Hot flashes may be the symptom everyone talks about—but perimenopause can affect your sleep, mood, memory, sex life, weight, periods, energy, and much more.
And sometimes the first sign is simply:
“I don’t feel like myself anymore.”
At Hourglass, we provide personalized, evidence-based care to help women understand what’s changing, explore their treatment options, and feel like themselves again.
Perimenopause is the transition leading up to menopause and commonly begins in the 40s, although changes can begin earlier. During this time, ovarian hormone production becomes increasingly unpredictable.
Menopause is reached after 12 consecutive months without a menstrual period, and the average age is approximately 51.
You do not have to wait until your periods stop—or until your symptoms become unbearable—to ask for help.
You don’t need to have all 30. And you don’t need to have hot flashes to be experiencing perimenopause.
Think: ovulation, periods & uterine protection.
Progesterone is produced primarily after ovulation. As ovulation becomes less predictable during perimenopause, progesterone production can become more inconsistent.
This can contribute to changes in menstrual patterns. When systemic estrogen is prescribed to someone who still has a uterus, adequate progesterone or another progestogen is generally needed to protect the uterine lining.
Think: temperature, vagina, bones, brain & more.
Estrogen affects tissues throughout the body, including the brain, bones, cardiovascular system, skin, vagina, and urinary tract.
During perimenopause, estrogen doesn’t simply decline in a straight line—it can rise, fall, and fluctuate unpredictably. Eventually, ovarian estrogen production declines substantially around menopause.
Changes in estrogen are associated with symptoms such as hot flashes, night sweats, vaginal dryness, urinary symptoms, and changes in bone health.
Think: sexual function, muscle & overall androgen health.
Women produce testosterone too. Unlike the more dramatic hormonal changes surrounding the final menstrual period, testosterone generally declines gradually across adulthood rather than suddenly disappearing at menopause.
Testosterone plays roles in sexual function and other tissues, but symptoms such as fatigue, low mood, or weight gain should not automatically be attributed to “low testosterone.”
The important part: Menopause care isn’t about chasing a “perfect” hormone number. It’s about understanding your symptoms, health history, stage of menopause, risks, and goals.
Menopause care is not simply prescribing hormones.
Our medical team can help:
Identify What’s Happening
Review your symptoms, menstrual history, medical history, medications, family history, and risk factors to determine whether your symptoms are consistent with the menopause transition—and whether something else should be evaluated.
Discuss Hormone Therapy
For appropriate patients, menopausal hormone therapy can be highly effective, particularly for hot flashes and night sweats, and can also help certain other menopause-related symptoms.
Offer Nonhormonal Options
Hormone therapy isn’t appropriate for everyone—and not everyone wants it. Evidence-based nonhormonal treatments and lifestyle strategies are also available.
Address Vaginal & Sexual Health
Vaginal dryness, painful sex, urinary symptoms, and changes in sexual health are common and deserve treatment—not embarrassment.
Look Beyond Today’s Symptoms
Midlife is also an important time to consider bone health, cardiovascular risk, metabolic health, sleep, sexual health, and healthy aging.
Perimenopause is often diagnosed primarily from your age, menstrual changes, symptoms, and medical history rather than a single hormone test.
Hormone levels can fluctuate significantly during this transition, which means one “normal” result doesn’t necessarily explain—or invalidate—what you’re experiencing.
A clinician with specialized menopause education can help distinguish symptoms that may be related to the menopause transition from symptoms that deserve further evaluation and help you understand the benefits, risks, and alternatives of available treatments.
Our approach is simple:
Listen first. Evaluate carefully. Educate clearly. Treat individually.
Your consultation is your opportunity to talk about what’s actually been happening—not just your hot flashes.
During your visit we’ll review:
When appropriate, we’ll discuss treatment options that may include:
Your treatment plan is individualized to you.
Perimenopause and menopause are normal stages of life.
Suffering through them doesn’t have to be.
Whether your symptoms are just beginning or you’ve been struggling for years, we’re here to listen, educate, and help you understand your options.