Women’s Hormone Optimization, Perimenopause & Menopause Care in Beverly Hills & Los Angeles
Women’s hormone care should start with the symptoms, medical history, stage of life, and individual risk profile—not with a one-size-fits-all hormone panel. At My Concierge MD, David Nazarian, MD evaluates women with concerns related to perimenopause, menopause, menstrual changes, sleep, mood, hot flashes, vaginal or urinary symptoms, libido, bone health, and other possible hormone-related concerns.
This page combines our previous Women’s Hormone Optimization and Menopause Support content into one comprehensive resource. Treatment may include lifestyle measures, nonhormonal options, or menopausal hormone therapy when appropriate after shared decision-making.
Perimenopause and Menopause
Perimenopause is the transition leading up to menopause, when ovarian hormone production becomes less predictable and menstrual cycles may change. Menopause is diagnosed after 12 consecutive months without a menstrual period when no other cause explains the change. Symptoms and timing vary significantly from one woman to another.
Common Symptoms
- Hot flashes and night sweats
- Sleep disturbance
- Mood changes or irritability
- Changes in menstrual bleeding during perimenopause
- Vaginal dryness, discomfort, or urinary symptoms
- Changes in libido or sexual function
- Fatigue or reduced sense of well-being
- Changes in body composition or weight
These symptoms are not specific to menopause. Thyroid disease, anemia, sleep disorders, medication effects, depression or anxiety, metabolic disease, and other conditions may produce similar symptoms and should be considered when clinically appropriate.
How Women’s Hormone Concerns Are Evaluated
Evaluation begins with a review of symptoms, menstrual history, medications, pregnancy or fertility considerations when relevant, personal and family medical history, blood pressure, cardiovascular and metabolic risk factors, and cancer history. Laboratory testing is selected according to the clinical question rather than ordered as a universal panel.
Depending on the situation, testing may include thyroid studies, blood counts, metabolic testing, and selected reproductive or androgen-related hormones. During the typical menopausal transition, hormone levels can fluctuate and a single estradiol or FSH value does not always explain symptoms.
Menopausal Hormone Therapy
Menopausal hormone therapy can be an effective treatment for bothersome vasomotor symptoms such as hot flashes and night sweats and may also help selected genitourinary symptoms. The decision to use hormone therapy depends on symptom burden, age, time since menopause, medical history, contraindications, and individual preferences.
Estrogen may be delivered through oral, transdermal, or local vaginal formulations. Women with an intact uterus who use systemic estrogen generally require appropriate endometrial protection with a progestogen unless there is a specific reason otherwise. Route, dose, and formulation should be individualized.
Estrogen, Progesterone, and Bioidentical Hormones
The term “bioidentical” refers to molecular structure, not to whether a product is compounded or automatically safer. FDA-approved estradiol and micronized progesterone are examples of bioidentical hormones. Compounded hormone products may be appropriate in selected circumstances, but they are not inherently safer or more effective than FDA-approved products.
Vaginal and Urinary Symptoms
Genitourinary syndrome of menopause can include vaginal dryness, irritation, pain with intercourse, urinary urgency, or recurrent urinary symptoms. Management may include moisturizers and lubricants, local vaginal estrogen or other prescription options when appropriate, and evaluation for other causes of symptoms.
Nonhormonal Treatment Options
Hormone therapy is not the only option. Depending on the symptom and the patient’s medical history, nonhormonal prescription treatments, sleep optimization, exercise, nutrition, weight management, cognitive-behavioral strategies, and treatment of contributing medical conditions may be considered.
Bone, Cardiovascular, and Metabolic Health
The menopausal transition is also an opportunity to reassess bone health, cardiovascular risk, blood pressure, lipids, glucose, body composition, smoking status, physical activity, and age-appropriate cancer screening. Hormone therapy should not be prescribed solely as a general anti-aging treatment.
Who May Not Be a Candidate for Systemic Hormone Therapy?
Systemic menopausal hormone therapy may be inappropriate or require specialist input in patients with certain histories such as estrogen-sensitive malignancy, unexplained vaginal bleeding, active or prior thromboembolic disease, certain cardiovascular conditions, significant liver disease, or other individualized risk factors. Alternatives should be discussed when hormone therapy is not appropriate.
Monitoring and Follow-Up
Follow-up focuses on symptom response, side effects, blood pressure, new medical diagnoses, bleeding patterns, preventive screening, and whether the chosen therapy continues to have a favorable benefit-risk profile. The lowest effective dose and appropriate route are selected based on the individual patient rather than a target hormone number alone.
Frequently Asked Questions
What is the difference between perimenopause and menopause?
Perimenopause is the transition before menopause when cycles and symptoms may become irregular. Menopause is reached after 12 months without a menstrual period when another cause is not responsible.
Do I need hormone testing to diagnose menopause?
Not always. In many women over the typical age range, the diagnosis is based primarily on menstrual history and symptoms. Testing can be useful when the presentation is atypical or another condition is suspected.
Is hormone therapy safe?
Safety depends on the individual patient, formulation, dose, route, age, time since menopause, and medical history. Benefits and risks should be reviewed before treatment and reassessed over time.
Are bioidentical hormones safer?
Not simply because they are called bioidentical. Some FDA-approved hormones are bioidentical. Safety depends on the specific product, dose, route, indication, and patient rather than the label alone.
Can menopause symptoms be treated without hormones?
Yes. Several nonhormonal strategies and medications may help, depending on the symptom and the patient’s medical history.
Written by David Nazarian, MD
Board Certified in Internal Medicine
Founder, My Concierge MD
To discuss perimenopause, menopause, or women’s hormone concerns in Beverly Hills or Los Angeles, schedule a consultation with My Concierge MD.
Medically reviewed by David Nazarian, MD on