Hot flashes & sleep
Hot flashes, night sweats, chills and sleep disruption that affect energy or concentration.
Folsom, California
Perimenopause & Menopause Care
Hot flashes? Poor sleep? Periods changing?
Understand your symptoms and explore hormonal and nonhormonal treatments that fit your health and preferences.
Call us · (916) 269-8865What would you like help with?
Symptoms can have more than one cause; evaluation can help identify what may be contributing.
Explore care
Changing or heavy periods
Cycles may change during perimenopause; unusually heavy or concerning bleeding deserves evaluation.
Mood, focus & energy
Irritability, anxiety, low mood, memory lapses or difficulty concentrating.
Vaginal & sexual health
Dryness, irritation and discomfort with sex may be related to genitourinary syndrome of menopause (GSM).
Bladder & pelvic support
Urgency, leakage or pelvic floor symptoms can affect comfort and daily activities.
Weight, bones & prevention
Changes in body composition and bone or cardiovascular health are part of midlife care conversations.
A quick introduction
A quick introduction to menopause
This short educational video introduces common changes. Around 80% of women experience hot flashes during the years around menopause, though symptoms and their impact vary. This is context—not a diagnosis or a reason to assume every symptom is hormonal.
12 monthswithout a period is the usual milestone for identifying natural menopause, when there is no other cause.
The Menopause Society · 2024 source
A common transition, lived differently
You can have symptoms while you still have periods.
Most natural menopause occurs between ages 45 and 55. Menopause is identified after 12 months without a menstrual period when there is no other cause. Symptoms vary widely; some people have few or none, while others want support well before periods stop.
Perimenopause
The transition leading up to menopause. Periods may become less predictable and symptoms can begin as hormone levels fluctuate. Pregnancy is still possible, so contraception may still matter.
Menopause
A point in time—not a long phase—identified retrospectively after 12 consecutive months without a period, when another cause is not responsible. The average age in the United States is 51.
Postmenopause
The years following menopause. Symptoms and health priorities can change over time; vaginal comfort, preventive care, bone health and cardiovascular health remain worth discussing.
Treatment education
Managing menopause symptoms
Watch ACOG’s overview, then explore the treatment options below. Your symptoms, health history and preferences guide the discussion.
Compare the options
What can help—and how do I choose?
Explore treatment options based on your symptoms, health history, and preferences.
Systemic hormone therapyCan help hot flashes and night sweats; benefits and risks depend on your history, timing and formulation.Explore options
Systemic menopausal hormone therapy is the most effective treatment for hot flashes and night sweats and can help prevent bone loss while used. FDA-approved estradiol is available in patches, gels, sprays, and tablets. If you have a uterus, systemic estrogen generally needs progestogen or another approved uterine-protective regimen.
Risks vary by formulation, route, timing, duration, and personal history. They may include blood clots, stroke, gallbladder disease, and certain cancers. Review risks individually and reassess regularly. Hormone therapy is not contraception or prevention for heart disease, dementia, or aging.
Nonhormonal treatmentMedication options for hot flashes may suit people who prefer not to use hormones or need alternatives.Explore options
Options for hot flashes may include certain SSRIs or SNRIs, gabapentin, and fezolinetant; some uses are off-label. Fezolinetant can cause serious liver injury and requires liver testing before and during treatment as specified in current prescribing guidance.
Vaginal & sexual health careOptions for dryness, irritation and discomfort with sex are individualized to symptoms and health history.Explore options
Vaginal moisturizers and lubricants may improve comfort. Depending on symptoms and health history, options can include low-dose vaginal estrogen, vaginal prasterone, or oral ospemifene. These are distinct from systemic hormone therapy.
Infection and other causes may need evaluation. A history of breast cancer or another hormone-sensitive condition calls for an individualized discussion. Bleeding after menopause should be evaluated promptly.
Bladder & pelvic support careLeakage, urgency and pelvic floor symptoms deserve evaluation; they are not automatically caused by menopause.Explore options
Urinary urgency, leakage or pelvic floor symptoms warrant evaluation that considers the symptom pattern, health history and possible contributors rather than assuming a hormonal cause.
