Menopause & Perimenopause

Parent Q&A

Seeking MD for Menopause/HRT (non-Kaiser) Jan 4, 2020 (2 responses below)
Fatigue in peri-menopause? or just fatigue? Help! May 22, 2019 (8 responses below)
Menopause - doctor recommendations Jan 1, 2019 (4 responses below)
Early menopause: can anyone recommend a doctor? Aug 8, 2018 (4 responses below)
Hormones, mood swings and possible peri menopause Jul 5, 2018 (4 responses below)
Trying to lose menopause weight Jun 30, 2018 (1 responses below)
Perimenopause help Sep 13, 2017 (3 responses below)
Bioidentical Hormone Provider? Aug 5, 2016 (0 responses below)
  • Seeking MD for Menopause/HRT (non-Kaiser)

    (2 replies)


    I am a 51 year old woman going through perimenopause. I am noticing some cognitive decline, and want to talk to a dr about doing HRT. I have Blue Shield PPO. Would prefer East Bay or SF location. Thanks!


    I'm in the same boat, and have been told that I have a couple complicating factors that really require someone who specializes in this area vs. a general Ob/gyn.  The only referral I've received in the Easy Bay is Risa Kagan, but when I called to make an appointment I was told by her staff that she's not accepting new patients and phasing out her practice due to impending retirement.  Thank you for posting and hopefully someone has suggestions.

    Pacific Women Ob/Gyn Group in SF.

  • I am sort of at a loss. I'm almost 44, no idea when my mom went through menopause or what her symptoms were. I have never been a morning person, and always found it hard to get out of bed in the morning or function for the first hour or so. But lately it's gotten WAY worse. It doesn't matter how much sleep I get. how good the sleep is, how much exercise I get, how much sugar I eat... I CANNOT get out of bed in the morning. Even if I've gotten 10 hours of sleep!

    Is this peri-menopause? Something else? Any ideas? I take vitamins, I eat healthy, I don't have much caffeine, and I've had my iron tested and I'm fine. 

    My doctor doesn't know what to do. Has anyone else experienced this??

    Have you had your thyroid checked? Hypothyroidism is pretty common and fatigue, among other things, is a side effect.  Ask your doctor to order you at least TSH and free T3, if you haven’t had those labs run. 

    I am in early menopause at age 42 and fatigue was definitely a symptom. I went on hormone replacement therapy and it has helped so much. Are you working with an OB/gyn? That would be the doctor to ask about whether the fatigue is related to perimenopause. The OB/gyn can test your hormone levels to see if you’re entering perimenopause.

    The other thing you should have checked is your thyroid hormones. Hypothyroid is a common cause of fatigue in middle aged women. I’m surprised your doctor didn’t think to check it. Treatment is very simple for most people (daily thyroid hormone pill).

    I'm 50 and have been in perimenopause for some years. I've also always been a night owl, and I definitely have even more trouble getting going in the morning than I used to. But what you're experiencing sounds more extreme.  If there haven't been any changes in your daily routines (diet, exercise, sun exposure) my first guess would be a thyroid problem.  I have a number of friends whose first symptoms of an ill-functioning thyroid arose during pregnancy, but any hormonal change, presumably including perimenopause, could be a trigger!

  • Menopause - doctor recommendations

    (4 replies)

    I am 42 years old and am heading into early menopause. I am looking for a recommendation for a medical doctor (Cigna) to work with me to improve my symptoms. Maybe a reproductive endocrinologist or an Obgyn. I’m also open to alternative treatment recommendations but I want a medical doctor to work with as well. My symptoms are exhaustion, irritability, and food cravings. The space between my periods has ranged from 6 months to 2 weeks within the past year. Basically I feel like I have PMS all the time. I got this diagnosis from my primary care doctor and she recommended a sleep study for my exhaustion prior to making any plans to relieve the menopause symptoms. I have already seen a sleep specialist and she thinks a sleep problem is very unlikely to be the cause of these issues and so do I. I recently moved from Brooklyn so the primary care doctor is new to me, and I won’t be able to see her again until mid-January.  If anyone has gone through something similar I would appreciate any recommendations. Thank you!

    I am 10 years older than you, and I've been through this already! To share my experience, I just went to a regular nurse practitioner with whom I discussed my symptoms, but none of my symptoms were particularly bothersome, leading to your openess to "alternative treatment recommendations."  I believe I did not have problems with menopause (I felt different, but nothing was really problematic), because I slept 8 good hours every night, ate mostly healthfully, exercised three days per week plus walking every day, and kept my stress down by not being afraid to decline commitments to my time that I didn't have time for. If I didn't stay firm to this lifestyle, I would probably have your symptoms whether in menopause or not. Best of luck to you!

