Perimenopause and Menopause Care

The years around menopause can bring hot flashes, poor sleep, mood changes and cycle changes. We listen, explain what is happening, and help you weigh hormone and nonhormonal options so you can choose what fits your life.

Become a Patient

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Understanding Perimenopause and Menopause

Menopause is the point when periods have stopped for 12 months in a row because the ovaries have slowed their hormone production. For most women it happens naturally in the early 50s. Perimenopause is the transition leading up to it, often beginning in the 40s and lasting several years. During this time estrogen and progesterone levels rise and fall unpredictably, which is why symptoms can come and go and periods can become irregular. Postmenopause refers to the years after that final period. Each stage is a normal part of life, but the symptoms are real and they deserve attention.

Most menopause is natural, but it can also follow surgery that removes the ovaries, or treatments such as chemotherapy. When periods stop before age 40, it is called primary ovarian insufficiency and needs its own evaluation. Smoking can bring menopause earlier. Lower estrogen affects more than periods. It can thin the tissue of the vagina and urinary tract, speed up bone loss and change cholesterol levels. Some symptoms of this stage overlap with other conditions, such as thyroid disease, anemia, depression and sleep disorders, so a careful look at the whole picture matters.

Care matters because effective options exist, and no one needs to simply push through years of poor sleep or hot flashes. Hormone therapy and nonhormonal treatments both have a place, and the right choice depends on your symptoms, health history and preferences. Most of this conversation works well by telehealth. Your provider may order labs at a local lab, such as thyroid levels or a blood count, and a bone density scan at a local imaging center when it is due. Pap tests and pelvic exams need an in-person visit, and we will help you arrange one. Any bleeding after menopause needs prompt evaluation.

Signs & Symptoms of Perimenopause and Menopause

Changes in your cycle. Periods may come closer together or further apart, get heavier or lighter, or skip months.
Hot flashes. Sudden waves of heat in the face, neck and chest, often with flushing and sweating, are among the most common symptoms.
Night sweats. Hot flashes during sleep can soak your sheets and wake you up.
Trouble sleeping. Falling asleep, staying asleep or waking too early can happen even without night sweats.
Mood changes. Irritability, anxiety, low mood or feeling less like yourself can show up during the transition.
Vaginal dryness. Thinner, drier tissue can cause itching, burning or pain with sex.
Urinary changes. Urgency, more frequent urination or more urinary tract infections can follow lower estrogen.
Brain fog and joint aches. Trouble concentrating, forgetfulness and achy joints are commonly reported.

What to Expect

A telehealth visit to talk through your symptoms, cycle changes, sleep, mood and health history
Labs at a local lab when they help rule out other causes, such as thyroid problems or anemia
An honest discussion of hormone therapy and nonhormonal options, including benefits and risks, so you and your provider can decide together
Attention to bone, heart and vaginal health, with a bone density scan at a local imaging center when it is due
Help arranging an in-person visit for Pap tests, pelvic exams and other hands-on care

How We Care for Perimenopause and Menopause

Assessment

We start with a video visit to talk through your symptoms, cycle pattern, sleep, mood and what is bothering you most. We review your personal and family history of blood clots, stroke, heart disease and breast cancer, since these shape your options. Hormone tests are usually not needed to recognize perimenopause after age 45, but labs may help rule out other causes.

Treatment Plan

Together we weigh your options. Hormone therapy is the most effective treatment for hot flashes and night sweats, and we discuss its benefits and risks for you specifically. Nonhormonal medicines, low-dose vaginal estrogen, moisturizers and lifestyle steps are also on the table. The decision is shared, and you set the pace.

Ongoing Care

We check in on how your symptoms are responding, watch for side effects and adjust doses or switch approaches as needed. At least once a year we revisit whether your plan still fits. We also keep up with bone health, cholesterol, blood pressure and other screenings as you move through this stage.

Benefits

Shared Decisions

You receive clear, balanced information about each option so you can choose with confidence, not pressure.

Experience in Women's Health

Brooke Tuttle, FNP-C, is a board-certified family nurse practitioner who has practiced family medicine since 2017 and places an emphasis on all aspects of women's health. Before becoming a nurse practitioner, she spent 11 years as a registered nurse in labor and delivery, postpartum and well-baby nursery care.

Care From Home

Visits happen by video for patients located in Utah, so you can talk openly from a comfortable, private space.

Your Treatment Journey

First Visit (Week 1)

We talk through your symptoms, history and goals by video. Your provider may order labs at a local lab and, if it is due, a bone density scan at a local imaging center.

