Author: Dr. Aoife O’Sullivan

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More menopause education from Dr. O’Sullivan

If you’ve recently found yourself crying over a toothpaste commercial, forgetting why you walked into a room, or lying awake at 3 a.m. even though you’re utterly exhausted—welcome to the club. You’re not going crazy. You might just be in perimenopause.

What Exactly Is Perimenopause?

Perimenopause is the hormonal rollercoaster that leads up to menopause—the time when your ovaries begin to slow down, but haven’t stopped producing hormones entirely. It usually starts in your late 30s to early 40s, though for some women it can begin earlier (and for others, much later). It can last years—yes, years—before you reach menopause, which is defined as 12 full months without a period.

Common Symptoms (aka, Why You Feel Like You’re Losing It)

The symptoms of perimenopause can be sneaky, wide-ranging, and frustratingly inconsistent. You might have a few mild changes, or feel like a walking hormonal mystery. Common culprits include:

• Irregular periods (shorter, longer, heavier, lighter… it’s a hormonal free-for-all)
  
• Mood swings or anxiety
  
• Brain fog and forgetfulness
  
• Sleep disturbances or full-blown insomnia
  
• Hot flashes or night sweats
  
• Fatigue and low energy
  
• Decreased libido
  
• Vaginal dryness
  
• Weight changes, especially around the middle
  

It’s not all in your head—and you’re not alone.

Why It Gets Dismissed

Perimenopause is wildly underdiagnosed. Many women are told they’re “too young” or it’s just stress, parenting, or life. And yes, those things can contribute—but hormonal changes during this phase are real, measurable, and absolutely affect your quality of life.

Unfortunately, medical training around perimenopause is minimal for most doctors, which means many women suffer unnecessarily or are offered antidepressants or sleeping pills instead of actual hormone management.

What You Can Do

Here’s the good news: help exists. You don’t have to grit your teeth and power through.
Start by tracking your symptoms—write them down, even if they seem random. Then talk to a clinician who’s trained in menopause and midlife hormone care (hi, that’s me!).

Treatment options may include:

• Hormone therapy (yes, it’s safe and effective when done right)
  
• Non-hormonal medications for certain symptoms
  
• Lifestyle shifts to support sleep, nutrition, and stress
  
• Education so you understand what’s happening and feel empowered

The Bottom Line: Perimenopause is real, it’s disruptive, and no—you’re not losing your mind. But you deserve better answers and expert care tailored to this season of life.

You’re not broken. You’re in transition—and with the right support, you can feel like yourself again.

👉 If you’re nodding along to every symptom in this post—it’s time to stop wondering and start getting answers. Book your 15-minute call today and let’s figure it out together.

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More menopause education from Dr. O’Sullivan

If you’ve been told hormone therapy will give you breast cancer, that you’re “too young” or “too late,” or that you should just “tough it out”—you’ve been misled. You’re not alone, and it’s not your fault. The confusion around menopausal hormone therapy (MHT) is rampant, even among clinicians. But let’s set the record straight.

So… What Is Hormone Therapy, Exactly?

Menopausal hormone therapy typically refers to estrogen, with or without progesterone (often depending on whether you still have a uterus). It’s used to treat the symptoms of perimenopause and menopause—things like hot flashes, night sweats, insomnia, brain fog, vaginal dryness, low libido, and mood changes. For many women, it’s life-changing.

And no, it’s not just about symptoms. Estrogen also has long-term health benefits for bones, brain, and possibly even heart health when started at the right time.

Where Did All the Fear Come From?

Blame it on the Women’s Health Initiative (WHI) study, released in 2002. The media exploded with headlines linking hormone therapy to breast cancer, blood clots, and heart disease—and millions of women (and doctors) panicked.

Here’s the kicker: the interpretation of that study was deeply flawed. The women in the WHI were, on average, 63 years old, often well past the menopause transition, and the study used forms of hormones we rarely prescribe today.

Subsequent reanalysis and newer studies have shown that for healthy women under age 60, or within 10 years of menopause, the benefits of hormone therapy outweigh the risks.