Leakage with coughing or activity, urgency or frequency, and pelvic pressure or vaginal bulging can point to different concerns. Depending on evaluation, care may include pelvic-floor assessment or referral, pessary fitting and management, or a surgical consultation. No single option is right for every symptom or person.
Changing or heavy periods
Evaluation may review the bleeding pattern, last period, pregnancy possibility, medicines and health history. Tests may be considered when indicated to clarify possible causes.
Depending on the cause, medical treatment or a procedure may be discussed alongside your preferences and health history.
Mood, focus and energy
Mood, concentration and energy changes can occur during the menopause transition. Sleep disruption, medicines, health history and other health concerns may also contribute.
Evaluation considers the symptoms and possible contributors, including whether examination or tests could clarify the picture. Hot-flash medicines are not automatically the right treatment for mood or focus concerns.
Weight, bones and prevention
Bone assessment is based on age, health history and individual risk. Changes in weight or body composition may have several contributors, including activity, sleep, medicines and health conditions.
Discuss age- and risk-appropriate screening, nutrition and strength or weight-bearing activity. Hormone therapy is not used for weight loss or to prevent heart disease.
Background on menopause care: NICE guideline NG23 · ACOG: The menopause years
Biote & BHRT hormone pellets: what to know
Haven OBGYN offers Biote hormone pellet therapy. It is one option to discuss during an individualized menopause consultation—not a requirement for care. Your provider can compare pellets with FDA-approved hormone treatments and nonhormonal options based on your symptoms, health history and preferences.
What are Biote and BHRT?
Biote describes a method of bioidentical hormone replacement therapy (BHRT) using small, compounded hormone pellets placed under the skin. Its patient information describes estradiol and testosterone pellets. The specific hormone, formulation and whether treatment is appropriate require a clinical discussion.
“Bioidentical” describes hormones with the same chemical structure as those made by the body. FDA-approved estradiol and micronized progesterone are available. Compounded preparations—including pellets—are not FDA-approved and are not proven safer or more effective. ACOG recommends FDA-approved preparations when available.
What does the pellet process involve?
- Consultation and assessment. Review symptoms, menstrual history, medicines, previous treatment and relevant risks. Biote describes laboratory testing as part of its pellet assessment. This is different from needing routine hormone testing to diagnose menopause; lab results alone do not establish a need for pellets.
- In-office placement. Biote describes numbing an area near the upper buttock, making a small incision and placing pellets under the skin, then covering the site with a dressing. Pellets gradually release hormone as they dissolve.
- Aftercare and follow-up. Follow the clinic’s instructions for wound care, exercise, bathing and swimming. Review symptom response, side effects and any recommended monitoring before deciding on further treatment. Biote describes pellet cycles lasting roughly three to six months, but duration varies; repeat treatment is not automatic.
Potential benefits, limitations and alternatives
Pellets deliver hormone over several months without a daily dose. Systemic estrogen can relieve hot flashes and night sweats, but this does not establish that compounded pellets are better or safer than approved treatments. Response varies, and improvement is not guaranteed. Patches, gels, tablets, local vaginal treatments and nonhormonal therapies may offer more appropriate or more easily adjustable options.
Risks and questions to review
- Compounded pellets are difficult to adjust or stop once inserted; discuss what happens if side effects occur.
- Insertion can cause bruising, bleeding, infection, or pellet extrusion. Hormone-related risks also remain.
- Systemic estrogen risks can include blood clots, stroke and certain cancers, depending on your treatment and history. If you have a uterus, systemic estrogen generally requires progestogen or another approved uterine-protective regimen.
- No testosterone product is FDA-approved for menopausal symptoms in women in the United States. Testosterone is not a general treatment for fatigue, weight loss, or brain fog.
- Testosterone can cause acne, increased facial or body hair, hair loss and voice changes; some effects may not reverse. Discuss dosing, monitoring and alternatives before treatment.