    This helped me:

    Evening primrose oil; red raspberry leaf tea; extra B vitamins; a good antidepressant (response to prescriptions varies from person to person, so you may have to try more than 1 medication).

    For sleep, I sometimes find a mini-dose of Trazadone helpful.

    I have seen a Functional Medicine Osteopath to treat hormonal issues (PMS).  She is out of network and has an office in Marin but can do video sessions after the first session.  Functional Medicine requires a lot of testing and supplementation.  It has been helpful for me.

    Her name is Stephanie Daniel, DO.

  • Hello, I recently turned 40 and my ob/gyn has diagnosed me with early menopause based on symptoms and blood testing.  My hormones are clearly unbalanced, possibly as a result of doing many unsuccessful cycles of IVF in my late 30s.  I am having rare but excruciatingly painful periods, chronic insomnia, hair loss, hot flashes, and intense mood swings.  My ob/gyn is pushing hormone replacement therapy.  While I think very highly of him, I'm hesitant to start taking more drugs, as my body is still recovering from all of the fertility medications I took in the last five years.  Can anyone recommend a doctor for a second opinion?  I am already doing acupuncture and seeing a therapist, so I'm open to non-medical ways to manage this transition, but I'm searching for an endocrinologist, integrative doctor, or other specialist experienced with menopause who can advise me on whether a prescription for hormones is appropriate.  Thank you so much for any advice you can share. 

    Sara Gottfried has a book "the hormone book".   She is a Harvard trained MD but prefers holistic/lifestyle solutions.  I read her book which is great, and I understand and that she has a practice in Berkeley,   I am new to the area so I can't confirm that but she would be a great resource.

    I had the same problem at the age of 37. I saw dr. Marcelle Cedars at UCSF. She put me on HRT as the symptoms you are describing were unbearable for me. She is now my obgyn as well. I love the fact that she educated me with scientific data and all the pros and cons of my case and the route we were taking. Hang in there, things will get better once you figure out how to deal with this. 

    Just wanted to say that I was in exactly the same boat -- a couple years of meds for a DE IVF cycle at age 43, after being diagnosed with early meno at age 38, just before giving birth naturally (my last egg!).  It took me years to finally try hormone replacement therapy, but it changed my life -- 100% for the better.  No more hot flashes, no more sleep disruptions, just me feeling like me.  I know it sounds daunting, but it normalized me like nothing else, and I tried acupuncture, herbs, and diet changes before HRT.  I know you will find your way, and maybe it will be a different path, but I am still on HRT 10 years later and couldn't be happier I went this route.

  • While we we do have a challenging ten YO, my moods are all over the board.  Mostly anxious, angry, fed up, sad and depressed.  I’m looking for a good functional medical practitioner or similar doc to help find a path to a better way.  Already have a talk-therapist but looking for something more.  Thank you!

    Have you considered acupuncture? This wonderful practitioner was recommended to me for postpartum depression/anxiety/mood disorder - I have been going in for treatments about every other week for a couple of months now, and taking the herbal medicine she has prescribed daily - feeling so much better! She specializes in women's health, and is a mom herself (so she gets it!). 

    Dr. Jules Bogdanski

    info [at]


    I am sorry to hear you are going through all this, and relate it to all too well as I've been going through much of the same (somewhat different situation, but in the end same issues with emotions, anger, anxiety and depression).  You didn't say what insurance you have, which would limit which doc you could go to. I'm with Kaiser, and was happy with my therapist (Dr. Takaoka) and psychiatrist (Dr. Kim) there.  While any therapist you end up clicking with will be able to help, for me the medication was what really helped me climb out of the hole I was sitting shaking in and start thinking and acting more rationally.  In mental health, trial and error are even more part of the course than in other types of medicine.  The first medication I tried (the mildest SSRI that is usually prescribed to pregnant women and I know several of my friends and coworkers take with great success) made me manic after only 3 days on the lowest dosage.  So, I was told that SSRIs are not for me and the psychiatrist gave me a choice of two other different classes of meds.  I tried one she said had the least side effects although it also had a lower success rate in treating my symptoms (busparine), and I was lucky to find out it worked GREAT.  

    I am completely functional now, and have almost no side effects from busparine.  And, now that I am able to do stuff, I am going to start going to the "worry group" at Kaiser which I couldn't even think about before the medication (it was too much for me to get through the day as it was let alone go to a group ).  I did manage to take a DBT (dialectic behavioral therapy) class at Clearwater, which was helpful and I liked.  Clearwater is not Kaiser, it's a private company, so I had to pay out of pocket, and it wasn't cheap, but worth it.  Good luck, I hope you find what works for you.  Keep trying different things, and you will!

