Perimenopause and Menopause Treatment in Walnut Creek
This page is for women in perimenopause, at menopause and after it. Hot flashes, night sweats, broken sleep, mood changes, brain fog, weight and shape changes, vaginal dryness and low libido can overlap. I begin with a work-up, because not every midlife symptom is hormonal. We use hormones where they fit and other medicines where they do not. We decide together what should be treated with hormones and what should be treated with other medications.
23+ YEARS EXPERIENCE | BOARD CERTIFIED MD | FORMER ASST. PROFESSOR OF MEDICINE | 5.0★ ACROSS 136 REVIEWS
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.
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.
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
When do perimenopause symptoms start?
They often begin in the mid-to-late forties, but timing varies. Symptoms can start while periods are still regular and may change as cycles become less predictable.
How long do menopause symptoms last?
The transition averages about four years, while frequent hot flashes last a median of about seven years. Vaginal and urinary symptoms can persist or become more noticeable after periods stop.
Is hormone therapy safe, and what are the risks?
Risk depends on age, timing, route, dose, medical history and whether progesterone is needed. For many symptomatic women under 60 or within ten years of menopause, benefits generally outweigh risks when there is no contraindication.
Do I need labs to diagnose perimenopause?
The diagnosis is usually made from the pattern of periods and symptoms. Labs can confirm the picture, establish a baseline or look for pregnancy, thyroid disease, anemia and other causes.
What if I cannot take hormones?
Nonhormonal options for hot flashes include certain SSRIs or SNRIs, gabapentin, oxybutynin and fezolinetant. Cognitive behavioral therapy can also help selected symptoms.
Does menopause cause weight gain?
Aging drives much of midlife weight gain. Menopause more specifically shifts fat toward the abdomen and can reduce lean mass. Hormone therapy is not a weight-loss treatment.
I can’t say enough wonderful things about Dr. Moazemi at Beau Visage Aesthetics! He is truly amazing at what he does. His gentle approach, attention to detail, and dedication to making you feel comfortable really set him apart. He takes his time, listens to your concerns, and has such an artistic eye when it comes to aesthetics. I especially appreciate how he focuses on enhancing your natural beauty rather than overdoing it. You can tell he genuinely cares about his patients and the quality of his work. I highly recommend him!
I can’t recommend Dr. Moazemi enough! I originally went to him for Botox, and from my very first appointment, he made me feel completely comfortable. He took the time to walk me through everything, explain the process, and patiently answer my million questions without ever making me feel rushed.
I’ve now gone to him three times, and I will absolutely continue going back. He’s incredibly kind, knowledgeable, professional, and genuinely cares about making sure you feel comfortable and informed. I’ve had such a great experience every single time. Highly recommend Dr. Moazemi!
Had a great experience at Beau Visage Aesthetics for my facial laser treatment! The entire experience was professional, welcoming, and informative from start to finish. Everything was explained clearly, all of my questions were answered, and I felt completely comfortable throughout the treatment. You can tell they genuinely care about their clients and the results they’re providing. I’m excited to continue my sessions and see the progress. Highly recommend Beau Visage Aesthetics!
I cannot say enough wonderful things about my visit today! From the moment you walk into this med spa, there is such an inviting, beautiful vibe that immediately puts you at ease. I started my appointment with a Deluxe HydraFacial with Jenn, and she truly blew it out of the water—her skin expertise, technique, and massage are next-level, and I left the treatment room completely relaxed with glowing, refreshed skin. From there, I saw Dr. Moazemi for an IPL treatment on my chest and hands. As a mature client, finding practitioners who truly understand aging skin is everything, and Dr. Moazemi is remarkably knowledgeable, thorough, and reassuring throughout the entire process. Having already seen noticeable results right away from a previous laser treatment here, I am incredibly excited to see my full before-and-after results and to continue my skin journey with them. If you are looking for a med spa that pairs high-level clinical skill with genuine warmth, this is absolutely the place—highly, highly recommend!
