Menopause

Menopause care in Miami.

Hormone therapy where it is indicated, non-hormonal options where it is not, and a clinician who will have the conversation either way.

The options

How this is approached here

  1. 01

    A symptom history that covers sleep

    Mood and cognition, not only hot flushes.

  2. 02

    Hormone therapy discussed on current evidence

    Including the risks, rather than declined on the strength of a study from 2002.

  3. 03

    Non-hormonal options for anyone who cannot

    Or prefers not to take hormones.

  4. 04

    Genitourinary symptoms treated rather than tolerated

    Local oestrogen has a different risk profile from systemic.

  5. 05

    Bone density and cardiovascular risk reviewed

    Because this is when the trajectory is set.

Symptoms

More than hot flushes

Hot flushes and night sweats

Which are what most people expect.

Sleep that breaks at three in the morning and will not resume.

Mood changes

Irritability and anxiety that feel unlike you.

Brain fog

Losing words, losing threads, and the fear that accompanies it.

Vaginal dryness

Discomfort with sex, and urinary urgency — the symptoms least often raised and most treatable.

Joint aches that arrive without an injury

Periods that become erratic

Heavier, or further apart — perimenopause, where most symptoms actually begin.

Hormone therapy

How the conversation is had here

  • The decision is personal, not categorical. We go through your history rather than answering in general terms.
  • For most women starting within ten years of their last period, the balance of evidence favours treatment.
  • Transdermal oestrogen carries a different clot risk from oral, which matters if you have risk factors.
  • Anyone with a uterus needs a progestogen alongside oestrogen to protect the endometrium. This is not optional.
  • Vaginal oestrogen has a different risk profile from systemic and is appropriate for many women who cannot take systemic treatment.
  • There is no mandatory stopping age. Continuing is reviewed annually, not vetoed at sixty.

If hormones are not for you

Options that are not a shrug

Non-hormonal prescription options for vasomotor symptoms

Including newer neurokinin antagonists.

Cognitive behavioural therapy

Which has genuine evidence for flushes and for sleep — not a consolation prize.

Vaginal moisturisers and lubricants used properly

Which is to say regularly rather than only before sex.

Bone and cardiovascular risk addressed directly

Since that is a large part of what hormone therapy would have been doing.

Menopause: common questions

Is hormone therapy safe?
For most women starting within ten years of menopause the balance favours treatment, but it depends on your history. We go through yours rather than answering in general.
I was told I could not have HRT. Is that final?
Not necessarily. Blanket refusals are common and often out of date. Bring what you were told and we will look at it.
What if I am still having periods?
Perimenopause is treatable too, and it is where most of the symptoms actually start.
Does HRT cause breast cancer?
Combined hormone therapy is associated with a small increase in breast cancer risk that rises with duration and falls after stopping. The size of that risk is comparable to drinking a couple of units of alcohol a day, and it belongs in a conversation with your own history in front of us.
I was refused HRT years ago. Is that still right?
Possibly not. A great deal of practice was shaped by an early reading of one trial in 2002 that has since been substantially revised. Bring what you were told.
How do I know I am in perimenopause?
Usually from the pattern of symptoms and cycle change, not a blood test. Hormone levels fluctuate so much during perimenopause that a single result tells you very little.

Know before you book.

Vireo opens in 2027. Until then the plan list, panel status and first-available wait for every office are published on this site and kept current. Questions can go to the practice office on (305) 555-0180.

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