Perimenopause, hormone therapy, genitourinary symptoms, sleep, anxiety, and sexual health

Menopause treatment remains individualized: hormone therapy can help eligible women with moderate-to-severe symptoms, and nonhormonal options are available. Mood changes may begin early, and hot flashes do not explain every mood symptom; hormone therapy has clearer benefits for vasomotor symptoms than for mood or cognition. Metabolism explanations and claims of cardiovascular benefit from hormone therapy remain insufficiently qualified and should be checked against current guidance.