Perimenopause treatment that doesn't dismiss what you're feeling

The average age of menopause in the US is 51 — but perimenopause can begin 10 years earlier. During this transition, ovarian hormone production becomes irregular: estradiol levels swing widely, progesterone tends to drop earlier and more reliably, and testosterone gradually declines. The symptoms can be substantial: irregular periods, hot flashes, night sweats, sleep disruption (often the first sign), mood changes including new-onset anxiety, brain fog, joint aches, weight gain (particularly visceral), changes in libido, vaginal dryness, and skin and hair changes.

Despite affecting essentially every woman, perimenopause is poorly served in mainstream medicine. Most providers learned about it in a single afternoon of medical school. Hormone therapy was demonized after the 2002 Women's Health Initiative results were widely misinterpreted, and a generation of women has gone without treatment that the current evidence strongly supports.

The modern understanding is clearer: for healthy women within 10 years of menopause, hormone therapy (estradiol with progesterone for women with a uterus) provides substantial symptom relief and has a favorable risk-benefit profile. Testosterone replacement, though not FDA-approved for women, is supported by clear evidence for libido, energy, and well-being in deficient women. We use these tools when they fit, and we don't fit when they don't.

Comprehensive labs. Full hormone panel including estradiol, progesterone, FSH, LH, total and free testosterone, DHEA-S, SHBG. Plus full thyroid (which often goes off during perimenopause and gets blamed on hormones), full metabolic markers, and inflammation markers. We need the full picture to choose the right protocol.

Estradiol replacement. Transdermal estradiol (patch, gel, or cream) is the preferred form — it bypasses the liver and avoids the small VTE risk of oral estrogens. Doses are titrated to symptom relief, with periodic labs.

Progesterone. Required for women with a uterus to protect the endometrium when taking estrogen. Bioidentical micronized progesterone (Prometrium) is the preferred form, typically taken at bedtime where it also helps with sleep. Some women without a uterus also benefit from progesterone for sleep and mood.

Testosterone. Low-dose testosterone cream or troche, off-label use, supports libido, energy, motivation, and muscle. Not FDA-approved for women in the US, but used by perimenopause specialists routinely. Dosed below male-replacement levels.

Non-hormonal options. For members who can't or don't want hormone therapy: low-dose SSRIs and SNRIs help with hot flashes; gabapentin can help with sleep; oxybutynin for night sweats; cognitive behavioral therapy adapted for menopause is genuinely effective.

Vaginal-only estrogen. For members whose main concern is genitourinary symptoms (dryness, discomfort, recurrent UTIs), vaginal estrogen is highly effective with minimal systemic absorption. Even safe for many breast cancer survivors with oncologist coordination.

Free 20-minute intake call. You describe your symptoms, your history, what you've tried, and what you want from treatment. We tell you honestly if HRT is right for you and what other paths might help.

Comprehensive lab work — included in the program. Quest or LabCorp draw center.

45-minute clinician visit. The clinician walks through your labs, listens to your symptoms in detail, and builds your written protocol. This may be hormonal, non-hormonal, or a combination. We don't push HRT on members who don't want it, and we don't withhold it from members who would benefit.

Prescriptions ship from licensed compounding or retail pharmacies. Your clinician is reachable for titration questions through the platform.

Quarterly follow-up the first year (re-labs at 90 days, symptom checks, dose adjustments). Annual thereafter once stable.