Tell your provider about unexplained bleeding, a history of blood clots, stroke, liver disease, or hormone-sensitive cancer. These can change which treatments are suitable. Bleeding after menopause needs prompt evaluation, even if it occurs while using hormones.
Process information summarized from Biote’s “The Biote Method Using Pellets” and “Pellet Therapy FAQs.” The safety and regulatory context above reflects ACOG and FDA guidance; company descriptions do not establish comparative safety or effectiveness.
Ask about the exact preparation, evidence, alternatives, uterine protection when needed, monitoring, adverse-effect plans, and cost. An MRS score or hormone level alone does not determine eligibility.
Discuss hormone treatment optionsSleep and lifestyle support
Cognitive behavioral therapy can help with the impact of hot flashes and sleep concerns. Sleep routines, physical activity, smoking cessation, and nutrition support overall health. “Natural” supplements are not automatically safe or effective.
Midlife health is more than symptom relief. Discuss bone-density screening and fracture risk, strength and weight-bearing activity, blood pressure, cholesterol, diabetes risk, and age-appropriate screening. Hormone therapy is not used to prevent heart attacks, strokes, or dementia.
Your visit
What to Expect at Your Menopause Appointment
You don’t need to know whether your symptoms are caused by menopause—or which treatment you want—before scheduling.
Tell us what’s changed
Discuss symptoms, period changes, health history and what has been most difficult.
Understand what may be contributing
Symptoms, sleep, medicines and health history help guide whether an examination or tests could clarify possible causes or inform care.
Build a plan together
Review available options, benefits and risks based on your preferences.
What to bring
- Medication and supplement list
- Last period date and bleeding changes
- Relevant test results or treatment records
- Your questions and treatment priorities
Routine hormone testing is not needed for everyone. Your care plan starts with your concerns and health history.
Request a Menopause AppointmentMenopause Symptom Check
Use the 11-question Menopause Rating Scale (MRS) to describe how symptoms affect your daily life.
Take the Symptom Check
Rate each item for how you feel now
Choose one number for all 11 items. There are no right or wrong answers. Your responses are calculated in this browser only; this tool does not store, submit, or send them as health-data analytics.
0 · None1 · Mild2 · Moderate3 · Severe4 · Very severe
0 of 11 answered. Complete all 11 to see a total and domain scores.
Somatic symptoms · 4 items · maximum 16
Psychological symptoms · 4 items · maximum 16
Urogenital symptoms · 3 items · maximum 12
—Total out of 44
Somatic · /160
Psychological · /160
Urogenital · /120
Reference bands: 0–4 minimal, 5–8 mild, 9–15 moderate, 16+ severe. These describe symptom severity—not a diagnosis or treatment threshold. A bothersome symptom is worth discussing at any score. Bleeding after menopause needs prompt evaluation regardless of your result.
Watch: Managing menopause symptoms
Educational video only; it is not tailored to your symptom score or an individual treatment plan.
Scoring: add all 11 item ratings (0–4) for a total of 0–44. Somatic items are 1–3 and 11 (maximum 16); psychological items 4–7 (maximum 16); urogenital items 8–10 (maximum 12). The MRS was developed and validated to measure symptom severity, not to choose care. No answers are stored or sent by this tool.
A conversation aid—not a diagnosis. You can request care at any score.
Sources: MRS validation study · MRS scoring and outcome measure
Care over time
Your plan can change as your needs change.
Symptoms, priorities and treatment preferences may shift. Follow-up is a chance to review what is helping and reconsider the plan.
- 1
Initial evaluation
Discuss symptoms, menstrual history, health history and whether evaluation for another cause is appropriate.
- 2
Care plan
Compare options for your concerns, including potential benefits, limitations and risks.
- 3
Follow up & adjustment
Revisit your response, side effects and goals; adjust the approach when needed.
Questions about menopause care
Find answers about symptoms, treatment choices and what to expect.
Symptoms & changes
How do I know if I’m in perimenopause or menopause?
