What if you are still having periods, your symptoms are changing, and contraception is still part of your life? A new clinician toolkit looks at that combination of questions. Its central idea is that perimenopause care has several possible goals, and those goals need to be made clear before treatment options can be meaningfully compared.
In this article
What the new paper covers
Jaclyn Piasta and Amani Zewail’s Hormonal Options for Perimenopause: A Clinician Toolkit appears as a Clinical Perspective in the November 2026 issue of Obstetrics & Gynecology. It discusses hormonal contraceptives, alternative hormonal approaches, and individualized care. It is a practical perspective for clinicians, not an ACOG clinical practice guideline and not a new randomized trial. Piasta and Zewail, page 571.
That distinction matters when reading the headline. Publication in ACOG’s journal does not make every proposed approach an official recommendation from the organization. The authors also disclose potential competing interests: Piasta reports advisory consulting relationships, while Zewail reports no potential conflicts. This information belongs to understanding the paper’s context, rather than deciding its conclusions by affiliation alone. Author disclosures, page 571.
Three goals that may overlap
The toolkit separates menstrual cycle control, contraception, and symptom relief. It then describes two broad strategies: suppressing ovarian activity with hormonal contraceptives, or supplementing estrogen using menopausal hormone therapy. The paper notes that menopausal hormone therapy does not reliably suppress ovulation or provide contraception. These are distinctions between approaches, not a suggestion that a reader choose one independently. Two therapeutic approaches, page 574.
For example, one reader might want to understand unpredictable bleeding while also asking about pregnancy prevention. Another might be focused on hot flashes and have different contraceptive needs. Their questions can sound similar at first while involving different priorities. Our hormonal birth control guide explains the background terms.
Why this life stage needs its own explanation
The authors describe perimenopause as a time of erratic hormone fluctuations, distinct from the more sustained estrogen deficiency associated with menopause. They also explain that routine hormone measurements often do not reliably reflect symptoms or determine treatment need. They describe specific situations in which laboratory evaluation can be relevant, rather than presenting testing as universally useful or universally unnecessary. Physiology and testing discussion, pages 572–573.
For someone approaching midlife, this helps explain why a question about symptoms and a question about a single test result are not interchangeable. For someone further beyond menopause, it also shows why a perimenopause-focused paper may not fit her circumstances. Our perimenopause hormone testing article provides more context.
What the paper does not settle
The toolkit discusses approaches that are off-label, including combinations used to address symptoms, contraception, and endometrial protection. Its tables distinguish relevant uses and limitations. A clinician perspective describing an approach is not the same as a regulator approving every use, and the article is not a personal prescribing guide. Table 1 and its notes, pages 574–578.
There is also separate 2026 ACOG guidance covering menopause-related hot flashes, sleep, and mood. It includes perimenopausal people within its scope. That makes the broad claim that perimenopause has “no guidance” misleading. The toolkit and guideline are different documents with different purposes; one does not replace the other. ACOG Clinical Practice Guideline No. 13, scope and recommendations.
Questions for your healthcare provider
- Which goals are we discussing: bleeding patterns, contraception, symptom relief, or several together?
- How does my medical history affect which approaches are relevant?
- Is an option being discussed an approved use or an off-label use, and what uncertainty comes with that?
- Which parts of this toolkit or the separate ACOG guideline apply to my situation?
Sources
- Hormonal Options for Perimenopause: A Clinician Toolkit — Piasta and Zewail, Obstetrics & Gynecology, November 2026, 148:571–583. Full paper reviewed.
- Clinical Practice Guideline No. 13 — ACOG, Obstetrics & Gynecology, November 2026, 148:e345–e369.
This article is for educational purposes and isn’t medical advice. Talk to your healthcare provider about your situation.
