. On a day-to-day basis, stop interrupting her and asking questions about matters you can otherwise address or figure out.

Celebrate Small Wins. Every day can feel like a guessing game or a roll of the dice for a perimenopausal woman. Will she or won’t she sleep? Will she or will she not feel anxious? Will she or won’t she have hot flashes? Each good day is a major win in the lifecycle of a menopausal family (yes, family). Don’t take these positive moments for granted. Acknowledge the goodness of the day, which will eventually turn into good weeks and good months as the necessary treatments are identified and take hold. Let her know you appreciate that this journey is a marathon and not a sprint.

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As you can see, what is commonly referred to as hormone replacement therapy (HRT) also goes by several other names – menopause hormone therapy (MHT), hormone therapy (HT) and estrogen replacement therapy (ERT).

Just as a diabetic wouldn’t be expected to go without insulin and a thyroid patient wouldn’t be encouraged to go without levothyroxine, many women feel the same about replacing the hormones that are being siphoned off during perimenopause and menopause.

Hormone therapy can abate many symptoms and serve as a key ingredient in protecting brain, heart and bone health as women age. Many women find that MHT alone remedies their most frustrating and severe symptoms, while others combine it with other adjuncts, such as naturopathic herbs, lifestyle changes, antidepressants and / or other non-hormonal medications.

This list of resources is continually updated.

5 Signs Your HRT Isn’t Working for You – Balanced Wellness, Aug. 2, 2020 - https://balancedwellness.co.uk/5-signs-your-hrt-isnt-working-for-you/
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10 Things Your Doctor Won’t Tell You about Hormone Therapy – Anne Harding, Everyday Health, April 8, 2015 - https://www.everydayhealth.com/news/things-your-doctor-wont-tell-you-about-hormone-therapy/

Conditions Improved by Bio-Identical Hormone Replacement Therapy: Female Symptoms List – The American Health Institute, Inc., Dr. Michael Galitzer - https://www.ahealth.com/content/education/bioidentical_hormones/symptoms.php

Estrogen Matters, Harriett Hall, Science-Based Medicine, Sept. 4, 2018 – https://sciencebasedmedicine.org/estrogen-matters/

The Evidence Base for HRT: What Can We Believe? – Climacteric, R.D. Langer, April 2017 - https://pubmed.ncbi.nlm.nih.gov/28281363/

The Experts Do Agree about Hormone Therapy – The North American Menopause Society – https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/the-experts-do-agree-about-hormone-therapy

Hormone Replacement Therapy: Where Are We Now? – Climacteric, R.D. Langer, H.N. Hodis, R.A. Lobo, M.A. Allison, February 2021 - https://pubmed.ncbi.nlm.nih.gov/33403881/

Hormone Therapy Saved Me from Mood Swings and Hot Flashes – Ginny Graves, Oprah, Nov. 10, 2020 – https://www.oprah.com/health_wellness/what-is-hormone-therapy-and-when-to-stop-using-it

Hot Flashes and Hormone Replacement Therapy – Dr. Susan Love Foundation for Breast Cancer Research – https://drsusanloveresearch.org/hot-flashes/

HRT and the Early Menopause: Scientific Evidence and Common Perceptions – International Menopause Society, March 2008 – https://www.imsociety.org/wp-content/uploads/2020/08/hrt-early-menopause-2008-07.pdf

HRT Benefits and Risks – Women’s Health Concern and British Menopause Society, November 2020 - https://www.womens-health-concern.org/wp-content/uploads/2021/01/11-WHC-FACTSHEET-HRT-BenefitsRisks-JAN2021-B.pdf   

Progesterone for Symptomatic Perimenopause Treatment – Progesterone Politics, Physiology and Potential for Perimenopause – OB/GYN, J.C. Prior, 2011 - https://www.cemcor.ubc.ca/files/uploads/Prior_2011_Progesterone_Symptomatic_Perimeno.pdf

Progesterone Therapy for Menopause – The Centre for Menstrual Cycle and Ovulation Research (CEMCOR), April 4, 2014 - http://www.cemcor.ubc.ca/resources/progesterone-therapy-menopause

Sara Gottfried, MD, on Perimenopause, Menopause and Hormone Resets – Goop - https://goop.com/wellness/health/gp-unpacks-perimenopause-hormone-remedies-with-sara-gottfried-m-d/

Self-Test for Hormonal Symptoms – Southern California Center for Anti-Aging - https://socalbhrt.com/wp-content/uploads/2021/03/Hormone-Self-Test-SoCalBHRT-2021.pdf

She Will Not Become Dull and Unattractive: The Charming History of Menopause and HRT – The UK Guardian, Niki Bezzant, Jan. 17, 2022 – https://www.theguardian.com/world/2022/jan/18/she-will-not-become-dull-and-unattractive-the-charming-history-of-menopause-and-hrt

Ten Tips for Prescribing HRT Remotely, Dr. Louise Newson - https://www.menopausedoctor.co.uk/professionals/ten-tips-for-prescribing-hrt-remotely

