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Perimenopause and menopause symptoms, and what helps
Symptoms can start in your early forties, years before periods stop. Here is what we see most, and the options for each.
Hot flashes and night sweats
The most recognized symptom and the one with the best evidence for treatment. Options include hormone therapy (the most effective), non-hormonal prescription medication for women who cannot or prefer not to use hormones, and practical triggers to manage. Most women feel a clear difference within four weeks of the right treatment.
Sleep, mood, anxiety and brain fog
Night sweats fragment sleep; falling estrogen also affects mood regulation and word-finding. We separate what is hormonal from what is sleep debt, thyroid, iron or depression, because each has a different fix. Treatments range from hormone therapy and targeted sleep plans to short-term medication and, when useful, referral to our VPMC Mental Wellness team.
Irregular, heavy or unpredictable periods
Common in perimenopause and usually benign, but heavy bleeding needs evaluation. We check iron and thyroid, coordinate with your OB/GYN for imaging or procedures, and discuss options that steady cycles and symptoms at the same time.
Joint aches, dry skin and hair changes
Often dismissed, often hormonal. We rule out inflammatory causes, review vitamin D and thyroid, and discuss how hormone therapy and strength training change these symptoms.
Vaginal dryness, pain and low libido
Local (vaginal) estrogen is safe for almost everyone, including many women who cannot take systemic hormones, and it works. We talk about it plainly and prescribe it routinely. See the pelvic floor and bladder page.
Common questions
How do I know if I am in perimenopause?
Mostly by symptoms and cycle changes, not by blood tests, which fluctuate day to day. At the first visit we use a validated symptom score and your history. Labs are used to rule out look-alikes such as thyroid disease or anemia.
Is this a gynecology practice?
No. We are internal medicine physicians with a focus on perimenopause and menopause. We treat the symptoms and the long-term risks that come with this stage, including heart, bone, weight, sleep and mood, and we work with your OB/GYN when a procedure or gynecologic exam is needed.
Do I need a referral?
No. Book directly online, or call or text. If you have an OB/GYN or primary care provider, we send them a summary with your permission.
Is hormone therapy safe?
For most healthy women within ten years of menopause or under 60, current guidelines consider hormone therapy a reasonable and effective option for bothersome symptoms. Some conditions change that answer, which is why the first visit is a full medical review. We follow the Menopause Society guidance and explain the trade-offs plainly.
Is it covered by insurance?
Visits are billed to your insurance as medical visits through Privia Medical Group. Medications are usually covered with a standard copay. See the insurance page.
Can I do visits by video?
Yes. After the first visit most follow-ups can be by secure video anywhere in Virginia.
You do not have to put up with it.
A 45-minute consult that takes your symptoms seriously and looks at the whole picture.