HydraFacial with Jennifer is truly a luxury experience. My skin always looks and feels amazing afterward: hydrated, refreshed, and glowing. Jennifer makes the whole experience so relaxing and enjoyable. I always look forward to my appointments with her!
I’ve gone to Dr. Moazemi at Beau Visage several times, including visits with colleagues, laser treatments and microneedling. He is always incredibly kind, gentle, and easy to work with. He takes his time, makes you feel comfortable, and is very accommodating with scheduling. His pricing is also excellent and very reasonable for the quality of care and treatments he provides. I’ve had a consistently great experience and would definitely recommend him!
I started microneedling with Dr. Moazemi this year and the results have been amazing, my skin is glowy and bouncy. I’d had microneedling before elsewhere and never got results like this. Dr. Moazemi is thorough in explaining treatments and recommends plans that actually deliver.
I also get hydrafacials from Jen, and I bring my mom too, we both love the results, especially before big events.
The space is friendly and professional from top to bottom. Highly recommend!!
I have gotten treatments from both Jen and Dr. Moazemi and would highly recommend this clinic! They are so friendly and professional and love that they offer such a wide range of services. 10/10 would recommend!
I cannot recommend Beau Visage highly enough, and Dr. Moazemi is truly in a league of his own. Not only is he exceptionally skilled in facial aesthetics, but his bedside manner is also unparalleled. He is incredibly kind, patient, and always takes the time to thoroughly answer every question I have so I never feel rushed. In an industry that can sometimes feel transactional, it is very clear that Dr. Moazemi genuinely cares about achieving the best possible outcomes for his patients rather than just pushing procedures. I completely trust him with my face and wouldn’t go to anyone else.
I had an appointment with Dr. Moazemi for Botox and filler, and I couldn’t be happier with my experience. From the start, he took the time to thoroughly explain the procedures, including the areas that could be improved, and never pressured me into anything. He’s kind, confident, and made me feel completely comfortable throughout.
It’s only day 3, and I can already see results! I know the final results aren’t fully settled yet, but I can already notice more symmetry and natural enhancement. I highly recommend Dr. Moazemi to anyone looking for someone professional, thoughtful, and talented.
I have been coming to Dr. Moazemi for treatments over the last year including Botox, PRP injections, and recently a Hydrafacial. I couldn’t recommend him enough! Everyone was so kind and professional. Pricing was very fair, especially since you are receiving the best quality of care and products. Dr. Moazemi was incredibly knowledgeable about facial anatomy and took the time to explain everything. I’m very happy with my results and my skin has never looked better. I would absolutely recommend this place to anyone!
I really enjoyed my experience here! I’ve had a few facials with Jen and her and Dr. Moazemi do a phenomenal job helping you with all the treatments they provide and also do a wonderful job educating you on how to take care of your skin. I’ve had the Hydrafacial and the Ultimate Glow Facial and you can’t go wrong with anything in their menu. 10/10 you’ll leave feeling absolutely satisfied after your session.
After reading the tons of positive online reviews about the Beau Visage Aesthetics, I decided to give it a try. And I'm so glad I did. I've been a client for about 2 years now, and i couldn't have been happier. Dr. Moazemi is very knowledgeable and patient. He explains the procedures in details and takes the time to answer all the questions. His precise hand and knowledge about human anatomy and physiology plays a big role in the always best outcomes of every procedure he does.I trust Dr.Moazemi 100%, and I highly recommend him. Thank you for keeping me beautiful :))
Dr. Moazemi has been wonderful to work with. When I started considering laser hair removal I called around to so many places because I know working with Hispanic skin can be challenging and not all lasers work. Dr. Moazemi called me back personally to discuss the options and make a recommendation. I’ve had two treatments so far and have had way more hair reduction than I expected. His prices are also very good for this area. Highly recommend Beau Visage!
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.
