Menopause Support
Menopause is a time to prioritize your health and wellbeing. While some women focus on lifestyle changes to manage symptoms and prevent disease, others may seek relief through hormone therapy or alternative treatments.
With the overwhelming information available, much of it misinformation, women benefit from personalized guidance from a certified menopause specialist.
Services Offered: evidenced-based
Menopause education & personalized health screening
Diet/lifestyle counseling
FDA-approved bio-identical hormone & non-hormone therapies, including GLP1’s where appropriate
Management of related conditions:
Vaginal/urinary health (genitourinary syndrome) & libido
Breast and bone health
Metabolic health (thyroid, blood sugar, lipids)
Fertility and contraception
Weight and body composition
Note: Please maintain a primary care provider for acute care needs. Referrals available here
Menopause Frequently Asked Questions
Are my symptoms related to menopause?
Menopause is a gradual transition that can span many years. Key points:
Menopause officially occurs one year after your final menstrual period, typically between ages 50-52 (though possible between 40-60)
Symptoms can begin up to 10-15 years before final menses and may last several years after
Factors affecting transition include genetics, lifestyle habits, surgery, or medication
Symptoms can fluctuate daily and monthly due to erratic hormone production
**Important Note About Fertility:** Pregnancy is possible even with menopausal symptoms throughout your 40s. Contraception and fertility planning should be part of every woman's perimenopause assessment.
When to Seek Care: If you suspect perimenopausal symptoms, schedule a appointment; diagnosis typically comes from reviewing your medical/menstrual history and specific symptoms, not hormone testing.
Do I need hormones?
Not all women need menopausal hormone therapy (MHT). This decision should be individualized based on:
Your specific symptoms & their impact on quality of life
Personal medical history and risk factors
Other potential causes of symptoms (like thyroid issues)
Your preferences for treatment approaches
The key is finding the right balance between managing symptoms that affect your daily life and considering potential risks. This decision should be made through detailed discussion with your healthcare provider.
Why do I need to see a menopause specialist?
You might not —menopause is a natural life stage, not a disease. However, a certified menopause specialist can help:
* Individualized risk assessment
* Evidence-based treatment of menopause-related symptoms
* Management of associated conditions:
Osteoporosis
Anxiety and depression
Insomnia
Cardiovascular disease
Diabetes
Migraines
Sexual dysfunction
**Warning: Be cautious of practitioners promoting unregulated treatments like pellets, injections, or compounded hormones. These are not recommended by major professional societies.
Do you prescribe bio-identical hormones?
Yes, but understand the terminology:
"Bio-identical" means hormones chemically identical to those your body produces
FDA-approved bio-identical options are available in various doses/formulations
Custom-compounded hormones rarely necessary and:
Not covered by insurance
Less regulatory oversight
Typically more expensive
No evidence of being safer or more effective
Are there non-hormonal treatment options?
Yes, several evidence-based options exist:
Lifestyle modifications:
Diet changes
Regular activity
Stress management
Acupuncture
Targeted supplements (when appropriate):
Valerian for sleep
Calcium and vitamin D if dietary sources are insufficient
Non-hormonal meds meay address multiple symptoms
Most "menopause supplements" lack research support and can be expensive
Aren't hormones dangerous?
MHT offers benefits but requires careful consideration:
Benefits can include:
Reduced hot flashes and night sweats
Improved sleep and mood
Better cognitive function
Relief from urinary and vaginal symptoms
Improved bone density
Potential reduction in heart disease and diabetes risk if started early
Important Considerations:
No systemic MHT is completely risk-free for all
Vaginal estradiol can be used safely without progesterone
MHT may be appropriate for most:
Women in perimenopause
Those within 10 years of menopause
Healthy older women with persistent symptoms
Treatment can continue beyond age 65 if beneficial
Individualized decisions with professional guidance
What lab work or testing will I need?
Most women don't need extensive hormone testing because:
Hormone levels fluctuate during perimenopause
Single measurements can be misleading
Normal levels don't rule out perimenopause
Symptoms, not levels, guide treatment
Testing may be warranted for:
Sexual dysfunction evaluation
Fertility concerns
Early menopause
Rule out other conditions (thyroid, vitamin deficiencies)
Screening for associated health risks (lipids, glucose)
**Note: Salivary/urine hormone testing not recommended for evaluating/treating symptoms.
Still have questions? Contact me
A Picture is Worth a Thousand Words:
This is the answer to the question, “Why don’t you test estrogen & FSH in perimenopause?”
And here is the answer to “What is the difference between all the different types of hormone therapy?” Click to see larger
Menopause Learning & Resources
Research: NO PAYWALL
MHT & Menopause Key Controversies Int Meno Soc 9/2024 Estrogen & Risk of Dementia AM J Geriatric Psych 7/2024
Estrogen-Alone & Breast Cancer Breast Can Res 4/2024
Menopause Hormone Use After 65 Menopause 4/2024
WHI UPDATE JAMA 4/2024
Semaglutide & MHT Menopause 4/2024
Contemporary View of MHT Menopause 3/2024
Excess morbidity and mortality associated with underuse of estrogen replacement therapy AJOG 2/2024
Critical Review of WHI Menopause 10/2023
“Systemic or Vaginal Hormone Therapy After Early Breast Cancer” JNCI 7/2022
Hormone Therapy After Breast Cancer Cancer 5/2022
Testosterone for Women Consensus Statement JCEM 9/2019
Websites:
International Menopause Society
Prosayla - Women’s Sexual Health (International Society for the Study of Women’s Sexual Health)
Articles:
Vagenda recurring on Substack Jen Gunter, MD
“Women in Menopause Getting Short Shrift” Atlantic 4/2024
“Out of Touch on Menopause” Ms Magazine 4/2024
“Menopause is Having a Moment” NYT 7/2023
“America Lost Way On Menopause Research” Wa Post 4/2022
Audio:
My interview on podcast “Flipside of Midlife” 4/2024
“How Women Have Been Misled About Menopause” NYT 2/2023
Hormone Replacement Therapy (HRT) and Menopause an interview with the authors of the fantastic book Attia, 2/2019
Books:
“Estrogen Matters” A Bluming
“Menopause Manifesto” J Gunter
LGBTQIA+ menopause resources:
The Advocate video blog