For women experiencing the challenges of perimenopause, finding the right support and treatment options close to home can make all the difference. Members of the Main Line Parent Community on Facebook recently shared their experiences with perimenopause-related fatigue and other symptoms, and highlighted helpful resources available here in our area.

Check out the Main Line Parent Health & Wellness Guide — your guide to live your best life around the Main Line!

Understanding Perimenopause Symptoms

Perimenopause, a natural transition in every woman’s life, happens when a woman’s ovaries start producing less estrogen and progesterone, essentially marking the journey from reproductive years toward menopause. On average, perimenopause occurs in a woman’s mid-40s. The fluctuating hormones can trigger a range of symptoms notably irregular periods, fatigue, weight gain, trouble sleeping, and night sweats. As a woman gets closer to menopause, add to the mix vaginal dryness, hot flashes, and joint pain. For many women, when the “change of life” hits, they feel uniformed and unprepared.

“The day I entered my 40s, my body started playing tricks on me,” shares Buneka I., a local community member. “No one talks about how perimenopause starts a decade before menopause. I don’t drink. I eat healthy, minimal [amounts of] processed food and sugar, minimal caffeine, and exercise regularly — and yet some days I can barely keep my eyes open.”

Hormone Replacement Therapy (HRT)

What to do if you’re suffering from one or many perimenopause or menopausal symptoms? The resounding advice from women in the Main Line Parent Community is HRT, especially bio-identical hormone replacement therapy (BHRT). Bio-identical hormones are chemically identical to those naturally produced by women’s bodies. Conversely, traditional HRT are older hormone therapies derived from non-human sources, like Premarin, which comes from the urine of a pregnant mare.  

Any type of hormone therapy must be prescribed by an MD or licensed medical practitioner like a gynecologist, a nurse practitioner, or functional doctor. Although many gynecologists prescribe some forms of HRT, “not all gynecologists are knowledgeable or even open to it,” says Main Line Parent Community member, Julie C. 

Before starting a patient on HRT, a doctor or nurse typically does a comprehensive intake, a screening for cancer risk, and a full blood panel test. Once a woman is deemed a healthy candidate, the practitioner will prescribe hormones such as estrogen and progesterone, and sometimes others, as well. The FDA-approved delivery methods vary, but include patches, creams, pills, and more. 

Pellet Therapy

Another delivery method for BHRT that has grown in use is pellet therapy. In this method, pellets containing compounded bioidentical hormones are inserted under the skin, usually in the hip area and last approximately 4–6 months. However, the American College of Obstetricians and Gynecologists and The Menopause Society recommend against using hormone pellets and instead, use FDA-approved hormone therapies. 

Dr. Karen Tang of Thrive Gynecology in Bryn Mawr explains, “they’re not regulated and have no standard safety and efficacy data. And they cannot be removed if someone has side effects.” 

As with any medical or pharmaceutical treatment, it’s important to do your own research and weigh the risks and benefits. However, the good news is that hormone replacement therapy works. It reduces many peri- and menopausal symptoms by replacing the hormones you no longer produce. For many women, this vastly improves quality of life! 

Interested in exploring this therapy? The Main Line Parent Community recommends this area resources.

BHRT/HRT in the Main Line Area

• Dr. Karen Tang at Thrive Gynecology in Bryn Mawr
• Coleen Korzen, DO, FACOG at Axia Women’s Health, Chester County OB/GYN in Downingtown
• Dr. Adam Leid at Core Clinic Mainline in Bryn Mawr
• Katherine Manion, NP at Main Line Women’s Healthcare in King of Prussia
• Dr. Bazzan at Jefferson Health-Marcus Institute of Integrative Health in Villanova and Center City
• Dr. Seema Bonney at the Anti-Aging & Longevity Center in Bryn Mawr

Beyond the Main Line Area

• Krysha Mallari NP at Body+Beauty Lab in Center City Philadelphia
• Leslie Fritz, CRNP at ILM Aesthetics in Skippack 
• Jenna Lee, CRNP at Renewed Vitality in Wyomissing

Other Local Resources for Perimenopause Support

If you’re not interested in HRT/BHRT but still want to address perimenopause or menopause symptoms, consider trying alternative approaches. Generations of women have relied on folk remedies, herbs, and supplements to relieve their symptoms. However, most natural remedies get mixed reviews; they work for some, but not for others. The Main Line Parent Community recommends a couple of local resources, which offer non-medical alternatives. 

• BeBalanced in King of Prussia offers natural hormone balancing solutions.
• Wild Spirit Apothetique offers natural alternatives including Rhodiola tincture for cortisol management, magnesium supplements, and other natural remedies.

Lifestyle Solutions for Perimenopause 

As a first line approach to resolving perimenopause symptoms, or in tandem with other therapies, many women find relief through lifestyle changes. To address weight gain, anxiety, and more, consider working with a local, menopause-informed fitness trainer or nutritionist. 

Local Menopause Coach and Personal Trainer, Maria Pavlov emphasizes the importance of a balanced approach. “Focus on healthy fats, lean proteins, and magnesium-rich foods,” she says. “Managing stress levels and maintaining consistent sleep patterns are also crucial.”

Another practical tip is to make changes to your daily routine to support yourself. Donna R., who navigated perimenopause while working in the area, shares a self-care strategy: “About three times a week, an 18–20-minute car nap while on a work break helped [me] tremendously. Set a timer [for] no more than 20 minutes. Even if you don’t sleep, your brain resets.”

A Comprehensive Care Approach

Unsure if the symptoms you’re experiencing are perimenopause-related? If you’re just beginning your search for answers, you probably want to start with your healthcare provider. Ask to get tested for thyroid function, iron levels, sleep quality, and vitamin D. Low levels of iron and vitamin D can lead to fatigue, and a thyroid imbalance can cause anxiety if high, or fatigue if low. If these issues are not the source of your symptoms, you can also request hormone level testing from your healthcare provider. This will likely spark a conversation about hormone issues and therapy, and whether your practitioner can provide that type of care. If not, it might be time to find practice that offers perimenopause and menopause support. 

Remember that while perimenopause is a natural transition and you don’t have to navigate it alone. The Main Line area offers numerous options for support and treatment, whether you prefer a traditional medical approach or are seeking more natural alternatives.

Additional Resources

If you’d like to read more about women’s overall, reproductive health from a local expert, check out It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told). Written by Dr. Tang of Thrive Gynecology in Bryn Mawr, it’s a helpful resource for understanding women’s gynecologic health, including perimenopause and menopause.