Progesterone is NOT a Progestogen / Progestin: It’s Nature’s Unique Biological Partner – The Centre for Menstrual Cycle and Ovulation Research, Dr. Jerilynn C. Prior, Sept. 30, 2016 - https://www.cemcor.ca/resources/progesterone-not-progestogenprogestin%E2%80%94-it%E2%80%99s-estrogen%E2%80%99s-unique-biological-partner

The Truth about Hormone Therapy – The Wall Street Journal, Erika Schwartz, Kent Holtorf and David Brownstein, March 16, 2009 - https://www.wsj.com/articles/SB123717056802137143

Treatment of Menopausal Symptoms with Hormone Therapy, Kathryn A. Martin, MD; Robert L. Barbieri, MD, June 24, 2020 – https://www.uptodate.com/contents/treatment-of-menopausal-symptoms-with-hormone-therapy

What to Do If Your HRT Seems to Have Stopped Working for You – Sally Turner, Patient.info, April 1, 2019 - https://patient.info/news-and-features/what-to-do-if-you-think-your-hrt-has-stopped-working

Why Do Doctors Know So Little about Natural HRT That Can Stop Menopause Wrecking Your Life? So Much Received Wisdom about HRT Is Outdated, Argues Author Who Says There Is a Treatment That Avoids Risks - But Barely Anyone Knows It's Available on the NHS, The Daily Mail, Jan. 17, 2022 - https://www.dailymail.co.uk/health/article-10411819/Why-doctors-know-little-natural-HRT-stop-menopause-wrecking-life.html

Though commonly stigmatized and all-too frequently (and wrongly) mistaken as conventional mental health disorders, anxiety and depression may show up for the first time during perimenopause due to the hormonal rollercoaster.

Women without a prior history of mental health concerns may suddenly find themselves with an onset of anxiety or depression – and often with no tangible or discernable cause or catalyst.

These materials and research uncover the many layers involved in mood changes during perimenopause. There is an inter-relationship between female reproductive hormones (namely estrogen and progesterone), key brain neurotransmitters (such as serotonin) and other hormones associated with the HPA (hypothalamus-pituitary-adrenal) axis responsible for anxiety and depression during perimenopause.

​Treatment approaches vary, from lifestyle interventions to mental health medications and menopause hormone therapy (MHT) / hormone replacement therapy (HRT).

Note: This list of resources is continually updated.

3 Common Myths about Antidepressants Debunked! – Heather Hirsch, MD, Oct. 11, 2021 - https://www.youtube.com/watch?v=DcvZGC9ME9M

Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause – Department of Psychiatry, Shanghai Municipal Hospital of Traditional Chinese Medicine, Fei-Yi Zhao, Qiang-Qiang Fu, Sarah J. Spencer, Gerard A. Kenney, Russell Conduit, Wen-Jing Zhang, Zhen Zheng, Oct. 12, 2021 – https://www.dovepress.com/acupuncture-a-promising-approach-for-comorbid-depression-and-insomnia--peer-reviewed-fulltext-article-NSS

After Two Decades, I Decided to Go off Antidepressants – Ashley Abramson, The Paper Gown, Zoc Doc, April 11, 2019 – https://thepapergown.zocdoc.com/after-two-decades-i-decided-to-go-off-antidepressants/

Antidepressants During and After Menopausal Transition: A Systematic Review and Meta-Analysis, Scientific Reports, Ching-Kuan Wu, Ping-Tao Tseng, Ming-Kung Wu, Dian-Jeng Li, Tien-Yu Chen, Fu-Chen Kuo, Brendon Stubbs, Andre F. Carvalho, Yen-Wen Chen, Pao-Yen Lin, Yu-Shian Cheng, Cheuk-Kwan Sun, May 15, 2020 – https://www.nature.com/articles/s41598-020-64910-8

Antidepressants for Menopause – Everything You Should Know – Winona, March 3, 2021 - https://bywinona.com/journal/antidepressants-for-menopause/

Antidepressants May Not Be All They’re Cracked Up to Be – Gabrielle Glaser, The Daily Beast, March 2, 2018 – https://www.thedailybeast.com/antidepressants-may-not-be-all-theyre-cracked-up-to-be

As Menopause Nears, Be Aware It Can Trigger Depression and Anxiety, Too - NPR Morning Edition, Jan. 16, 2020 - https://www.npr.org/sections/health-shots/2020/01/16/796682276/for-some-women-nearing-menopause-depression-and-anxiety-can-spike 

Depression and Related Disorders during the Female Reproductive Cycle – Women’s Health, Future of Medicine, Ltd., Laura J. Miller; Christina Girgis; Renu Gupta, 2009 – https://journals.sagepub.com/doi/pdf/10.2217/WHE.09.44

