Which pathway addresses perimenopause?
Perimenopausal symptoms with matching biomarkers route to BHRT. Local genitourinary symptoms can be addressed with local estradiol within BHRT review. Cardiovascular, thrombotic, and breast history are reviewed before initiation.
Full answer
Perimenopause is characterized by erratic ovulation, fluctuating estradiol, declining progesterone, and rising FSH. The symptom set spans vasomotor, sleep, mood, cognition, libido, weight, and genitourinary domains. The Bioidentical Hormone Optimization pathway (BHRT) addresses symptomatic perimenopause when biomarkers and personal/family history support initiation. Local vaginal estradiol is discussed for genitourinary symptoms. Cardiovascular, thrombotic, and breast history are reviewed before initiation. Every plan is synchronous-video reviewed and recalibrated on a defined cadence.
Educational. Not a substitute for individualized provider review.
- BHRT Optimization pathway — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-06-03