I am 45 and have been naturally helping my body through perimenopause since I was 40, which is when I started. I have enlisted the help of a naturopathic doctor and have taken it upon myself to educate myself as much as I can on what I can do naturally to help this transition.
I am not on the pill (in fact, I think I've been on the pill for a total of about 12 months in my entire life. The pill is the single worst RX for really messing up a woman's system, especially the adrenals and the thyroid. Your doctor won't tell you that, though. I suspect most doctors probably don't even know that.).
I do take a natural progesterone cream I get from my naturopathic doctor, which I started July 2012. That helps with the PMS symptoms I've had since a teenager (actually, took all of them away). I still have my periods, but I don't have them; I had a NovaSure Ablation done when I was 40 to help cure my suddenly heavy bleeding/clotting as well as to take care of hyperplasia (thank God, noncancerous).
So everything inside is still intact and normal, so that my body is getting/going through the natural decline in feminine hormones, like it should. I don't "need" any "extra" female hormones; my body will regulate itself out normally. My allopathic doctor is aware that I'm currently going through perimenopause; she isn't all that excited about making sure I'm on this or that hormone replacement therapy. First, she knows that I have a genetic liver mutation where I can't do that. Second, she knows that I prefer to go through this naturally. If something's off, then I will counterbalance it with food or a supplement geared for that deficiency/need.
I chelated for heavy metal toxicity, discovered my food allergies/intolerances, changed my eating to organic whole/wholesome foods, cut out fast food/white sugar and flour/processed/preserved/
MSG/artifical sugars/HFCS, drink reverse-osmosis water, take supplements (some of which are strictly to help support the change). I cleaned out my body so that my body has a clean slate in which to work with the changing hormone levels in my body.
The only way a woman can go through menopause and not have issues is to change what she puts into her body. Your body can go through the change just fine on its own--as long as you give it what it needs to work and get the job done. How did women for hundreds and thousands of years get through the change without all of these fantastic pharma drugs? They changed their diet, added foods that supported the change, and took different herbs and such that they knew helped with this or that issue.
I have had issues with messed up female hormones (and if I'd known that putting a small dab of Progesterone cream on the back of my hand 2x/day would take care of the problem, I would have done it long ago!) and now with my adrenals; once those glands get out of whack (think thyroid as well), well then, you've set yourself up for a whole lot of hurt, misery, and years of getting your body put back to rights.
Unless you've gone through a hysterectomy and had everything taken out--or have no ovaries left--your body still has the female hormones it needs to get through the change. It's only when your body is completely devoid of any female hormones that you have to worry about needing extra hormones, and then I'd think about taking something natural, that works with the body.
My mom and 4 of her sisters had hysterectomies, HRT, anything and everything the doctors will push on women to "get them" through menopause. Another one of her sisters went the natural way--like me--and to this day, she is the healthiest of all of them.
The Wisdom of Menopause by Dr. Christiane Northrup, MD is an excellent resource for anyone looking to go through the change naturally, without resorting to pharma drugs. She is a naturopath OB/GYN; I highly recommend her book. She has a whole bunch of herbs and other nutriceutical products you can buy that will help your body through the change just as well as any "pharma" drugs. She also addresses pharma drugs in case you sincerely want to go that route or your case is severe; she also gives advice on what you can use to supplement pharma hormonal drug treatment programs. It's a big book, but well worth the investment. The book is literally a bible on women's health and how to be healthier.
Oh, and pharma drugs DO mess with your estrogen levels (along with the progesterone and the other female hormones no one talks about, not to mention the adrenal glands and the thyroid). Pharma drugs always end up with side effects; that's how synthetic medications work.