Depression During the Menopausal Transition: An Update on Epidemiology and Biological Treatments, Luciano Minuzzi, MD, PhD., Benicio N. Frey, MD, PhD., Claudio N. Soares, MD, PhD, FRCPC, Focus: The Journal of Lifelong Learning in Psychiatry, Jan. 1, 2012 – https://focus.psychiatryonline.org/doi/10.1176/appi.focus.10.1.22

Depression or Menopause? Presentation and Management of Major Depressive Disorder in Perimenopausal and Menopausal Women, Anita H. Clayton, MD, and Philip T. Ninan, MD., Journal of Clinical Psychiatry, 2010 – https://www.psychiatrist.com/pcc/depression/depression-menopause-presentation-management-major/

Estrogen and the Brain – Jan Shephard, MD, FACOG - http://npsymposium.com/wp-content/uploads/2021/05/A4-Estrogen-and-the-Brain-Shepherd-1-up-Color.pdf

First-Ever Guidelines for Detecting, Treating Perimenopausal Depression – The University of Illinois College of Medicine - https://chicago.medicine.uic.edu/first-ever-guidelines-for-detecting-treating-perimenopausal-depression/

​Help, Am I Going Mad? Mental Health and Menopause – A Meaningful Midlife, Aug. 8, 2019 – https://www.ameaningfulmidlife.com/blog/2019/8/4/help-am-i-going-mad-mental-health-and-perimenopause

Hormone Imbalances and Depression – Things You Should Know – Winona, March 29, 2021 - https://bywinona.com/journal/hormonal-imbalances-depression/

Hormones and Emotional Health – Women’s International Pharmacy, 2020 – https://www.womensinternational.com/blog/hormones-and-emotional-health/

HRT vs. Antidepressants in Perimenopausal Depression - Professor Jayashri Kulkarni, Sept. 26, 2020 – https://psychscenehub.com/video/hrt-vs-antidepressants-in-perimenopausal-depression-by-prof-jayashri-kulkarni/

The Impact of Hormones on Serotonin in Depression – The ZRT Laboratory Blog, Dr. Kate Placzek, Feb. 9, 2018 - https://www.zrtlab.com/blog/archive/impact-hormones-serotonin-depression/

“It Feels Impossible to Beat” – How I Was Floored by Menopause – Rose George, The UK Guardian, Aug. 16, 2018 – https://www.theguardian.com/news/2018/aug/16/it-feels-impossible-to-beat-how-i-was-floored-by-menopause

Low Mood and Depressive Symptoms during Perimenopause – Should General Practitioners Prescribe Hormone Replacement Therapy or Antidepressants as the First-Line Treatment? – Mandy Leonhardt, June 27, 2019, Post Reproductive Health – https://journals.sagepub.com/doi/10.1177/2053369119847867

Menopause and Mental Health – Is It Wreaking Havoc with Your Moods? – Harley Therapy Counselling Blog, Sheri Jacobson, June 17, 2021 – https://www.harleytherapy.co.uk/counselling/menopause-and-mental-health.htm

Menopause: Is It All In Your Head? – The ZRT Laboratory Blog, Dr. Kate Placzek, June 3, 2016 - https://www.zrtlab.com/blog/archive/menopause-all-in-your-head

Mental Health Issues Are the Menopausal Side Effect We’re Not Talking About – Meryl Davids Landau, Woman’s Day, March 11, 2022 – https://www.womansday.com/health-fitness/a30515712/how-menopause-affects-mental-health/

Perimenopause and Depression – Honor Health – https://www.honorhealth.com/healthy-living/perimenopause-and-depression

Perimenopausal Depression: A Review of Diagnosis and Management – Psych Scene Hub, Jan. 21, 2022 – https://psychscenehub.com/psychinsights/perimenopausal-depression-diagnosis-and-management/

Perimenopause Ups and Downs Can Last Years – Amy Burkholder, CNN, Jan. 10, 2007 – https://edition.cnn.com/2007/HEALTH/01/10/peri.menopause/

Psychiatry and the Menopausal Transition: Clinical Caveats – Psychiatric Times, Marlene P. Freeman, MD, Sept. 3, 2014 - https://www.psychiatrictimes.com/view/psychiatry-and-menopausal-transition-clinical-caveats

These Mental Health Symptoms of Menopause Don’t Get Mentioned Enough but Affect the Majority of Women – Well + Good, Kara Jillian Brown, May 22, 2021 - https://www.wellandgood.com/mental-health-symptoms-menopause/

Use of Antidepressants during Perimenopause – Deborah R. Kim and Hadine Joffe, Women’s Health, July 1, 2006 - https://journals.sagepub.com/doi/10.2217/17455057.2.4.627

When Anxiety, Insomnia Aren’t Just in Your Head – The Wall Street Journal, Melinda Beck, Oct. 12, 2010 - https://www.wsj.com/articles/SB10001424052748703794104575546072780597414

When Depression Sneaks Up on Menopause – Natasha Gilbert, Knowable Magazine, Jan. 27, 2022 – https://knowablemagazine.org/article/mind/2022/when-depression-sneaks-menopause