Perimenopause is the transition leading up to menopause. Changing periods, hot flashes, night sweats, disrupted sleep, or vaginal dryness may be clues. Natural menopause is identified after 12 consecutive months without a period when there is no other explanation. The average age is about 51, but symptoms can begin years earlier. Haven can review your symptoms and history and consider other causes.
Source: ACOG: Patient care guidance
Can I have menopause symptoms while I’m still having periods?
Yes. Perimenopause symptoms can begin while periods are changing. You do not need to wait 12 months without a period to ask for an evaluation or discuss treatment; that milestone identifies natural menopause, not eligibility for care.
Source: NICE: Menopause guidance
Do I need blood tests to check my hormone levels?
Usually not. For most otherwise healthy people aged 45 or older with typical symptoms, assessment is based on symptoms and menstrual history. Hormone levels fluctuate, so a single normal result does not rule out perimenopause. Testing may help at younger ages, when the picture is unclear, or when another condition could explain symptoms. Hormonal contraception can make assessment less straightforward.
Source: NICE: Menopause guidance
How long do menopause symptoms last?
The experience varies. Hot flashes and night sweats often last several years and may continue longer; vaginal dryness may persist or worsen without treatment. You do not have to wait for symptoms to become severe before asking for help.
Source: ACOG: Patient care guidance
Can menopause cause anxiety, brain fog, or poor sleep?
Hormone changes, night sweats, and interrupted sleep can affect mood and concentration. Persistent or worsening symptoms deserve evaluation for other causes too. Hormone therapy is not recommended specifically to prevent dementia or improve cognition.
Source: ACOG: Patient care guidance
Why am I gaining weight, especially around my waist?
Hormonal changes can shift fat toward the abdomen, while aging, muscle loss, sleep, activity, and nutrition also influence weight. Strength training, regular movement, adequate sleep, and sustainable nutrition habits can help. Hormone therapy is not a weight-loss treatment.
Source: ACOG: Patient care guidance
What can help with vaginal dryness or painful sex?
Vaginal moisturizers provide ongoing moisture, while lubricants reduce friction during sex. If symptoms continue, low-dose vaginal estrogen or other prescription treatments may help. Pain deserves evaluation because infections, skin conditions, and pelvic floor problems can also contribute.
Explore vaginal and sexual health care
Source: ACOG: Patient care guidance
Is a lower sex drive normal during menopause?
Changes in desire are common but are not inevitable. Pain, poor sleep, medications, mood, relationship factors, and hormonal changes can all contribute. If the change bothers you, an evaluation can help identify causes and appropriate treatment.
Source: ACOG: Patient care guidance
Are irregular or heavy periods normal during perimenopause?
Periods often change, but heavy, prolonged, or frequent bleeding should be evaluated. Bleeding between periods or after sex also needs attention. Hormonal changes may contribute, but fibroids, polyps, and changes in the uterine lining are other possible causes.
Source: ACOG: Patient care guidance
Can I still get pregnant during perimenopause?
Yes. Pregnancy is possible while periods are changing. Menopausal hormone therapy is not contraception. Discuss your contraception needs with your clinician.
Source: FDA: Menopause information
Treatment options
What helps with hot flashes and night sweats?
Systemic menopausal hormone therapy is the most effective treatment. If hormones are unsuitable or you prefer another approach, certain prescription nonhormonal medicines and menopause-focused cognitive behavioral therapy may help. Treatment depends on your symptoms, medical history, and preferences.
Explore nonhormonal treatment options
Source: ACOG: Patient care guidance
What is the difference between hormone patches, pills, and vaginal estrogen?
Patches and pills deliver hormones throughout the body to treat symptoms such as hot flashes. Low-dose vaginal estrogen mainly treats vaginal and urinary symptoms, with much less absorption into the bloodstream; it does not treat hot flashes. If you have a uterus, systemic estrogen generally needs a progestogen to protect the uterine lining.
Explore systemic hormone therapy
Source: ACOG: Patient care guidance
Do natural remedies or supplements work?