Weeks 2 to 4

We review any results and choose a starting plan together, whether that is hormone therapy, a nonhormonal medicine, a vaginal treatment or lifestyle steps.

Months 2 to 3

Many treatments take a few weeks to reach full effect. We review how you are sleeping and feeling, address side effects and adjust the plan.

Long-Term Care

Symptoms can change over the years. We revisit your plan at least yearly, keep up with bone and heart health, and help you arrange in-person care such as Pap tests when it is due.

Warning Signs That Need Prompt Care

Bleeding after menopause. Any bleeding or spotting after 12 months without a period needs prompt evaluation.

Very heavy bleeding. Soaking through a pad or tampon every hour for several hours, or passing large clots, needs urgent care.

Bleeding between periods or after sex. New bleeding patterns during perimenopause should be checked.

Pain or swelling in one leg. This can signal a blood clot, especially if you take estrogen, and needs prompt care.

Chest pain or sudden shortness of breath. These can signal a blood clot in the lung or a heart problem and need emergency care.

Signs of stroke. Sudden weakness or numbness on one side, trouble speaking, a drooping face or a sudden severe headache need emergency care.

A new breast lump or change. Any new lump, skin dimpling or nipple discharge should be evaluated promptly.

Severe low mood. If you have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline.

If you have chest pain, sudden shortness of breath, signs of stroke, or heavy bleeding with dizziness or fainting, call 911 or go to the nearest emergency room.

When to Reach Out

If these changes sound familiar, you do not have to wait them out. Reach out through our contact page to talk about your options.

Evidence-Based Treatment

Current guidance from menopause experts supports hormone therapy as the most effective treatment for hot flashes and night sweats. For healthy women who are under 60 or within 10 years of menopause, the benefits often outweigh the risks, which include blood clots, stroke and, with some combined regimens used over time, a small rise in breast cancer risk. Women with a uterus who take estrogen also need a progestogen to protect the uterine lining. Hormone therapy is not a good fit for everyone, such as women with a history of breast cancer, blood clots or stroke. Nonhormonal options include certain antidepressants (SSRIs and SNRIs), gabapentin and fezolinetant, a newer medicine that acts on the brain's temperature control center, and cognitive behavioral therapy can ease hot flashes and sleep problems. Vaginal dryness often responds to moisturizers, lubricants or low-dose vaginal estrogen. Bone health is supported by weight-bearing exercise, enough calcium and vitamin D, not smoking, and bone density screening at age 65, or earlier when risk factors are present.

Common Questions About Perimenopause and Menopause

Is hormone therapy safe?

For many healthy women who start it before age 60 or within 10 years of menopause, the benefits of hormone therapy for symptoms outweigh the risks. Risks include blood clots, stroke and, with some combined forms used over time, a small increase in breast cancer risk. Your personal and family history matters a lot, so your provider will go over your specific benefits and risks before you decide.

Do I need a blood test to know if I am in perimenopause?

Usually not. For women over 45, perimenopause is typically recognized by symptoms and cycle changes, because hormone levels swing from day to day and a single test can be misleading. Labs may still help rule out other causes, such as thyroid problems or anemia, and testing can be more useful for younger women or after a hysterectomy.

Can menopause care be handled by telehealth?

Much of it can. Talking through symptoms, reviewing your history, discussing treatment options and adjusting medicines all work well by video for patients located in Utah. Labs are ordered to a local lab and a bone density scan to a local imaging center. Pap tests, pelvic exams and breast exams need an in-person visit, and we will help you arrange one.

What if I cannot or do not want to take hormones?

There are good nonhormonal options. Certain antidepressants, gabapentin and newer medicines that act on the brain's temperature control can reduce hot flashes. Cognitive behavioral therapy, regular activity, cooling strategies and better sleep habits can help too. For vaginal dryness, moisturizers and lubricants are a good first step.

Can I still get pregnant during perimenopause?

Yes. Ovulation can still happen even when periods are irregular. If you do not want to become pregnant, birth control is generally recommended until you have gone 12 months without a period, or until your provider confirms you no longer need it based on your age and the method you use.

Does insurance cover menopause care?

Sagebrooke Family Medicine is an insurance-based practice, and we are currently joining insurance plans. Your costs depend on your plan, including any copay, deductible or coinsurance. Contact the practice to find out whether your plan is accepted, and check with your insurer about coverage for medications, labs and bone density scans.

Talk Through Your Options

Reach out through our contact page to ask about a telehealth visit for perimenopause or menopause care, for patients located in Utah.