I am 54 and have not hit menopause. For more than 20 years I have been on Mirena (not the same IUD, obviously, but on a series of Mirena IUDs) and as a positive side effect, my periods changed into occasional spotting and no more. I still get that

Since age 51, I have been on the lowest dose estradiol patch and Mirena supplies progesterone, so together, these two constitute my HRT, taking preventatively. I have never had any symptom commonly associated with pet menopause or menopause except for the overactive bladder, but OAB got helped by percutaneous nerve stimulation, a non-invasive procedure. I also do Kegels. All in all, perimenopause has not been a problem. Note that I had a late menarche and my mother had a late menopause, which might be why I am late (sort of a late bloomer and a late finisher).

I listened to a podcast about women's health and hormones and learned that HRT is best started within 10 years of menopause but even better, preventatively. I then requested it from my gynecologist who went through calculating my specific risks and benefits. This way we concluded that it would be a good choice for me. I will be honest and say that I had appearance concerns and not only health concerns in mind - I knew that women on my maternal side developed dark facial hair in older age and I wanted to avoid that. That is one reason among many why I use the estradiol patch.