Perimenopause & Menopause Care
Symptoms taken seriously, and a plan for the decades ahead.

In perimenopause, estrogen and progesterone fluctuate before periods stop. Menopause is confirmed after 12 months without a period. Symptoms can begin years earlier.

Hot flashes and night sweats, sleep disruption, mood and anxiety changes, brain fog, joint and muscle aches, vaginal dryness and painful sex (genitourinary syndrome of menopause), and loss of bone and muscle.

• Symptom and goal review, medical and family history, blood pressure and labs when useful.
• FDA-approved menopausal hormone therapy (estradiol by patch, gel or pill, with progesterone for those who have a uterus) when it fits.
• Local vaginal estrogen for genitourinary symptoms.
• Nonhormonal options when hormones are not right for you.
• Strength training and protein to protect muscle and bone, plus bone density screening when indicated.
• Coordination with your gynecologist for screening and anything outside our scope.

In November 2025 the FDA began removing the boxed warnings about heart disease, breast cancer and dementia from menopausal hormone therapy labels. The boxed warning on endometrial cancer remains for estrogen-alone products used by people with a uterus. Updated labels note that starting hormone therapy before age 60 or within 10 years of menopause has the most favorable balance. Two nonhormonal medicines are FDA-approved for moderate to severe hot flashes: fezolinetant (Veozah) and elinzanetant (Lynkuet). Veozah carries a boxed warning for rare but serious liver injury and requires liver testing before and during treatment. Testosterone for women is not FDA-approved in the US and is used off-label only in specific situations.