Menopause & Perimenopause Care

Usually by pattern rather than by a single test. Perimenopause commonly begins in the early forties, sometimes the late thirties, while periods are still regular. Typical changes include disrupted sleep, mood shifts, brain fog, joint aches, changes in cycle length or flow, and weight moving to the middle without a change in diet. Hormones fluctuate rather than simply falling at this stage, so one blood test on the wrong day can look completely normal.

That is the single most common thing we hear, and it is worth understanding why it happens. In perimenopause, oestradiol swings substantially from day to day, so a single reading can genuinely land in the normal range while you feel terrible. A normal result rules some things in and out; it does not rule out perimenopause. It is also why we test thyroid, ferritin and metabolic markers at the same time, since those mimic it closely and are treated differently.

It depends on you, and any page that answers this with a flat yes or no is not being straight with you. Risk and benefit vary with your personal and family history, your age, how long since menopause you are starting, and which hormones by which route. The evidence has been substantially revised over the past two decades, particularly around timing of initiation. Bring your history to the consultation and a physician will go through it with you properly.

Hormone therapy starts at $550, and what you pay depends on which hormones you need and how they are delivered. BioTE pellets are quoted separately after blood work. The consultation is complimentary.

It is worth discussing, and it is routinely overlooked. Women produce testosterone too and levels decline with age. It is relevant to energy, mood, muscle maintenance and libido, and it is a normal part of how we approach hormone therapy for women rather than an afterthought.

Extremely common, and almost never raised, usually because nobody asks. We ask. There are effective treatments, and importantly they are not the same as systemic hormone therapy, so this is worth addressing even if you decide against systemic treatment.

All three work, and the honest answer is that it depends on what you value. Creams and injections are adjustable and easy to stop. Pellets mean nothing to remember and steady levels, but the dose cannot be changed once inserted. If you are new to hormone therapy we usually suggest starting on something adjustable and moving to pellets later if you want the convenience.

Not directly, and we are not going to pretend otherwise. It can help with the things that make weight harder to manage, such as sleep, energy and muscle maintenance. If weight is the primary concern, metabolic testing and a medical weight loss programme are the more honest route, and thyroid and insulin resistance are worth ruling out first.