{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"The Modern Midlife Collective","title":"Episode 34: \"I'm in Perimenopause — How Do I Know When It's Time to Start Estrogen?\"","html":"","width":"100%","height":180,"duration":1514,"description":"I’m in Perimenopause — How Do I Know When It’s Time to Start Estrogen?Episode OverviewIn this solo episode, Dr. Jillian Woodruff tackles one of the most common and nuanced questions in menopause medicine: How do you know when it’s time to start estrogen?Recorded while on a family vacation on the East Coast — because some topics are too important to wait — Dr. Jillian walks through the practical clinical framework she uses every day in her practice. She covers the signals she looks for, why laboratory results alone are not enough to guide this decision, and why perimenopause is often the optimal time to begin the conversation — not years later when symptoms have already disrupted sleep, mood, cognition, intimacy, and quality of life.The episode also covers the relationship between estrogen and periods — including why estrogen can sometimes make bleeding worse in early perimenopause — the non-negotiable role of progesterone in any woman with a uterus on systemic estrogen, and a full discussion of Genitourinary Syndrome of Menopause (GSM) and why painful sex, vaginal dryness, and recurrent UTIs are treatable and should never be accepted as inevitable parts of aging.Key TakeawaysYou do not have to wait until symptoms become severe before discussing hormone therapy.Perimenopause is often the ideal time to begin evaluating treatment options.New symptoms matter more than isolated laboratory values.Hot flashes and night sweats are more than inconveniences and can affect overall health and quality of life.Early bone loss may be an important reason to discuss hormone therapy.Mood and cognitive changes may have hormonal contributors.Progesterone is often the first hormonal intervention considered in early perimenopause.Women with a uterus who use systemic estrogen require endometrial protection with progesterone or a progestin.Vaginal estrogen is a separate treatment category from systemic hormone therapy and has a different risk profile.GSM is common, progressive, and...","thumbnail_url":"https://img.transistorcdn.com/vSb4RMla_S75bpWB9Zxjk3g6nojoX9zmEdCD7Xe_JSw/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9kMTZj/YjIwZGE1ZTU5Mjk2/NmU2NTU1NmM3N2Ni/ZTc0MC5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}