The perimenopause misinformation machine is cashing in

The algorithm has found perimenopause. After decades of silence, the life stage preceding menopause is suddenly everywhere — pushed by influencers, TV doctors, and a growing army of supplement brands eager to sell fixes. But the clean narrative being sold online doesn’t match what clinicians who actually study this transition are seeing in their clinics.

Here’s the core problem: there is no reliable blood test for perimenopause. Mary Ann Lumsden, former president of the International Menopause Society, explains why bluntly. “You can’t interpret hormone measures because they change so much,” she says. “And that is quite normal.” Estrogen, progesterone, and other hormones swing wildly during this period — a roller-coaster that makes any single snapshot useless, despite what direct-to-consumer testing companies imply.

The same caution applies to hormone replacement therapy. HRT can be transformative for postmenopausal women, helping with hot flashes, bone density, and muscle maintenance. But the drugs were trialed on menopausal women, not those still actively cycling. For perimenopausal women, standard HRT can get overwhelmed by their own fluctuating hormone production, Lumsden says. Paula Briggs, who leads the menopause service at Liverpool Women’s Hospital, adds another concern: abnormal bleeding. She describes the social media push to get younger women on HRT as “almost cult-like.”

Supplements might be the murkiest corner of this economy. Lumsden says some of her patients take what they believe are testosterone supplements, but subsequent blood work shows zero increase in testosterone. “Whatever they’re getting, it’s not testosterone,” she says. Then there’s the problem of blaming midlife hormones for everything. Nanette Santoro, a menopause researcher at the University of Colorado, notes that symptoms like fatigue and brain fog don’t track neatly with menstrual cycle or hormone changes. The real danger is women attributing serious symptoms to perimenopause and not getting checked for other conditions — like endometriosis, thyroid disorders, or autoimmune disease — that need different treatment entirely.