What Your Doctor Might Not Know

Many doctors haven’t received updated training in menopause care and are still relying on outdated guidance from 20+ years ago. This means they might say “no” to hormone therapy simply because they don’t know how to prescribe it—or they’re afraid of liability.

That’s not good enough.

You deserve a doctor who’s trained in evidence-based, nuanced menopause care—who understands when hormone therapy is appropriate, which type is best for your needs, and how to monitor you safely.

Is Hormone Therapy Right for You?

That depends on your medical history and your preference but every woman should be taught about it and know that it’s worth exploring. Hormone therapy can be safe and highly effective for many women. And if it’s not the right fit, there are non-hormonal options that can also help.

This isn’t about vanity or weakness. This is about quality of life, function, and feeling like yourself again.

Final Word

Hormone therapy isn’t for everyone—but it’s not the villain it’s been made out to be. If your symptoms are impacting your life, you deserve real answers, not recycled fear.

This is your body. Your hormones. Your choice. Make it an informed one.

Want help deciding what’s right for you? Book a visit to explore your options with an expert who gets it – Me!

👉 Still scared of hormones? You’re not alone—and you’ve been misinformed. Let’s talk about what’s true, what’s outdated, and what’s right for you.\

More menopause education from Dr. O’Sullivan

If you’ve been having hot flashes, brain fog, or cycle changes—and your doctor has shrugged it off because “you’re too young for menopause”—you’re not imagining things. You might be in perimenopause, the phase leading up to menopause that can start years before your periods stop for good.

Yes, even in your 30s. Definitely in your 40s.

What Is Perimenopause, Really?

Perimenopause is the hormonal transition before menopause. It’s when estrogen and progesterone start fluctuating—sometimes wildly—and your body begins adjusting to the eventual end of ovulation.

While menopause is marked by 12 consecutive months without a period, perimenopause can last 4 to 10 years, or more (yep, years). And it’s often the most symptomatic phase of the whole hormonal transition.

Common Symptoms in Your 30s and 40s

Symptoms during early perimenopause are often subtle—or easily dismissed as stress, parenting, or “just getting older.” But the hormonal shifts are real, and they can cause:

• Irregular periods (heavier, lighter, longer, shorter)
  
• Hot flashes and night sweats
  
• Brain fog or trouble concentrating
  
• Mood swings, anxiety, or irritability
  
• Sleep disturbances
  
• Fatigue
  
• Vaginal dryness or pain with sex
  
• Decreased libido
  
• Weight gain or changes in body composition
  

If you’re nodding along to several of these, it’s worth having a conversation with a menopause-trained provider.

Why You’re Being Told “You’re Too Young”

Sadly, many clinicians are not trained in recognizing perimenopause—especially in women under 45. Hormone levels can still fall within “normal” ranges, even while fluctuating enough to cause major symptoms. And standard lab tests often miss the bigger picture.

It’s frustrating, invalidating, and leaves far too many women suffering silently—or being prescribed antidepressants or birth control without a full understanding of what’s happening hormonally.

What You Can Do About It

If you suspect you’re in perimenopause, trust your gut. You know your body. Start tracking your symptoms, your cycle (or lack of one), and anything that feels “off.” Bring this to a doctor who actually specializes in menopause care.

Treatment can include:

• Hormone therapy tailored to perimenopausal needs (yes, it’s safe!)
  
• Non-hormonal options for mood, sleep, and hot flashes
  
• Lifestyle support for nutrition, stress, and movement
  
• Validation (sometimes, that alone is powerful)
  

The Bottom Line

You are not too young for perimenopause. And you’re definitely not too young to feel heard, supported, and treated with expertise. If your body is changing and you’re feeling off, don’t let outdated assumptions keep you from getting the care you deserve.

This isn’t in your head. It’s in your hormones—and help is out there.

👉 Hot flashes in your 30s? Yep, that’s a thing. If your doctor says you’re “too young,” it might be time to talk to someone who actually gets it.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan

We often hear about “menopause” as the big hormonal milestone—but what most people don’t realize is that perimenopause is often the real troublemaker. If menopause is the finish line, perimenopause is the chaotic, unpredictable obstacle course that leads up to it.