Evidence for most menopause supplements is limited or inconsistent. Natural does not guarantee safety, and products may interact with medicines. Bring a list of supplements to your visit so your clinician can review benefits, risks, and alternatives.
Source: FDA: Menopause information
How can Haven OBGYN help?
At Haven OBGYN, we evaluate perimenopause and menopause symptoms, review your medical history and priorities, and discuss hormonal and nonhormonal options. Care can address hot flashes, sleep disruption, vaginal discomfort, sexual health, abnormal bleeding, and midlife health concerns.
Do I need progesterone with estrogen?
If you have a uterus and use systemic estrogen, a progestogen is generally needed to protect the uterine lining. This is not a universal requirement with low-dose vaginal estrogen; the specific treatment and your history matter.
Source: ACOG: Patient care guidance
How long would I use hormone therapy?
There is no universal stop date. Duration is individualized to your symptoms, goals, response, and risks, with treatment reviewed at least yearly.
Source: ACOG: Patient care guidance
Safety & follow-up
Is hormone replacement therapy safe?
For many healthy people with bothersome symptoms who are younger than 60 or within ten years of menopause, benefits may outweigh risks. This is not a guarantee of safety: your medical history, formulation, route, dose, and duration matter. Risks can include blood clots, stroke, gallbladder disease, and certain cancers. Systemic therapy is not used to prevent heart disease, stroke, or dementia. Review benefits and risks with your clinician.
Source: ACOG: Patient care guidance
What if I bleed after menopause?
Contact your clinician promptly for any vaginal bleeding after 12 months without periods, even light spotting or a single episode. Many causes are benign, but evaluation is important to rule out precancerous changes or uterine cancer. Do not use a symptom score to decide whether to seek care.
Source: ACOG: Patient care guidance
Is hormone therapy appropriate for my health history?
A history of breast or endometrial cancer, stroke or heart attack, blood clots, liver disease, unexplained bleeding, or pregnancy calls for individualized review before systemic hormone therapy. These details can change which options are appropriate.
Source: ACOG: Patient care guidance
What side effects should I report?
Breast soreness, bloating, and headache can occur. Tell your clinician about troublesome or new side effects. New bleeding should be discussed promptly; bleeding after menopause needs prompt evaluation, even if it happens once.
Source: FDA: Menopause information
Biote & BHRT
Are bioidentical hormones or pellets safer?
Bioidentical describes hormones chemically identical to those your body produces; some FDA-approved estradiol and progesterone medicines meet that definition. Compounded preparations and pellets have not been shown safer or more effective than FDA-approved options. ACOG recommends FDA-approved treatments rather than routinely using compounded menopausal hormones when approved options are available. Compounded pellets are not FDA-approved and can be difficult to adjust or stop after insertion.
Biote, pellet therapy, and alternatives
Source: ACOG: Patient care guidance
What assessment and follow-up come with Biote pellets?
Haven OBGYN offers Biote pellet therapy. Assessment considers symptoms, health history, risks, and preferences; an MRS score or hormone level alone does not determine eligibility. Follow-up reviews response and side effects before any further treatment. Repeat treatment is not automatic, and FDA-approved alternatives should be discussed.
Biote, pellet therapy, and alternatives
Source: ACOG: Patient care guidance
This page is general education and does not replace medical advice, diagnosis, or individualized treatment recommendations.
Bleeding after menopause?
Any vaginal bleeding after 12 months without a period needs prompt evaluation—even if it is light or happens once. Your symptom score should never determine whether you seek care.
When else should you consider a conversation?
- Hot flashes, night sweats, sleep, mood, or concentration are affecting daily life.
- Period changes are concerning, unusually heavy, or difficult to manage.
- Vaginal dryness, pain with sex, or urinary symptoms affect comfort.
- You want to understand hormone or nonhormonal treatment benefits and risks.
- You are unsure whether changes are related to menopause or something else.
Haven OBGYN · Folsom
Let’s talk about what has changed.
Bring your questions. We’ll help you understand your options.