    I experienced everything you described. My primary care doc prescribed me Lexapro. It worked! And when I began getting the heat flashes, my acupuncturist sold me Epimedium Curculigo and that also worked! Acupuncture has helped me and my daughter that suffers from major depressive disorder.

    Take good care.

  • Trying to lose menopause weight

    (1 reply)

    I'm looking for a nutritionist who can help me lose menopause weight. Weight gain of 50 lbs or more over last 10 years; some of it fluid retention, which I'm sorting out with my MD, but not all. I have a fat baby in my belly that has exacerbated my chronic back and pelvic pain and makes it difficult to walk, move, and work. Clothes don't fit. Nothing I've done has worked. I need to see results, something, every week, even a lb lost a week would be a huge thing for me. I can't do this by myself any longer. Just losing any weight, using food as medicine, to help my hypertension and other things would improve how I feel. But I am lost when I go out to eat or to the store .... Do any of you have suggestions? East Bay and eastwards work best for me but I can meet up and continue with facetime or skype. Thank you!

    Hi, I hear you!  I’m 50 and and have a compressed nerve in my hip due to my extra weight.  Dr. Jason Fung’s book, The Obesity Code, was the help that I needed to figure out how to lose weight.  I’m not on any medications, so I didn’t need a nearby doctor to monitor me and change meds as I lose weight.  I have lost 50 lbs in the past 6 months, which is pretty amazing.  Dr Fung partners online with the Diet Doctor website, if you like to have online support and meal plans.  The weight loss has come from diet changes, and I have been doing well enough to walk for 30-45 minutes each day recently.  It’s nice to be able to walk without pain.  I’m continuing  to lose weight, and I expect that I will be eating this way for the rest of my life to keep my weight healthy.

    If you are diabetic or on blood pressure medication, then Virta Health might be a good option.  It’s expensive, but it includes doctor visits (for monitoring and medication changes) and continuous coaching.  It might be covered by your insurance.  They are publishing their results, and the improvement and reversal of diabetes and weight loss is very impressive.

    For the record, I was not able to lose weight on my health plan’s recommended MediFast nor their nutrition counseling that follows the MyPlate guidelines.  Those were things that I tried first, and they just didn’t work for me, personally.  

    Wishing you success in your weight loss journey and better health.

  • Hi, I wish to go on HRT and would like to see a practitioner ( preferably in the East Bay) who is well informed about this therapy. I have a Blue Shield PPO coverage. If you like your practitioner , please share their contact info. Also, if possible, tell me about how the therapy has helped you with your menopausal symptoms. I am aware of the controversy surrounding the possible side effects of the therapy ( increased risk of stroke, heart attack, ...), and am also well read regarding the newer research that has found for recently menopausal women the therapy can be helpful and without bad side effects. Therefore, I hope to get answers about who to see and your own personal experience (before and after the therapy). Thank you.

    I took HRT for several years and I don't think you will have any trouble finding an Ob/Gyn who can support you in this. My experience with several local Ob/Gyn practices is they do keep up to date with the research. Just pick a practice you like. I got my original prescription at one of the big practices in Berkeley. Sorry I don't remember which doc, but she was very well versed and explained that the research findings were based on POST-menopausal women who were looking to HRT as a way to protect heart health. At the time, that was a trend. The study with the scary results was not about perimenopausal women like me trying to get through a few years of hot flashes.  My doc told me the risk was small, even though I have high blood pressure (controlled by meds). I went on HRT because my symptoms were interfering with my job. I would be sitting in a meeting (with a bunch of men bc I work in a male-dominated industry) and suddenly I'd be on fire, gasping for air, pulling off my jacket, my face bright red, sweat breaking out, etc. It was awful.  Sometimes my male boss would ask me "Everything OK?" which was embarrassing, since I really didn't want to discuss it with him, but I'm sure he must have been alarmed. I also stopped sleeping well at night because of all the hot flashes. The HRT totally removed these horrible events. It really was a miracle. I stayed on HRT for 4 years or so, during which time I switched to Kaiser, where I also found my ObGyn there to be very supportive and reassuring. Ask your doctor! 

  • Perimenopause help

    (3 replies)

    Hello community,

    I am a soon to be 41 year old woman with severe insomnia and several other indications of having likely entered the perimenopausal years. The insomnia has been around for quite awhile, but some of the other manifestations are newer. I have not had much success with acupuncture, but am always open to names if there is someone who has helped you with this issue. Other than that, I would love to hear any ideas for alternative modalities that have helped with the various "conditions" (excessive heat, hair loss, insomnia, etc.) that accrue with this lovely new phase of my life! Specific practitioners would be great ~ in the East Bay preferred, but other areas are a possibility as well if the care is top-notch. Bonus points if it is affordable! Thank you.

