Perimenopause & Menopause
This transition deserves more than a prescription and a handout.
Perimenopause and menopause are complex, often misunderstood, and frequently undertreated. At Areté, I take the time to understand what's actually driving your symptoms, and build a plan around the full picture of your health.
What you may be experiencing
The symptoms that bring most women in.
Many women spend years managing symptoms individually without anyone looking at the full picture.
Vasomotor symptoms
Hot flashes, night sweats, temperature dysregulation. Often the most disruptive and the most treatable.
Sleep disruption
Difficulty falling or staying asleep, waking in the night, unrefreshing sleep. Often hormonal in origin but not always.
Cognitive changes
Brain fog, word-finding difficulty, memory lapses, difficulty concentrating. Real and underrecognized in this transition.
Mood & anxiety
Irritability, low mood, new onset anxiety, emotional dysregulation. Hormonal shifts play a significant but often unaddressed role.
Body composition changes
Weight gain, loss of lean mass, shifts in where fat distributes. Metabolic changes that diet and exercise alone may not resolve.
Genitourinary & sexual health
Vaginal dryness, painful sex, recurrent UTIs, low libido. Common, treatable, and worth addressing directly.
Joint pain & fatigue
Muscle aches, joint stiffness, persistent fatigue. Hormonal contributions are real and frequently missed.
Irregular cycles
Changes in frequency, flow, and predictability are normal in perimenopause, but deserve clinical evaluation.
It's not always just hormones.
Hormonal changes often overlap with thyroid dysfunction, sleep disorders, chronic stress, anemia, medication effects, mood disorders, and metabolic changes that compound how you feel. Good care doesn't assume a single cause. It evaluates the full picture using current medical evidence, so treatment reflects what's actually driving your symptoms, not just the label they fall under.
How I approach care
Comprehensive evaluation & Individualized treatment.
Every patient begins with a thorough clinical assessment: your full health history, current symptoms, lab work, lifestyle factors, and goals. From there, I build a care plan that addresses what's actually happening, not just the most obvious presenting symptom.
Hormone therapy
When appropriate, hormone replacement therapy is one of the most effective evidence based tools available for perimenopause and menopause. I prescribe and manage HRT individually, considering your symptoms, history, risk profile, and preferences, through FDA approved and compounded options.
Beyond hormones
I also evaluate thyroid function, metabolic health, sleep quality, nutrition, stress physiology, and other contributing factors. For many women, optimizing these alongside hormones makes a significant difference in how they feel and function.
Labs & monitoring
Appropriate lab work is part of every evaluation. Hormone panels when indicated, metabolic markers, thyroid function, cardiovascular risk, bone health markers, and more. Testing is individualized, not a fixed checklist. For established patients in Ridgway, Ouray, Telluride, and Montrose, labs can also be drawn at home and delivered to Quest Diagnostics directly.
Ongoing care
Perimenopause and menopause are transitions, not events. Care needs to evolve as your symptoms change, treatment is adjusted, and new concerns emerge. Membership provides the continuity that this transition requires.
A note on perimenopause
The years before your last period matter too.
Perimenopause can begin a decade before your last period, and during that time, hormone levels fluctuate unpredictably. A single lab value may be misleading. Clinical evaluation of your symptoms, history, and pattern over time is often more informative than any single test result. If you've been told your labs are "normal" but you still feel wrong, that's worth a real conversation.
Explore symptoms in depth
Common questions, explored further.
These are some of the topics patients ask about most. Each article goes deeper into what to expect, what's normal, and when to seek care.
Perimenopause symptoms
Read article →
How long do perimenopause and menopause symptoms last?
Read article →
Frozen shoulder & menopause shoulder pain: what every woman should know
Read article →
Perimenopause fatigue & brain fog: when it's not just hormones
Read article →
What is HRT? Hormone therapy for menopause benefits & risks
Read article →
Frequently asked questions
Answers to what women ask most.
Do I need to be in menopause to be seen?
No. Perimenopause often begins years before menopause is confirmed, and many women experience significant symptoms during this transition. You don't need a specific lab value or a formal diagnosis to deserve clinical attention. If something has changed and you want answers, that's enough.
Is hormone therapy safe?
For most healthy women under 60 or within 10 years of menopause, the current body of evidence supports HRT as safe and effective, and for many, the benefits significantly outweigh the risks. The picture is more nuanced for women with certain health histories. At Areté, HRT decisions are made individually, based on your specific symptoms, history, risk profile, and current medical evidence, not a one size fits all protocol.
My labs came back normal but I still feel awful. Why?
This is one of the most common things I hear. Standard lab panels don't always capture what's happening during perimenopause. Hormone levels fluctuate significantly and a single snapshot can be misleading. Clinical evaluation of your symptoms, history, and full picture often reveals what a standard panel misses. "Normal labs" doesn't mean nothing is wrong.
Do you prescribe bioidentical or compounded hormones?
Yes, when clinically appropriate. Both FDA approved and compounded hormone preparations are available. Compounded hormones allow for individualized dosing and formulations not available commercially. Particularly useful for patients with sensitivities or those who need doses outside standard ranges. Treatment decisions are always individualized.
How is this different from seeing my regular provider?
Standard visits are typically 15 minutes, structured around billing codes, and focused on the most acute presenting concern. At Areté, visits are longer, structured around your goals, and designed to look at your full picture: hormones, metabolism, sleep, nutrition, stress, and more. As an integrated system rather than separate problems. You see the same clinician every time, who knows your full history and follows your progress over time.
Written by Michelle Mullins, AGACNP-BC, FNP-BC
Ready for real answers?
Start with a Discovery Call.
15 minutes to talk through your symptoms and whether Areté is the right fit for where you are in this transition.
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