For many women, perimenopause is actually more symptomatic and destabilizing than menopause itself—and yet, it remains poorly understood, underdiagnosed, and often dismissed.

What Makes Perimenopause So Challenging?

Perimenopause is the transition phase leading up to menopause, when your hormones start fluctuating, but your ovaries haven’t completely retired yet. Estrogen and progesterone don’t decline in a smooth, gentle line—they swing like a hormonal rollercoaster. Some days you’re flooded with estrogen. Other days, you’re scraping the bottom.

This instability affects everything: your mood, sleep, cycle, energy, libido, and brain function. And it can last 4 to 10 years.

Key Reasons Why It Can Feel Harder Than Menopause:

1. Unpredictable Hormones = Unpredictable You
   In menopause, hormone levels are low but relatively stable. In perimenopause, they’re erratic—which means symptoms come and go, often without warning. One week you feel fine. The next, you’re rage-crying into your pillow.
   
2. Symptoms Are Often Dismissed or Misdiagnosed
   Many women are told they’re too young, too stressed, or just dealing with “life.” Instead of proper hormonal support, they’re offered antidepressants, sleep aids, or nothing at all. It’s invalidating—and incredibly common.
   
3. Periods May Still Be (Sort of) Happening
   Since periods can continue in perimenopause—just more irregular—many women (and providers) don’t recognize what’s really going on. It’s easy to miss the hormonal context when a cycle is still limping along.
   
4. It Hits at a Busy Time in Life
   Perimenopause tends to hit in your late 30s or 40s—often when you’re managing careers, kids, aging parents, or all of the above. The timing adds another layer of stress to an already tricky transition.
   

Menopause Can Feel Easier—Here’s Why

Once you reach true menopause (12 consecutive months without a period), hormone levels drop to low but more consistent levels. For many women, symptoms like mood swings, brain fog, and cycle-related chaos ease up.

That’s not to say menopause is symptom-free—but it’s often more stable and easier to treat than the hormonal whiplash of perimenopause.

What Can Help?

The key to surviving (and thriving in) perimenopause is getting support early. That means:

• Tracking symptoms
  
• Working with a menopause-trained provider
  
• Considering hormone therapy, if appropriate
  
• Getting your sleep, stress, and nutrition dialed in
  
• Understanding this is a phase—not a personal failure
  

Final Word

If you’re wondering why you feel so off—and no one’s giving you answers—perimenopause could be the missing link. And yes, it really can be harder than menopause. But you don’t have to suffer through it alone, confused, or dismissed.

You deserve support now, not just after the fact.

You don’t have to keep white-knuckling your way through this rollercoaster. Let’s make a plan that supports you—not just when the chaos ends, but right now.

More menopause education from Dr. O’Sullivan

Let’s talk about something most women don’t hear enough about—vaginal estrogen. It’s low-dose, local, and radically underused, despite being a total game-changer for issues like dryness, itching, burning, painful sex, and recurrent UTIs.

What Is Low-Dose Vaginal Estrogen?

Unlike systemic hormone therapy (like patches or pills), vaginal estrogen is localized. That means it works right where you need it—in the vaginal and urinary tissues—without significantly affecting your whole body’s hormone levels. It comes in several forms: cream, tablet, ring, or a soft insert (hello, options!).

What It Helps

As estrogen declines during perimenopause and menopause, vaginal tissues become thinner, drier, and less elastic. This can lead to:

• Pain with sex (dyspareunia)
  
• Burning, itching, or dryness
  
• Urinary urgency or frequency
  
• Recurrent UTIs
  
• Loss of confidence, intimacy issues, and discomfort that goes far beyond the bedroom
  

Low-dose vaginal estrogen can reverse these symptoms and restore tissue health—safely and effectively.

Is It Safe?

Yes. Multiple medical societies, including the Menopause Society and American College of Obstetricians and Gynecologists, agree: Low-dose vaginal estrogen is safe for most women, even long term.

And here’s the kicker—it’s not associated with increased risk of breast cancer, stroke, or blood clots, unlike what you may have heard about some types of tablet hormone therapy when started in older women in their 60’s and 70’s . Yet so many clinicians and pharmacists still confuse the two.