    RE: Perimenopause help ()

    Rachel at City Pulse Accupuncture in Oakland is great. I saw her for fertility issues & a friend saw her for menopause & really liked her as well

    RE: Perimenopause help ()

    At 52, I am finally on the other side and full on into menopause.  I can say it's much better on the other side!  I had a 10+ year perimenopausal phase, the worst symptoms were intense and frequent hot flashes, persistent insomnia, and extremely heavy periods.  I found relief through the usual lifestyle recommendations: healthy diet including eliminating caffeine and sugar, regular exercise, yoga and mediation, good sleep hygiene, plus supplements.  I tried many but found Remifemin and Remifemin PM most effective, particularly with Traditional Medicinals Nighty-Nite Valerian tea (note there ate two types, get the one with valerian).  Valerian in tea form is a mild sedative.  The supplements must be taken regularly for an extended period of time to feel the effect.  None of this fully eliminated my symptoms, but reduced them to a very manageable level.  Good luck on your journey!

    RE: Perimenopause help ()


    I feel your pain. I did use acupuncture for hot flashes and it, along with Black Cohosh (which the acupuncturist recommended) help A LOT. I went to Nancy Rakela on Sixth street in Berkeley. Her number is (510) 540-6267. Nancy had been recommended by a friend of mine who went to her for the very same reason. I would definitely recommend Nancy; she is very knowledgeable, calm, gentle and her office is gorgeous and relaxing. If I had trouble with insomnia, I would certainly seek Nancy's advice.

    Good luck! 

  • Bioidentical Hormone Provider?

    (0 replies)

    I (unfortunately) appear to be one of those post-menopausal women with ongoing sleep/hot flash issues that have only been responsive to HRT rather than more natural management approaches. Since I seem to be in for the long haul, I'd like to switch to bioidentical hormones - any recommendations for experienced health care providers in this arena?

Archived Q&A and Reviews

Questions: Seeking a Gynecologist Questions about Menopause Advice on Other Pages

BHRT Specialist for Menopause, MD or PAC

May 2011

My 60-ish mother recently relocated to the Bay Area from the Denver suburbs where she was seeing a nurse practitioner regarding managing menopause with bio identical hormone therapy. Since moving, she just hasn't been able to find a provider who is knowledgeable and supportive of BHRT. Any recommendations, preferably for a female practitioner in the Alameda/Oakland/Berkeley area, would be much appreciated. Hormonal in Alameda

I would contact the Gottfried Center for Integrative Medicine in Oakland. Sarah Gottfried specializes in menopause. She has completely turned my life around. Good luck. Grateful

Gyn who specializes in bioidentical hormones?

Jan 2011

My gyn basically dismissed my request for bioidentical hormones, saying the difference was like buying a designer dress or one off the rack; they are both the same at the end of the day. I disagree, and I'd like to find a more sympathetic doctor who is knowledgeable on the subject. Does anyone have a recommendation for a good gyn, preferably one who takes Blue Cross HMO and is an expert on working with you during perimenopause to find a good hormonal solution? Tired of the hot flashing

Dr. Sara Gottfried in Oakland. She is excellent and knows ALL about bioidentical hormones, perimenopause and menopause. Not sure about insurance as I pay out of pocket, but it is COMPLETELY worth it. (I had chronic insomnia, sweats, awful mood swings and heart palpitations. Kaiser's answer for me was birth control pills.) May take awhile to get an apointment so call soon. ~~ Balanced

I highly recommend Dr. Sondra Altman in Walnut Creek, aka the Menopause Maven. She is an incredibly skilled and kind gynecologist who specializes in menopause and perimenopause. I found that many doctors who advertise that they prescribe bioidentical hormones or do ''antiaging'' medicine charge a fortune, and there are many excellent types of bioidentical hormone therapy that are FDA approved. Dr. Altman is very reasonable (in fees and attitude) and will really listen to you and work with you to find the best solution. We had to try a few different types of hormone therapy to find the best type for me, but I'm so glad I found her and I feel so much better. Got my mojo back

Any wisdom about handling menopause?

Oct 2009

Hello BPNers! I've hit menopause. Hot flashes, insatiable appetite, fatigue..the works. Who do you recommend, either regular medical treaters or complementary/alternative treaters? Any other words of wisdom about handling ''the change'' would be gratefully received. One hot mama

You can help yourself by changing diet and taking certain supplements. I'd suggest reading Ann Louise Gittleman's books ''Before the Change'' and ''After the Change''. She's a reknowned nutritionist and has great info. Sugar is the biggest culprit (for many health problems) so if you eat a lot of sugar, I'd suggest cutting down. Also caffeine.

