Q & A

Check out some of our Frequently Asked Questions.

The gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called  perimenopause (literally meaning “around menopause”). It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention. 

Menopause, whether natural or induced, is called premature when it happens at age 40 or younger. This occurs in about 1% of women in the United States. Premature menopause that is not induced can be genetic, metabolic, autoimmune, or the result of other poorly understood conditions. Premature menopause should be evaluated thoroughly.

Menopause symptoms related to induced menopause can be similar to those from natural menopause, including hot flashes, sleep disturbances, and vaginal dryness. But premenopausal women who experience induced menopause can have more intense symptoms and, therefore, a greater need for treatment to control them than women who undergo natural menopause. And because you may be going through menopause at a young age, you need ongoing monitoring and sometimes treatment to lower your risk of menopause associated diseases, such as osteoporosis, later in life.

Women experiencing premature menopause (age 40 or younger) that is not medically induced go through perimenopause and may have the same symptoms as women with natural menopause, including hot flashes, sleep disturbances, and vaginal dryness. However, compared to women who reach menopause at the typical age, women who experience premature menopause—whether natural or induced—spend more years without the benefits of estrogen and are at greater risk for some health problems later in life, such as osteoporosis and heart disease. 

You may need a complete evaluation to diagnose the reason for your menopause — it could be an underlying condition that needs treatment. 

It is not a disease. Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility. Menopause occurs, on average, at age 51. It occurs most often between ages 45 and 55

The term “premenopause” refers to the phase of life that precedes menopause. For many women, it is an optimal time to reassess their health.

Postmenopause includes all the years beyond menopause, which is the date of your last menstrual period.

Each woman’s menopause experience is different. Many women who undergo natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stop when they reach menopause. Other changes may include hot flashes, difficulty sleeping, memory problems, mood disturbances, vaginal dryness, and weight gain. Not all these changes are hormone-related, and some, such as hot flashes and memory problems, tend to resolve after menopause. Maintaining a healthy lifestyle during this time of transition is essential for your health and can even prevent or blunt some of these changes.

Memory and other cognitive abilities change throughout life. Difficulty concentrating and remembering are common complaints during perimenopause and the years right after menopause. Some data imply that even though there is a trend for memory to be worse during the menopause transition, memory after the transition is as good as it was before. Memory problems may be more related to normal cognitive aging, mood, and other factors than to menopause or the menopause transition. Maintaining an extensive social network, remaining physically and mentally active, consuming a healthy diet, quit sugar, not smoking, and consuming alcohol in moderation may all help prevent memory loss. Atherosclerosis (hardening of the arteries) may also contribute to mental decline. Aim for normal cholesterol, normal weight, and normal blood pressure to help protect your brain. Women who are concerned about declining cognitive performance are advised to consult with their healthcare providers.

Most women make the transition into menopause without experiencing depression,  but many women report symptoms of moodiness, depressed mood, anxiety, stress, and a decreased sense of well-being during perimenopause. Women with a history of clinical depression or a history of premenstrual syndrome (PMS) or postpartum depression seem to be particularly vulnerable to recurrent depression during perimenopause, as are women who report significant stress, sexual dysfunction, physical inactivity, or hot flashes. The idea of growing older may be difficult or depressing for some women. Sometimes menopause just comes at a bad time in a woman’s life. She may have other challenges to deal with at midlife, and menopause gives her one more problem on her list. It has been suggested that mood symptoms may be related to erratic fluctuations in estrogen levels, but limited data exist on why this occurs. The wide range of psychological symptoms reported during the menopause transition, from irritability and blue moods to the recurrence of major depression, can be identified and often treated by a woman’s primary care provider or a menopause practitioner.

