Perimenopause and Menopause Treatment in Walnut Creek

Is It Perimenopause — and Is It Hormonal?

Perimenopause is the transition to the final menstrual period and the year after it, and it usually begins in the forties. Cycles change, hot flashes and night sweats can start while periods are still regular, and sleep, concentration and mood can shift. Menopause is confirmed after twelve consecutive months without a period. If you are younger than 45 and your periods have stopped or become irregular, I do a further medical work-up and may refer you to a specialist.

Not every midlife symptom is hormonal. Hot flashes, night sweats and the vaginal and urinary changes of menopause are the most clearly tied to falling estrogen, and hormone therapy is most likely to help them. Fatigue, low mood, poor sleep, brain fog, joint pain, hair thinning and weight change can reflect hormones, aging, stress, medication, thyroid disease, iron deficiency, sleep apnea or several causes at once. Sorting that out comes first: calling everything hormonal can delay the right diagnosis, and dismissing everything as aging is just as unhelpful. I go through the options in more depth in my guide to perimenopause treatment options.

How I Evaluate You

For a woman 45 or older with a typical history, perimenopause is usually a clinical diagnosis. A single FSH or estradiol result can be misleading because levels fluctuate, so labs are used when they answer a specific question, establish a baseline or look for conditions that mimic menopause.

Your first visit is one hour. We review menstrual history, symptoms, contraception, migraine, clotting and cardiovascular history, breast and gynecologic history, medications, sleep, mood and your priorities. Depending on that history, testing may include thyroid function, blood count and iron studies, metabolic markers or reproductive hormones.

Changed or unexplained bleeding is investigated before anything is treated, and any bleeding after twelve months without a period should be assessed promptly. Blood pressure, metabolic risk, bone health, smoking, alcohol and family history do not automatically rule treatment in or out, but they shape the benefit-risk discussion.

What I Prescribe

When systemic hormone therapy is appropriate, my usual starting point is an estradiol patch with oral micronized progesterone for a woman who has a uterus, adjusted to your history, symptom burden and preference. For many symptomatic women younger than 60 or within ten years of the last period, benefits generally outweigh risks when there is no contraindication. Patches appear to carry less clot risk than estrogen tablets. Prior breast or uterine cancer, unexplained bleeding, blood clots, stroke, heart attack or significant liver disease can change or rule out systemic treatment.

• FDA-approved products first. Their dose, purity and manufacturing are regulated. A compounded preparation can be discussed, with its trade-off: no FDA approval, less product testing and a less certain evidence base.
• Local vaginal estrogen for dryness, discomfort with sex or recurrent urinary symptoms, even when systemic treatment is not needed.
• Physiological-dose transdermal testosterone for low sexual desire, with monitoring, once other contributors have been assessed. It is not a general treatment for energy, mood or weight.
• Nonhormonal options for hot flashes — certain SSRIs or SNRIs, gabapentin, oxybutynin and fezolinetant — and referral for cognitive behavioral therapy when it fits, including for sleep.

I do not offer hormone pellets. The American College of Obstetricians and Gynecologists advises against pellet therapy: once a pellet is placed, hormone levels that run too high cannot be brought back down.

Cost and Getting Started

The consultation fee is $150 and is waived if you proceed with treatment. Initial laboratory testing is usually $200 to $350, depending on what needs to be checked. Ongoing care is $150 per month. Medications are dispensed by a pharmacy and billed separately.

• A one-hour consultation, history and examination
• Targeted testing rather than a fixed lab panel
• A review of the findings and a treatment decision made with you
• Monthly follow-up at first, then about every three months while the plan is being established, and about every six months once treatment is steady

At each follow-up I ask what changed and what did not, review side effects and bleeding, and aim for the lowest dose that addresses the agreed symptom. Continuing treatment is a recurring decision, not an assumption.

Menopause and Your Skin, Hair and Shape

Estrogen decline affects collagen, hydration and skin thickness. Hormone therapy may improve some skin measures, but it is not prescribed for skin alone. Hair thinning also becomes more common at midlife, but thyroid disease, iron deficiency, genetics and medication can matter, and a separate hair loss evaluation can distinguish them. For skin concerns, see skincare routines and erbium laser resurfacing.

Midlife weight gain is mostly an aging effect; menopause more specifically changes where fat is stored and can reduce lean mass. Hormone therapy is not a weight-loss treatment. If weight is a concern, see our medical weight loss page.

Menopause Treatment Questions

A Clearer Plan for the Next Stage

You do not need to decide on hormones before you come in. Bring the changes you have noticed, your questions and any prior results. We will separate what fits the menopause transition from what needs another explanation, then choose what matches your goals and medical history.

This page sits within our broader hormone therapy services. Men can read about testosterone therapy in Walnut Creek.

Sources

• The 2022 Hormone Therapy Position Statement of The North American Menopause Society
• The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society
• Long-term Effects of Menopause and Sex Hormones on Skin Thickness
• Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition
• Menopausal Hormone Therapy and Long-Term Health Outcomes in the WHI Trials
• ACOG Clinical Consensus on Compounded Bioidentical Menopausal Hormone Therapy