I see a fabulous nutritionist in Bkly. Anasuya Batliner.848-8439. She looked at my whole health history and worked with me on supplements and diet, but she also had me do an adrenal hormone test (it's a saliva test sent to a lab). That gave us SO much information about my stress hormones, which play a huge part in menopause symptoms. I'm doing great now. Occasional minor hot flashes, losing weight because I was able to change my metabolism (I also eat really well and exercise...which wasn't always the case) and plenty of energy. Good's definately doable without meds. 56, in menopause and happy

Welcome to the Club! This is a fantastic time of life, if you look at it that way. The most distressing thing is probably the hot flashes, as these are visible to those around you, and may disturb your sleep. Mine used to leave me drenched to the point of needing to bring a change of clothes to the office. Here's what works for me:

-- Avoid Caffeine; switch to decaf. You can still enjoy the ritual of coffee without the buzz. Frankly, I find that I don't need the buzz at this phase of my life. Hopefully this will work for you as well.

-- Avoid sugar. In me, and some of my friends, this seems to exacerbate all the negative things associated with menopause. Once off sugar for about a week, you will see that the cravings for all kinds of food disappear. It's definitely tough going at first, but worth it.

-- Eat more raw foods; greens with phytoestrogens will help replace your own, and help reduce other symptoms. Ginger and edamame (soy) are fantastic at helping, too.

-- Get more sleep. This is the hardest thing for me.

-- Avoid stress. I've noticed that when I'm stressed, even a little, by something as simple as a thinking about a stressful situation, the initial ''burn'' of that hot flash can start, especially if I've had coffee, or slipped and had that danish for breakfast. By avoiding caffeine & sugar, eating raw foods, and getting to bed earlier, I don't experience them so much. Hang in there; these are natural processes, and you can manage them. Cool Dry Mama

Hello, I have been suffering through this for over a year. I know I am going to get a lot of flak for this but I am on a very low dose of Bio-identical hormones. They are not our mothers hormones. I just could not take it anymore. I was miserable. I could tuff it thorough the physical- hot flashes, night sweats- increased appetite... the emotional however was a different story. Tears, depression, anger, crisis of confidence. Changed my life. Changing on my terms.

Your OB/GYN would be a good place to start... even if just to see what s/he says. My acupuncturist has really helped me out a lot with herbs and such. Some lifestyle changes may be helpful. What was the most helpful for me was adding in some regular exercise... for me it was simply 3x week on an elliptical at the Y for 30 minutes. Some dietary changes really helped too. I did an elimination diet to start with... cut out all added sugars (except brown rice syrup), wheat, corn, eggs, dairy, alcohol, and caffeine. Drink LOTS of water. There is a product called ''Transitions'' that is found at places like Pharmaca or Whole Foods or Vitamin Express that I also found very helpful. And Evening Primrose Oil. And fish oil.

I ended up doing all of this because I really, really wanted to feel good. It is a lot to take on as a daily regimen, but it really worked for me. Good luck to you! Hot too

I am now 11 months without a period and at my worst (July 09) I was having maybe 10 hot flashes a day, waking up multiple times every night, absolutely exhausted, etc. I also gained weight. I went to the Doctor and we decided to try the following: no coffee or any caffeine, no alcohol, no sugar, no wheat. I also added a probiotic and vitamins and fish oil. I did this for 10 weeks and guess what? I lost 15 pounds and my hot flashes have dropped to once a week or so. I am sleeping through the night! I am still off coffee but added green tea. I have added back sugar and wheat but watching it. I may have to stop again...I am still not drinking alcohol.

It was difficult but I am just so pleased with the results. I needed a good cleanse! I have to say that I did get quite ill at the end of the second week which I think was detoxing. And the first days without my morning coffee were pretty bleak! Hot Flash Mama No More

Here is a fantastic website resource that I've been using for a number of years now, begun by women doctors who have a clinic in Maine. One of the original founders of this clinic was Christiane Northrup MD, who wrote the menopause bible, The Wisdom of Menopause. They do sell programs and products for hormonal balance on this website, but what I personally love are their women's health articles (the link below is directly to the articles page). You can also subscribe to their very informative email newsletter. These are sincerely helpful women doctors. I find that diet and exercise are of utmost importance now. If you're already eating right and exercising, wonderful. If not, begin right away. This will have a tremendous impact on how you feel particularly going into this transition. * * Still Adjusting to the New Me

I was on estrogen creams for a while to help relieve the hot flashes, etc. I found great relief from the clear gel packs used by chiropractors and physical therapist. Got the long, skinny size. Keep it in freezer and when you get that hot flash and feel like it's 110 degrees, pull it out of the freezer and wrap it around your neck. Immediate relief Works for me. Cheap and drug free! - Anon

I applaud your looking for lots of different types of treatments. That's what I am doing...went to Pharmaca for some herbal remedies, checked in with my medical doctor, and am seeing a great therapist on Solano Avenue, Fran Wickner. Lorri

I have been seeing my acupuncturist/herbalist for many years for an auto-immune disease. I started getting hot flashes a few months ago. She put me on some herbs that totally did the trick. We had to play with the dosage, but within a week or so, my hot flashes were gone and have not returned. A friend of mine was complaining about dealing with hot flashes, so I recommended my acupuncturist. Same results. My friend had been suffering for a year!! Now her hot flashes are gone!

