You are not losing your mind. Your hormones are changing.

Perimenopause is the transition period leading up to menopause, when hormones begin to fluctuate. It can start in your late 30s or 40s and last several years. Menopause is officially the point when you have gone 12 consecutive months without a period. Symptoms can be similar during both phases, and treatment is often needed years before you technically reach menopause.

For most women, current evidence supports that hormone therapy is safe and effective when started at appropriate times and monitored properly. The concerns raised by the original Women's Health Initiative study have been refined by decades of subsequent research. At NEOS, hormone therapy is always personalized based on your individual health history, labs, and risk factors, with ongoing safety monitoring.

Bioidentical hormones have the exact molecular structure as the hormones your body naturally produces. NEOS prescribes FDA approved bioidentical estradiol and progesterone rather than synthetic versions, which allows for more precise dosing and better tolerability for most patients.

Yes. Women produce testosterone throughout their lives and it plays an important role in libido, mood, energy, muscle mass, and cognitive function. When testosterone levels decline, women can experience symptoms that estrogen and progesterone alone do not resolve. Low dose testosterone can be a safe and effective part of a complete menopause protocol.

You do not have to wait until menopause. Perimenopausal symptoms can begin in your late 30s and 40s and often benefit from treatment years before your final period. Current evidence supports starting hormone therapy in the perimenopausal or early menopausal window, generally within 10 years of your final period, for the best safety and benefit profile.

This is decided individually based on your symptoms, risk factors, and goals. Many women benefit from long term hormone therapy well beyond the traditional five year window that older guidelines suggested. NEOS reassesses your protocol regularly and adjusts as your needs change.

A comprehensive baseline that includes CBC, CMP, full thyroid panel (TSH, free T3, free T4, thyroid antibodies), estradiol, progesterone, testosterone (total and free), DHEA-S, cortisol, FSH, LH, metabolic markers such as fasting insulin, HbA1c, and a full lipid panel, plus micronutrient testing to identify deficiencies that can drive fatigue, mood, and hormone imbalance.

Yes, as add-on testing when clinically indicated. MIRA monitor is an at-home device that tracks estrogen (E3G), LH, PdG (progesterone metabolite), and FSH from urine samples. It is especially useful in perimenopause because you can see exactly what your cycle is doing day by day and tie hormone shifts directly to your symptoms. DUTCH testing (Dried Urine Test for Comprehensive Hormones) shows how your body is metabolizing sex hormones and cortisol across the day, which is helpful for detox patterns, estrogen dominance, and adrenal rhythm issues that blood work cannot see. Four-point salivary cortisol testing evaluates HPA axis function and is helpful for chronic stress, unexplained fatigue, and burnout patterns.