The hormones, plainly
The vocabulary, before the prescribing conversation
If you searched 'progesterone' and got contraception, or 'testosterone' and got men's gym content, that's not your fault — it's what the open web optimises for. This is the perimenopause version, with one focused page for each hormone, plus the synthetic family and the newer non-hormonal options.
How they fit together
One conversation, four hormones, talking to each other
The brain (hypothalamus and pituitary) sends FSH and LH down to the ovaries. The ovaries answer back with estrogen and progesterone, on a monthly rhythm. Testosterone runs alongside, made in the ovaries and adrenals, on its own quieter dial. In perimenopause that loop starts to misfire. This is why one symptom is rarely traceable to one hormone.
Brain
Hypothalamus & pituitary
Send FSH and LH: the 'go ovulate' signal.
FSH · LHOvaries
Estrogen & progesterone
Answer back monthly. Estrogen builds, progesterone steadies, until the cycles get erratic.
Estradiol · ProgesteroneWhy it matters
When estrogen swings, the brain pushes FSH harder. Progesterone falls in cycles where you don't ovulate. Testosterone drifts. One symptom rarely traces to one hormone, and one number on one day rarely tells the story.
The cast
Pick the hormone you came here for
Four names you'll keep hearing. Two do most of the day-to-day work, one gets brushed off as "the men's one", and two more turn up mostly on lab forms. Here's each in plain language — in the order they tend to matter.
The load-bearing one
Estrogen
The one most people mean when they say 'hormones'. Estradiol is the version your ovaries make most of in your reproductive years.
Read estrogenThe calming one (and most-mis-Googled)
Progesterone
The hormone that calms, sedates, and balances estrogen. The one most likely to be mis-Googled into contraception content.
Read progesteroneYes, you make it. Yes, it matters.
Testosterone
Yes, you make it. Yes, it matters. No, the search results aren't about you.
Read testosteroneThe 'test result' hormones
FSH and LH
The hormones the lab measures when someone tries to 'confirm' menopause with a blood test. Often less useful than people think.
Read fsh and lh
If you came here from a search
Progesterone is not the same thing as the progestin in your pill
Most search results for "progesterone" point at hormonal contraception, where the active ingredient is a progestin — a synthetic molecule designed to suppress ovulation. The progesterone discussed in perimenopause and MHT is micronized progesterone, a body-identical form taken in a much lower, cyclical dose, usually at night. Same family, very different drug, very different conversation.
Read the progesterone pageThe synthetic family, and the newer drugs
Progestins, Premarin, ethinyl estradiol, tibolone, NK3 antagonists, BHRT
A lot of the older fear about HRT is fear of a specific old combination. A lot of the newer marketing about "bioidentical" hormones is selling you something the regulated version already does, more safely. And a genuinely new option (NK3 receptor antagonists like fezolinetant) is starting to give people who can't take estrogen a real lever for hot flashes for the first time.
Read the synthetics pageIf you've had a hormone-sensitive cancer
The conversation is different, but it isn't closed
For a long time the answer to "MHT after a hormone-sensitive cancer?" was a flat no, full stop. The picture is more careful than that now. Decisions are made between you, your oncology team, and a menopause-aware doctor — not by a search engine — and they depend on the specific cancer, the receptor status, your treatment, your symptoms, and what's on the table for quality of life.
- Local vaginal estrogen is a separate question from systemic MHT. The doses are tiny, the systemic absorption is low, and current guidance from major menopause societies treats it as discussable for many people after breast cancer — including those on aromatase inhibitors — when GSM is hurting daily life.
- Non-hormonal options for hot flashes have moved on. SSRIs and SNRIs (with caveats around tamoxifen interactions), gabapentin, oxybutynin, and the newer NK3 receptor antagonists (fezolinetant, with elinzanetant on the way) give people who can't take systemic estrogen real levers for vasomotor symptoms.
- Treatment-induced menopause is its own pathway. Chemotherapy, ovarian suppression, oophorectomy, and aromatase inhibitors land harder and faster than the gradual perimenopause story most resources are built around.
- "No MHT" is a starting position, not the whole answer. Even when systemic MHT is off the table, sleep, mood, joint pain, GSM, libido, bone, and brain symptoms still need a plan.
What this page isn't
A primer, not a prescription
These pages exist so the words make sense before the appointment. They don't tell you what to take, what dose, or which route. The treatments page handles that conversation, and the appointment-prep tools help you take it into the room.