When I started to go through perimenopause my gynecologist offered a commercial contraceptive that caused my symptoms to worsen. When on the synthetic progestins and combo estrogens I had panic attacks, hot flashes, night sweats, and insomnia. My doctor prescribed me bio-identical progesterone cream that they were able to tailor for me. My symptoms improved 100% after taking it. I needed what was considered "low dose" compared to what is commercially available. Commercial forms of these meds are all high doses and if you are like me with a COMT gene polymorphism then the high dose of hormones causes severe panic attacks and makes the symptoms of perimenopause worse. I hope that whoever is reading this can understand that we need options that are not ONE-SIZE-FITS-ALL. Some of us need an option that can be tailored down. Please consider this when evaluating the need for alternatives vs. commercial hormones.