So, of course, I'd recommend that route. Here is the name and info for my acupuncturist. She is in Berkeley on Dwight Way, very near MLK: Roberta Lewis, 510-540-8528

After years of suffering with fibroids before menopause, I am committed to not having menopause be a nightmare! I started out early with night sweats so bad I had to change the sheets in the middle of the night, and that went along with the sleepless nights I was having as well!

I know nothing about standard medical treatments. I tried black cohash caps for quite awhile, and I did get some reduction of flashes for a bit, but it didn't last. I know it works better for some women.

What has completely abated my negative menopuase symptoms is a combination of acupuncture, chinese herbs and excercise. I rarely have hot flashes now. I sleep through the night most night and I have more energy. It's been a super easy for me, and after seeing my mother suffer greatly and so many of my friends go sleepless and sweat like crazy - I'm very releaved.

I did a series of acupuncuture treatments with an acupuncturist (Lia Willebrand) and she worked up a couple of different herb combinations for me. Maybe I did 6 treatments and then my symptoms shifted and the sweating stopped. If I start to flash again, and they persist for more than a day or two, I go back in for a couple of treatments and I might take the herbs for a week or two. I can't deal with cooking the chinese herbs no matter how much I'm suffering so I have a forumula in caps that works well for me. I also got committed to moving my body - whether it is walking, running, biking - something. This seems critical. I'm pretty psyched that I've been mostly symptom free and having a smooth menopause. I vote for trying alternative treatments and movement before going the western med route. Good luck! LTV

I've been having hot flashes and night sweats for going on 8 years now. My last period was over 3 years ago. Yes it does go on and on and on. I am 58. I suffered terribly those first two years, including heating up suddenly in small meetings of all guys plus me, and flailing around desperately for paper to fan myself with, and feeling I would die if I couldn't get cool. So I started carrying a nice silk Japanese fan in my purse at all tims (get one at the Asian Art Museum in SF!). I get a lot of compliments on my fans when I pull one out - most people think I'm just showing off my nice silk fans. haha. I bought a succession of desktop fans for my desk at work and my bedside table (check out the tiny but powerful Vornado fans = the best). Finally after a discussion with my Ob Gyn about risks and trade-offs I went on HRT which totally eliminated all symptoms. Heaven. Happiness. Stayed on that for about two years and then weaned myself off, hoping it was over. Hot flashes and night sweats came back, but not as bad. But vaginal dryness was unacceptable so now I have the est-ring, which is estrogen just locally (vaginally). Works great for the vaginal dryness problem, doesn't do much for the hot flashes but they are now getting fewer and farther between, so bearable. Hoping yours is not as bad as mine. But there are fixes, and you DON'T have to suffer.

Perimenopause with toddler

April 2009

Has anyone survived perimenopause, especially the impatience, to put it mildly, while parenting a toddler (who is no longer in crib, read: yikes and sleep deprivation!)? Single moms? Would appreciate any unique suggestions for soothing the savage beast (meaning ME!) other than the usual (bath, massage, get support...) thanks, in advance, for any inspiration!

Hi, I'm 44 and was in the same boat, and I decided to go on birth control pills on the advice of my nurse practitioner. The name of them is ''Microgestin Fe 1/20.'' You take the active pill for 21 days and then the inactive one for seven days (when you're supposed to have your period). As my NP warned me, there are many symptoms during the first three or four months as your body adjusts to them, such as off-schedule periods, endless spotting, a little nausea, and anxiety. But I'm very, very glad to be on them -- it has helped so much with the extreme PMS I was having. I'm in the fourth month now and although I've experienced the above symptoms they are lessening and I feel much more stable (and patient with my toddler, though still way less than perfect). BC pills aren't for everyone, but I thought I'd let you know about this option. Wishing you the best.

