Hot flashes, hormone therapy, and the science of perimenopause
episodePreviously titled “Hot flashes and hormone therapy: the science of perimenopause” — renamed by the publisher on Sep 18, 2026
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What is perimenopause and why has it been historically neglected by medicine?
Hey, it's Flora and you're listening to Science Friday. We're talking about a condition that affects more than four billion people on this planet, but historically has been pretty neglected by medicine. Any guesses? Perimenopause, the window before menopause where hormones begin fluctuating wildly, leaving women with brain fog, hot flashes, dropping bone density, and mood changes. Now, thanks in part to social media, perimenopause is way more in the public discourse than it used to be. But it's not just awareness that's blown up, it's also this promise that you don't have to suffer like those before you, thanks to hormone therapy. And testimonials abound. This week marks my first week being on estrogen and progesterone.
In the past week, my energy levels go up, my sleep's gotten better, and I'm not as moody or crabby. After decades of controversy over prescribing estradiol and progesterone due to concerns of increased breast cancer and heart disease risk, new research has many providers reconsidering their approach. Here to sort out the science are two pioneers of this field. They're both running some of the biggest long-term studies on perimenopause and the effects of hormone therapy. doctor Nanette Santoro is a reproductive endocrinologist at the University of Colorado Anschutz. She's the lead investigator on a three decade study following three thousand women to better understand the menopause transition. It's called the Swan Study.
And Dr. Genevieve Neal Perry is a neuroendocrinologist and chair of UNC OBGYN. She's also a co-investigator on many large studies studying the effects of hormone therapy and she researches how the brain changes in response to perimenopause and menopause. Welcome both of you to Science Friday. I am so excited to talk to you about this.
Thanks. Pleasure to be here. Absolutely.
You both have been studying this since before it was cool. Um, do you feel like we're in a moment for perimenopause? And how would you describe it?
Well we're definitely in a moment. And while I think it's wonderful. That there's this much attention being paid to this life passage since I and Genevieve now are both survivors of perimenopause. Uh it's it's uh a bit of a touchy time because we do lack information. So as you've said, you know, we don't have all the information we need to proceed.
How do hormone fluctuations cause brain‑fog, hot flashes, and mood changes during perimenopause?
And uh some directions in which the field is going are are a little concerning.
Let's talk about the information we do have. Just the basics, what's happening under the hood during perimenopause?
Well, there's this impression that, you know, women are just sort of like Whistler's mother, just sitting quietly in a rocking chair while their hormones just peter out. And that's not what's happening. So as you said in the beginning, you know, hormones are up and down. So there's a period of fluctuation. But as we've also learned from the Swan study. Really is a body wide uh set of changes that are That are dramatic for some But for many uh they're inconvenient, annoying. And there's probably few women who don't really notice much of anything.
You mentioned that symptoms aren't the same for everybody. We actually we asked listeners to call in and um we got a bunch of responses with some people saying Perrymenopause totally altered their personality and others saying they barely noticed it.
I don't like it. I don't like it at all. I ran into my doctor's office and literally yelled to say, Please help me. I feel like I'm going to lose my mind. Never had a single symptom or problem. The thing that was so shocking to me on top of the hot flashes, the sleep disturbances is um I wasn't myself. I didn't call people back. Everything seemed harder than it should be. But of course, you know, I'm on the other side now and I'm considered menopausal. And I would say the skies have cleared a bit. But um it was really hard for a long time.
Do we know why perimenopause hits some people harder than others?
We have some evidence that there are some people who are a little more vulnerable than others to it, and there are some racial and ethnic differences in uh severity of symptoms that can erode your well-being.
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Chapters
8 chapters
1
What is perimenopause and why has it been historically neglected by medicine?
0:02–2:32
2
How do hormone fluctuations cause brain‑fog, hot flashes, and mood changes during perimenopause?
2:32–4:48
3
Why do some women experience severe symptoms while others notice little or nothing?
4:48–7:11
4
What is the neuro‑biological mechanism behind hot flashes?
7:11–9:29
5
How did the Women’s Health Initiative shape the controversy around hormone therapy?
9:29–12:05
6
What recent research has changed the risk‑benefit view of estrogen‑progestogen therapy?
12:05–14:19
7
Are commercial products and “bio‑identical” claims supported by scientific evidence?
14:19–16:31
8
What practical advice do the experts give for navigating perimenopause and hormone therapy today?
16:31–18:23
Speakers
1 identifiedMore from Science Friday
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