Perimenopause hype is driving unnecessary tests and HRT requests, experts warn

Perimenopause has entered the chat. But according to experts quoted in MIT Technology Review, the hype is pushing people toward products and decisions that do not match how biology, evidence, and clinical trial approvals actually work.

Start with the blunt mismatch: there is no test for perimenopause. The article explains that perimenopause is the sometimes years-long period before menopause, and menopause itself is defined as the life stage that occurs a year after a person has had their last period. During perimenopause, hormone levels can fluctuate wildly, with estrogen, progesterone, luteinizing hormone, and follicle-stimulating hormone all “roller-coast” before leveling off after menopause. That volatility is exactly why Lumsden says hormone measures are hard to interpret: “You can’t interpret hormone [measures] because they change so much.” It is “quite normal.” So when algorithms, TV doctors, and social media influencers nudge people toward blood tests and fast treatments based on presumed perimenopause status, the foundation is wobbly.

Why this matters beyond individual discomfort is that the symptoms can be real and the stakes can be big. The article notes that perimenopause often starts around age 46 or 47, and many people in their 40s begin experiencing symptoms like hot flashes, irregular or unusually heavy periods, and anxiety. It also quotes Lumsden saying, “Often symptoms are at their worst in the perimenopause,” in part because of the hormone fluctuation. In other words, this is not about dismissing the experience. It is about the leap from “symptoms” to “diagnosis” to “buy these products or demand this therapy,” especially when the diagnostic pathway is not as clean as the marketing suggests.

That leap is where hormone replacement therapy gets pulled into the hype machine. HRT is designed to top up or replace hormones like estrogen and progesterone, which naturally decline around menopause. The article emphasizes that there are different drugs, ways to take them, and doses, and that HRT can help many menopausal women. It can also help prevent osteoporosis and maintain muscle strength. But the key regulatory and evidence point is that these drugs were trialed in and approved for menopausal women, not perimenopausal women. Lumsden’s concern is pharmacologic and practical: “If you give standard HRT, it may well get swamped by [the woman’s] own hormone production.” Briggs adds another risk channel: HRT can cause abnormal bleeding in perimenopausal women.

In the article’s framing, the problem is not that HRT is universally bad. It is that social media messaging can create an “as soon as possible” reflex that ignores timing, symptom cause, and who the therapy has actually been studied in. Briggs says the promoted thinking is “not helpful,” and she is particularly worried about how younger women are being encouraged to assume they are perimenopausal and seek HRT treatment, describing it as “almost cult-like, this idea that everybody must have HRT.” From a governance and product-ethics lens, that is a glaring example of demand being shaped faster than evidence can support it.

Then there is the supplement boom, which the article describes as an explosion in marketing for vitamins and supplements targeted to middle-aged and menopausal women. But evidence for many of these is “limited or nonexistent,” and Lumsden says she “can’t see a mechanism for a lot of them.” The article also highlights a concrete clinical curiosity: some patients tell Briggs they take testosterone supplements to manage symptoms. But blood tests revealed no increase in testosterone levels. “Whatever they’re getting, it’s not testosterone,” Lumsden says. Even if the intent is symptom relief, the second-order effect for clinical systems and boards is messy: unclear dosing, unclear ingredients, and outcomes that do not map cleanly to the advertised narrative.

Finally, the article pushes back on one more seductive assumption: not all midlife symptoms are caused by hormones. It points out that social media symptom lists for perimenopause include fatigue, brain fog, aches and pains, digestive issues, and more, but these do not link closely to the menstrual cycle changes and hormone changes across menopause, according to Nanette Santoro, a professor of obstetrics and gynecology at the University of Colorado Anschutz who studies menopause. Santoro’s warning is blunt: “Attributing everything unpleasant that happens to a woman over 35 to perimenopause is not based on any scientific evidence.” The article even gives an example from the reporter’s own story: pelvic pain is “almost definitely” endometriosis, and Lumsden tells them endometriosis can be made worse by HRT. That’s the real operational lesson. When therapy is chosen because a trending label says “perimenopause,” the risk is treating the wrong driver of symptoms.

For decision-makers watching this space, the story is a reminder that modern attention economies reward certainty, and biology often refuses to cooperate. People are already juggling care for children and aging parents, often while holding down jobs, and the article underscores the exhaustion of midlife. The strategic stakes are that a misaligned market can waste money on tests, apps, and supplements, overload clinicians with premature demands for HRT, and potentially worsen outcomes when symptoms are caused by something else. If you build, invest in, regulate, or scale offerings around perimenopause, the “hype” is not just a consumer issue. It becomes a clinical and financial one, where the gap between diagnosis and treatment timing is where real harm can slip in.