Get thee to Abigail Surasky, acupuncturist extraordinaire! She helped me navigate a couple of years of hellacious perimenopause. We finally were able to get somethings ''smoothed out''. She is in Berkeley and her number is 845-8017. 40's w/ a toddler can be fun

Check out the book ''What your doctor may not tell you about premenopause'' by John R. Lee, MD. For me what has made a transformation is acupuncture, exercise, cutting certain foods (wheat, sugar), eating more fresh/raw foods, and taking estrogen supplements. I'm also a single mother and was at breaking point for some time there. The acupuncture & estrogen have really helped rebalance me enough for me to even be able to consider dealing with exercise and diet. staying balanced

Female gynecologist for over-40 women

Jan 2011

I'm looking for a female Gynecologist NOT an OB/GYN unless all GYNs do both(?) in the East Bay or SF to deal with typical issues of an over 40 yr old woman (who has had children) anon

Try Risa Kagan , M.D., in Berkeley. She specializes in issues related to perimenopause & menopause and no longer delivers babies. Leslie

Post-menopause, seeking new female gyn

Oct 2008

My current gyn is about to retire. I have a complicated gyn history and am looking for an outstanding female gyn with medical expertise AND a thoughtful and caring bedside manner. I am preparing to have a D and may need surgery after that. I also have a bicornuate uterus. The more recent your experience, the better. In Need

I highly recommend Dr. Risa Kagan of the East Bay Physicians Med. Group. After 2 high risk ''later in life'' pregnancies,I started to experience some'' uncomfortable'' changes with my body for almost 2 years.My Internist ordered tests ranging from hormone tests to ultrasounds all with normal results. I was frustrated! Dr. Kagan resolved my issues in my first visit with her! She is a straight forward,no nonsense,doctor who is extremely knowledgeable with women who are perimenopausal and menopausal. Dr.Kagan is located in Berkeley. Phone #(510)204-8190 Denise

Katarina Lanner-Cusin, M. D. of Berkeley and UCSF and Marilyn Honegger, M.D. of Berkeley and Orinda are fabulous. Hopefully you could get in to see one or both. Dr. Honegger is my gyn, and a great diagnostician who is much in demand for surgery. Kararina performed surgery on my grown daughter, who flew back here from a job in Hawaii for the surgery because there was no one as good there. You might research their specific areas of surgical expertise, if you can. Both are also wonderful people, by the way. Best of luck. Judy

Menopausal memory loss

Sept 2007

OK, so why didn't anyone tell me about this menopausal memory/cognition fog? I feel like I have lost 50% of my IQ on a working basis. Half the time I feel like I'm stoned (without the munchies or giggles, fwiw). As someone who's lived and died by wit and mental sharpness my whole life, this is devastating, and I don't know anything about it - how long will it last? Will it be permanent or will it pass with menopause? What can I do to survive being a part-time dope, and still keep my job, my self-image, and my sanity? 46 and suddenly stupid

Oh, I am so glad you wrote this post and I can't wait to read the responses. I was going to post this question myself but kept forgetting! I keep meaning to do a lot of things and just can't keep it together. I write everything down on the calendar now and then forget to look at the calendar. It is making me crazy! Is there a drug to help with this??? Because I will take it. 45 and suddenly stupid too

I don't have any advice - just wanted to chip in and say that I'm having the same problems. I was expecting to be able to advance in my job and look forward to a great pension, but I'm now, at the age of 55 (and beginning menopause) worried that I can't even do my current job, let alone get any kind of promotions. I was always very bright and picked up things so easily. Now I'm embarrassingly dense and very, very worried about keeping my job. My performance evaluations in the last two years have been dreadful. I'm really looking forward to some advice. dense and worried

Hang in there--it gets better. Your mental function improves when you're through, and you also get better at coping with the losses. If you can manage your panic about the way your memory & mental sharpness are changing, you increase your mental capacity. Fear, anxiety, tension, stress are all memory-UNfriendly.

Plus, there is often a hidden benefit. I found that I had to develop other resources when my razor-sharp mind lost some of its edge. I gained patience, compassion, tolerance, and an appreciation, understanding, and growing respect for people who were more ''heart'' and less ''head.''

Not to mention a little more humility, and a better sense of humor! --Look for the gold in it

Wow, your email could have been written by me, if I hadn't forgotten to write it! ;

But seriously, I can relate 100% to your dilemma. I also live by my wits, and I have to stand up and deliver in front of groups everyday of my working life. You didnt mention hot flashes, those make an attractive addition to the fumbling for words, mental lapses and distractability that I am presently experiencing.

The only thing that helps me is that many of my colleagues are in the same boat I am. There is strength in numbers.

A short anecdote that may make you feel better, last month was my birthday, and I rented a house in Bodega Bay for the kids and grandkids for a week. The first morning there, I woke up and thought it was my birthday! It took me almost two hours to realize that my birthday was the following Monday!! I was really embarrassed and sort of scared, like I was having an ''Alzheimers Moment'' (or 2 hours).