Why You Haven’t Heard About It

Because the topic is awkward, taboo, and—let’s be honest—not exactly a bestselling headline. Many women (and doctors) feel uncomfortable bringing it up, and sadly, that means millions suffer in silence.

The Bottom Line

If vaginal or urinary symptoms are affecting your quality of life, don’t just power through. Low-dose vaginal estrogen is a small solution that can make a big difference.

👉 Dryness, burning, UTIs, painful sex? This tiny little treatment can make a massive difference. Ready to feel comfortable again? Let’s chat.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan

If the scale has crept up despite you doing “all the right things,” you’re not imagining it—and you’re not alone. Weight gain in perimenopause and menopause is real, and hormones play a key role. But the good news is: it’s not hopeless.

Why Weight Gain Happens

1. Estrogen Declines = Body Composition Shifts
   As estrogen drops, your body redistributes fat—especially to the belly and midsection. This isn’t about willpower; it’s biology.
   
2. Slower Metabolism
   Muscle mass naturally declines with age, and that lowers your resting metabolism. You burn fewer calories even if your habits haven’t changed.
   
3. Poor Sleep, High Stress, and Cortisol
   Sleep disturbances and stress increase cortisol, a hormone linked to fat retention and cravings.
   
4. Insulin Resistance
   Hormonal changes can lead to increased insulin resistance, making it harder to maintain stable blood sugar and easier to gain weight.
   

What Doesn’t Work (Anymore)

Crash diets, skipping meals, or killing yourself with cardio may have worked in your 20s—but now they often backfire, triggering more stress, fatigue, and hormone imbalance.

What Does Work

1. Strength training – Build muscle to boost metabolism
   
2. Protein-rich meals – Helps with satiety and lean mass
   
3. Sleep support – Prioritize sleep hygiene and hormone balance
   
4. Manage stress – Mind-body tools, therapy, boundaries
   
5. Consider hormone therapy – For some women, estrogen therapy can reduce fat accumulation and support lean body mass
   

The Bottom Line

Midlife weight gain isn’t just about calories—it’s about hormones, metabolism, and giving your body the right tools to thrive. The goal? Strength, energy, confidence—not skinny jeans from 2006.

👉 Your body isn’t betraying you. It’s just asking for something different. Let’s figure out what that is—and get you feeling strong again.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan

Spoiler alert: Your sex drive isn’t broken. It’s just been left out of the conversation. Desire changes in midlife are common, normal, and absolutely treatable—but most women are never told that.

What Happens to Desire in Midlife?

1. Hormonal Shifts
   Estrogen and testosterone decline, which can affect arousal, lubrication, sensitivity, and desire.
   
2. Physical Discomfort
   Vaginal dryness and painful sex? Not exactly a turn-on.
   
3. Stress, Fatigue, and Mental Load
   Libido doesn’t thrive under chronic stress or exhaustion—hello, modern womanhood.
   
4. Relationship Dynamics
   If intimacy feels disconnected or routine, desire naturally follows.
   

What’s “Normal”?

There is no one-size-fits-all libido. What matters most is how you feel about it. If changes in desire are bothering you or affecting your relationship, it’s worth addressing.

What You Can Do

• Address physical barriers (vaginal estrogen, lubricants, etc.)
  
• Explore hormone therapy (including testosterone, if indicated)
  
• Reduce stress and improve sleep
  
• Get curious—what do you find pleasurable?
  
• Work with a doctor who takes sexual health seriously
  

The Bottom Line

Low desire doesn’t mean you’re broken, frigid, or failing. It means your body, brain, and hormones are changing—and you deserve care that recognizes that.

Your sexuality didn’t expire at 45. It just needs support.

👉 If your sex drive has packed up and left, it might be time to invite your hormones back to the conversation. Want to talk about what’s actually going on? Book a call.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan

Bone health isn’t sexy—but broken hips in your 70s aren’t either. Here’s the thing: you don’t feel your bones thinning. But by the time a fracture happens? It’s too late to go back.