vaginal dryness is extremely common during menopause. It’s just one of a collection of symptoms known as the genitourinary syndrome of menopause (GSM) that involves changes to the vulvovaginal area, as well as to the urethra and bladder. These changes can lead to vaginal dryness, pain with intercourse, urinary urgency, and sometimes more frequent bladder infections. These body changes and symptoms are commonly associated with decreased estrogen. However, decreased estrogen is not the only cause of vaginal dryness. It is important to stop using soap and powder on the vulva, stop using fabric softeners and anticling products on your underwear, and avoid wearing panty liners and pads. Vaginal moisturizers, like organ argan oil [my favorite] and some lubricants may help. However most water-based lubricants on the market have a too high of a osmolality. What that means is that they will draw moisture out of the vaginal cells as they dry, and that is not what you want. They have been classified as cytotoxic by a report from the World Health Organization from 2014. But most manufactures are still ignoring that. An osmolality-controlled water-based lubricant you can find from the company Good Clean Love. Or you use a silicone base lubricant, silicone might have a negative connotation for many, however they are great for the vagina, because they do not interfere with the vaginal microbiome like water base lubricants do, and also never get dry or sticky. My patients unsurpassed favorite is called Uberlube , you can find it here : 


Persistent vaginal dryness and painful intercourse should be evaluated by your healthcare provider. If it is determined to be a symptom of menopause, vaginal dryness can be treated with low-dose vaginal estrogen, or the oral selective estrogen-receptor modulator ospemifene can be used. Regular sexual activity can help preserve vaginal function by increasing blood flow to the genital region and helping maintain the size of the vagina. Without sexual activity and estrogen, the vagina can become smaller as well as dryer.

Aging skin undergoes loss of structural proteins (collagen) and elasticity, which creates sags and wrinkles. It also becomes less able to retain moisture, leading to increased dryness. Hormones play an important role in skin health. In particular, for women diminished levels of estrogen at menopause contribute to a decline in skin collagen and thickness. Beyond hormone changes, a number of other factors can increase the visible signs of aging skin. In smokers, the effects of aging are more pronounced, and long-time smokers have more skin damage. Maintaining skin health is one of several good reasons not to smoke or to quit smoking. Exposure to sunlight and other sources of ultraviolet (UV) light is another significant factor in skin changes. Long-term UV ray exposure causes negative effects on skin appearance, including lines, wrinkles, rough texture, and brown spots, to build up over time. Aging skin also is more prone to skin cancer. For this reason, use of a good sunscreen is essential. For optimal UV protection, women should use a broad-spectrum sunscreen, which blocks both UVA and UVB rays. Ideally, it should be applied every day to exposed areas and reapplied every 2 to 3 hours during outdoor activities. Avoiding the sun during peak hours (11 am to 3 pm) and wearing a broad-brimmed hat and solar protective clothing are also advised. Avoid tanning to ensure healthier, more attractive skin—tanned skin means that skin is damaged. Other skin-healthy habits include eating a well-balanced diet, getting adequate sleep, and drinking adequate water. A moisturizer also can minimize water loss from the skin and make it appear more hydrated. Most cream-based moisturizers contain ingredients that boost the outer layer of the skin. Other components, such as hyaluronic acid and topical retinoids, have shown to provide skin benefits.

In certain circumstances, depending on your symptoms or medical history,  I might recommend other additional tests that can be added for an additional fee.

Also, I might recommend certain supplements that you will have to purchase. But I will provide you with resources where to get these

I cannot test online for STD’s, for that reason I do recommend that you have been tested  since your last sexual encounter for Chlamydia, Gonorrhea and Trichomonas. 

The vaginal Microbiome test is a vaginal swab that you can perform easily at home. You will get the test kit shipped with all instructions and materials needed,  in order to return it.

The gut health and intestinal microbiome test is a stool test that you perform at home . You will receive the test kit with detailed instructions, including how to return it.

Once I have your result kits back, you will be able to schedule an online consultation with me.

I do recommend that you have a Gynecologist who can provide prescriptions for you. I am currently only licensed in Maryland , so I can only provide prescriptions for clients living in Maryland

If you determine that you have recurrent BV or yeast, I will likely recommend a 6 month treatment course of a prescription medication. As mentioned above, I can provide these only for clients residing in Maryland. But you should be able to obtain these from your gynecologist or primary care physician.  

However there are numerous other vaginal dysbiosis conditions that might need different approaches, in the form of medications, supplements and some hygiene and lifestyle changes.  The cost of supplements is not  not included in this program. Particularly if gut rebalancing is needed, I will recommend a supplement protocol.