The 7 Biggest Myths About Hormones (That I Heard This Week Alone)

Hormones: they’re confusing, they're chaotic, and everyone seems to have an opinion about them, especially when you hit your 40s. This week alone, I heard seven persistent myths that made me want to scream into a bottle of progesterone. If you're on hormone therapy or considering it, these myths may sound familiar. Let’s set the record straight.

Myth #1: You can’t start hormones until you’ve gone 12 months without a period

Let’s bust this one wide open because I vehemently disagree. The idea that you have to wait until you’ve officially crossed through the grand door of menopause (12 consecutive months without a period) is outdated. Perimenopause can last 6–10 years. That’s a long time to suffer through symptoms waiting for some arbitrary calendar mark.

If you’re having symptoms and you're of appropriate age, there’s no reason you can’t start earlier—assuming a thorough workup and informed decision-making. I’ve been prescribing hormones since 2005, and I’m living proof: I still have regular periods but take progesterone for very real, very disruptive symptoms. When the time comes and I’m ready for estrogen, I’ll take that too. Because let’s be honest, those hormones help me and everyone around me.

Myth #2: If you’re on hormones in perimenopause, you can’t get pregnant

Wrong. So wrong. If you’re still ovulating - even irregularly - and you have unprotected sex, pregnancy is possible. HRT (or hormone therapy) does not equal birth control. I see so many women assume they’re “safe” because they’re in their 40s. But unless you don’t have your ovaries or a uterus, your partner had a vasectomy, your tubes are tied or you’re on birth control, you’re still in the baby-making lottery.

Trust me, the first time you’re several days late with your period because of perimenopause will still have you questioning the need for a pregnancy test

Conversely, if you're hoping to get pregnant in your 40s, know that it is possible. There might be some hurdles especially if your ovulation is irregular. Either way, this myth can cause major confusion (or surprises).

Myth #3: Herbs like black cohosh are the same as hormones

I love herbs. I’ve used them my entire career. But black cohosh is not estradiol. Maca is not testosterone. Wild yam cream? Not the same as actual bioidentical progesterone and your body can not convert wild yam into progesterone. That is only done in a lab. Herbs can help with symptoms, yes—but if you’re hoping for the bone, brain, or cardiovascular protection that estrogen provides, herbs alone aren’t going to get you there. They aren’t a direct 1:1.

The mechanisms are completely different. It’s not about being anti-herb. It’s about knowing what tool works best for which job.

Myth #4: Your hormone dose should stay the same all the time

Wouldn’t that be nice? But hormones are dynamic, especially in perimenopause. You might need dose adjustments, changes in delivery method (patch, gel, capsule), or even a different brand based on how your body absorbs it. Heck, even your skin thickness or where you apply it can impact absorption.

If you’re feeling off, advocate for adjustments. This is not always a “set it and forget it” situation. You might have periods of time where you need to adapt and adjust.

Myth #5: If you’re on systemic estrogen, you don’t need vaginal estrogen

Wrong again. Systemic estrogen (like patches or gels) often doesn’t reach the vaginal tissues enough to relieve symptoms like dryness, pain, recurrent UTIs, or loss of sensation. That’s why low-dose vaginal estrogen, vaginal DHEA or even vaginal testosterone exist. They’re localized solutions to local problems.

And yes—you can be on both systemic and local at the same time.

Myth #6: You’re too young for perimenopause if you’re not 50yo yet

Let me scream this from the rooftops: perimenopause can start in your late 30s or early 40s. The average age of menopause is 51–52, which means perimenopause starts well before that. If you're 42 and having symptoms, you're not necessarily "too young." You're probably right on time.

That said, not everything is perimenopause. At 35, if you’re skipping periods or feeling “off,” it might be PCOS, a thyroid issue, nutrient deficiency, or stress. We don’t want to mislabel everything as perimenopause—but we also don’t want to dismiss it when it’s valid.

As an aside, if you’re not experiencing many symptoms and you ARE 50yo, that’s okay too! Remember the average age to go through menopause is 51-52yo therefore women have to be both older and younger for that to be the average.

Myth #7: You’re too old to start hormones after age 60

One word: nope. A 62-year-old woman reached out to me recently with all the classic symptoms—hot flashes, night sweats, brain fog, painful sex—and had been told she was “too old” for hormone therapy. That’s incorrect. The Menopause Society says women over 65 can stay on hormones with appropriate monitoring. Starting later is also possible with proper evaluation.

Yes, the ideal window to start hormones is often considered within 10 years of your last period. But that’s not a hard stop. If your labs and risk factors check out, relief is still possible.

The Bottom Line:

Hormones can feel like herding cats, but I’m here to help so you can live your best Queen life.

Stay curious, stay empowered, and please, don’t believe everything you hear in the comments. What other questions (myths) are you curious about?