Why Estrogen Matters for Bone Density

Estrogen is a key player in maintaining bone strength. During perimenopause and menopause, as estrogen levels drop, bone loss accelerates. In fact, women can lose up to 20% of their bone density in the first 5–7 years after menopause.

This puts you at higher risk for:

• Osteopenia
  
• Osteoporosis
  
• Fractures (especially hip, spine, and wrist)
  
• Loss of mobility, independence, and long-term health
  

Who Should Be Paying Attention?

Short answer: all women 40+. Especially if you have:

• A family history of osteoporosis
  
• A smaller body frame
  
• Early menopause or surgical menopause
  
• Smoking, alcohol use, or chronic steroid use
  
• Low calcium or vitamin D intake
  
• Low physical activity
  

How to Protect Your Bones

1. Get a baseline bone density scan (DXA)—especially around menopause
   
2. Consider hormone therapy—estrogen helps slow bone loss
   
3. Strength training & weight-bearing exercise—essential for stimulating bone growth
   
4. Calcium + Vitamin D—get it from food first, supplement if needed
   
5. Avoid excess alcohol and smoking—they weaken bone
   
6. Assess your fall risk—because it’s not just about the bone, it’s about the landing
   

What About Medication?

For women with significant bone loss, prescription medications like bisphosphonates or newer therapies may be appropriate. These can reduce fracture risk—but prevention is still the gold standard.

The Bottom Line

You don’t need to wait for a fracture to start caring about your bones. Midlife is the perfect time to get proactive. Because strong bones mean strength, mobility, and freedom—for decades to come.

👉 Strong bones now = a strong, independent future. Let’s assess your risk and make a prevention plan before a fracture makes the decision for you.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan

When you think of testosterone, you might picture muscle-bound men and aggressive gym energy—but women make testosterone too, and it plays a critical role in health and vitality, especially during and after menopause.

What Does Testosterone Do in Women?

Testosterone is produced by the ovaries and adrenal glands and contributes to:

• Sexual desire and arousal
  
• Energy and motivation
  
• Mood regulation
  
• Muscle mass and strength
  
• Cognitive sharpness
  
• Overall sense of vitality
  

During perimenopause and menopause, testosterone levels decline, often significantly—yet many women are never told this might be contributing to their symptoms.

Who Might Benefit from Testosterone Therapy?

Women who experience:

• Low libido
  
• Difficulty with arousal or orgasm
  
• Persistent fatigue
  
• Low motivation or “flat” mood
  
• Declining muscle strength or stamina
  —despite optimal estrogen levels—may benefit from carefully prescribed testosterone therapy.
  

It’s especially helpful when vaginal estrogen and systemic hormone therapy aren’t enough to address sexual desire concerns.

Is It FDA-Approved?

In the U.S., no testosterone product is FDA-approved for women, but it’s still prescribed off-label by trained clinicians. It can be compounded or prescribed at low doses using products originally developed for men, adjusted for female physiology.

Australia and the UK do have testosterone formulations approved for women, and the evidence base supporting use in selected cases is growing.

Is It Safe?

When used correctly and monitored regularly, testosterone therapy is considered safe for midlife women. Potential side effects (like acne or hair growth) are rare when dosed appropriately. More serious side effects, such as enlargement of the clitoris and deepening of the voice tend to be seen when women are treated with high-dose pellets instead of testosterone through the skin.  You’ll be monitored for symptoms, blood levels, and any changes over time.

What Results Can I Expect?

Improvements in libido and sexual satisfaction are the most well-studied outcomes. Some women also notice:

• Increased energy
  
• Better mood
  
• More drive or motivation
  
• Improved muscle tone
  

But it’s not a miracle drug—and it’s not for everyone. The key is a personalized approach, with expert guidance.

The Bottom Line

Testosterone is not just a “male hormone.” For some women, it’s the missing piece in their midlife health puzzle. If you’ve addressed estrogen and progesterone and still feel off—testosterone may be worth exploring.

👉 Low energy? Zero libido? Testosterone might be the missing piece. If you’re wondering whether it’s right for you, let’s talk through your options.

Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.

More menopause education from Dr. O’Sullivan