DC Metro Area — Just over the line in Kensington, MD · Telehealth in 12+ states
Menopause & Perimenopause Care
Sleep that stopped working. Cycles that don't make sense anymore. Mood, brain fog, joint aches, hot flashes, painful sex. If any of that's been brushed off as "just stress" or "just aging," we'd like to actually talk through it.
We schedule extra time for menopause consultations because you can't sort this out in ten minutes. In office or via telehealth.
Where You Are in It
Perimenopause is the years-long transition leading up to menopause. It can start in your late 30s and last over a decade. Hormones aren't just declining — they're fluctuating wildly. That's where most symptoms come from.
Menopause is the day you've gone twelve consecutive months without a period. The average age in the US is 51. It's a single point in time, not a phase.
Postmenopause is everything after that. Hormone levels stabilize at a new baseline, and symptoms like genitourinary changes can keep evolving. Care doesn't end at the year mark.
Symptoms We Take Seriously
All of these are real, common, and treatable. None of them mean you have to "just push through it."
Sleep changes
Falling asleep is fine, but you're wide awake at 3 a.m. One of the earliest perimenopausal symptoms.
Mood, anxiety, brain fog
Estrogen fluctuations affect serotonin and cognition. Words don't come, names slip, mood swings hit harder.
Cycle changes & bleeding
Shorter, longer, heavier, or just unpredictable. Most are hormonal — some patterns warrant a closer look.
Hot flashes & night sweats
The classic ones. Often respond well to systemic hormone therapy, with non-hormonal options too.
Painful sex & vaginal dryness
Genitourinary syndrome of menopause (GSM) is hugely undertreated. Vaginal estrogen and other options work.
Joint aches & body changes
Estrogen has anti-inflammatory effects throughout the body. When it drops, joints stiffen and ache.
Recurrent UTI symptoms
Often urethral atrophy from GSM, not actual infection. Antibiotics won't fix it. Vaginal estrogen often does.
Heart palpitations
Brief episodes of racing or fluttering, often around hot flashes. Usually benign in this context but worth mentioning.
Anything else
Headache patterns shifting, libido changes, weight changes, hair changes — bring it. We'd rather know.
What We Offer
We discuss the full range of options and you decide what fits. We don't push hormone therapy and we don't refuse it without a real reason.
Hormone therapy (HRT)
FDA-approved bioidentical estradiol (patches, gels, oral) and micronized progesterone. We use modern, evidence-based regimens — not the formulations from the 2002 WHI study that made hormone therapy controversial.
Vaginal estrogen
Cream, tablet, ring, or insert. The gold standard for genitourinary symptoms. Systemic absorption is minimal — a very different safety profile than systemic HRT.
Non-hormonal options
SSRIs/SNRIs and gabapentin for hot flashes and mood. Vaginal moisturizers and DHEA. Ospemifene for painful sex. Real alternatives, not afterthoughts.
Hormonal IUD as HRT progestin
If you have a hormonal IUD (Mirena), it counts as the progestin component of hormone therapy — so you only need to add estrogen. One of the cleanest HRT setups available.
Bleeding evaluation
For cycle changes that warrant a closer look — pelvic ultrasound, endometrial biopsy in office with full comfort measures (nitrous, TENS, cervical block), and the workup that goes with it.
Surgical menopause care
If you've had bilateral oophorectomy at a younger age, you need a different approach to long-term hormone continuity. Stopping at 50 because that's the 'natural' age isn't appropriate.
Trans & gender-diverse care
Care that fits if you're on gender-affirming hormones, post-surgery, or navigating reproductive aging outside the standard playbook. We don't assume — we ask.
Bone & cardiovascular check-ins
Coordinating screenings (DEXA, lipids, blood pressure) with your hormone plan and your overall picture. Menopause is a good moment to recalibrate preventive care.
What to Expect at a Menopause Consultation
Book a consultation
Available in office in Kensington, MD or via telehealth in 12+ states. We schedule extra time so we can actually talk through your symptoms, history, and goals.
We talk it through
Cycle pattern, sleep, mood, sex, urinary symptoms, family history, what's bothering you most. We rule out other causes (thyroid, iron, sleep apnea) when needed.
Options & honest tradeoffs
We walk through what's available — hormone therapy, vaginal estrogen, non-hormonal options. We discuss risks honestly, including any history that affects what's appropriate. You decide.
Start, follow up, adjust
If you start treatment, we follow up to see how you're doing. Doses, formulations, and delivery methods get adjusted based on how you actually feel — not on a fixed protocol.
Ongoing care
Annual exams, screening updates, refills, and check-ins via the patient portal. Your provider stays involved long-term, not just for a one-off visit.
Read More
Is This Perimenopause? Symptoms That Get Dismissed
What gets blamed on stress or aging that's actually hormones — and why other providers miss it.
Read more →Menopause Hormone Therapy: What the WHI Study Got Wrong
Two decades of follow-up tells a very different story than the 2002 headlines.
Read more →Non-Hormonal Options for Menopause Symptoms
If you can't or don't want to use hormones, you still have real options.
Read more →What to Expect at a Menopause Consultation
A step-by-step look at what a consultation with us actually involves.
Read more →Painful Sex After 40? It's Probably GSM
Genitourinary syndrome of menopause is hugely undertreated and very treatable.
Read more →Bleeding in Perimenopause: What's Normal, What to Get Checked
Most cycle changes are hormonal. A few patterns warrant a closer look.
Read more →Birth Control During Perimenopause
Pregnancy is less likely in your 40s, but still possible. Options that double as symptom management.
Read more →Trans Patients and Menopause
Care that fits when the standard playbook doesn't.
Read more →Insurance & Cost
We accept CareFirst, Anthem, BCBS, Aetna, Cigna, and UHC. Annual preventive visits are covered with no out-of-pocket cost under the ACA. FDA-approved hormone therapy is covered under standard pharmacy benefits. We do not accept Medicaid, Medicare, or Tricare.
Ready to Talk About It?
Book a menopause consultation — in office or via telehealth. We schedule extra time so we can actually hear what's going on.
Schedule Now