The moral of the story is, oh I don't know what the darn moral is, but I also don't think we are alone. Find other women who can relate to your experience. I have also decided I just have to let up a bit with my type A personality and go with the flow. Its all part of the life cycle. Been there, done that

I think that's why they call us wise old crones. Us post menopause women look super smart compared to hormone-battered youngsters. Hang in there and consider that it is a way to learn empathy for those less sharp or quick than you. Old Lady

i'm just creeping into the menopause subject myself, not ready to advise anyone yet, except to pass on resources:

go to the ''Power Surge message board'' forum:

one of their subforums is titled: '''Am I Losing My Mind?' The most common expression uttered by women during menopause,'' with currently 498 topics!

also, thyroid problems often come on at menopause, and ''brain fog'' is one sign of low thyroid, so it's worth looking into that. signed: getting there...

OBGYN for menopause symptom management

May 2005

I am looking for a recommendation for an OBGYN or MD (preferably berkeley/oakland area) who can provide advice and support on managing menopause symptoms. I have had menopausal-related depression and also formication (which is not nearly as fun as it sounds - excessive itching and the sensation that bugs are crawling over your body! really!!!) I have Healthnet Insurance. Thanks, anon


  • Arzou Ahsan

    Perimenopause at 38?

    April 2005

    I'm almost 38 and had my last child two years ago. Over the past two months I've had trouble staying asleep (waking 1-2 hrs early--struggling to return to sleep) and hot flashes (usually 3 days a week). In addition, my sex drive is down and I'm more irritable. From what I've read on the web, the symptoms sound like perimenopause. I'm wondering if other women have found effective homeopathic treatments (including an acupuncturist)? What about increasing soy in your diet...did it help? I know my symptoms don't warrant HRT (nor am I interested). Help! Hot but not bothered

    OK, this is just what I have been feeling too. I am 39 and had my last child 3 years ago. And now, on and off for the past 9 months I have had the same thigs you described, along with changing periods (mine are now every 24 days and lighter and darker). I have scheduled an apt. with my doctor to discuss this and have blood drawn to look for any hormonal chages. It is frustrating to say the least that I am not yet 40 and dealing with this! Andrea
    i too started experiencing perimenopause symptoms at about your age. everyone at that time told me i was too young. i happened upon lonnie barbach's (yes, that lonnie barbach :-) ) book ''the pause''. she did the research and wrote it because she too was ''young'' when her hormones changed. it's great - she explains what's happening in your body and then covers alternative as well as traditional hrt. as far as hrt goes, i don't know if she's updated her info, but the alternative stuff is good. i personally used phytoestrogenic capsules i got at the health food store. they worked for years. then i changed to vitex tincture (a hormone balancer) which i also used successfully for years. when my periods stopped i had to switch to black cohosh which is also working really well. another good book is herbalist susun weed's on menopause. i treated myself for years, dr. marcy shapiro in albany helped me when i needed to switch to the black cohosh. hopefully herbs will work all the way through and no need to take hrt. p.
    I am menopausal at 48 and had terrible sleep problems initially due to the hot flashes. I don't think I slept well for two straight months. I went to my OB/GYN after also researching various vitamins that I could take. Long story short, she said that black cohosh seems to work well. I have been taking that, along with some menopausal vitamins I found at Safeway. I like these because there's an AM bottle and PM bottle, each with different ingredients (e.g., soy and black cohosh for the daytime and melatonin for the night one). It's called Natrol?s Complete Balance AM/ PM for menopause and you can check it out at the following website: http:// The combination of these vitamins, plus changing my diet (no more red meat, no chocolate (!), cut way back on refined sugar) helped tremendously. You might also check out the book ''Taking Charge of Your Perimenopause''. Good luck! anon
    I had great success using progesterone cream (emerita brand, sold at whole foods) and following some other guidelines in a book by dr lee (sorry I can't remember the first name or title-- loaned it to a friend who never gave it back). I think I drank licorice tea, made sure I had enough chromium and some other micronutrients, etc--(he talks about all this stuff, including the symptoms of estrogen dominance, in the book). In my case it wasn't perimenopause but bad periods, etc. Nonetheless, worked like a charm (in fact I got pregnant on the first try even though I was an older mom).
    I would recommend reading The Wisdom of Menopause by C. Northrup. She is an MD with a very holistic approach. She even says that symptoms can represent an emotional problem that one needs to deal with. She reviews the pros/cons and effectiveness of both traditional medical treatments for menopausal symptoms, as well as herbal and alternative treatments. eve
    it sounds like peri-menopause to me as well. a great book i tell my patients to get is by dr. lee- it's called WHAT YOUR DR. MAY NOT TELL YOU ABOUT PREMENOPAUSE- it's about your hormones from age 30-50 -applying a very small amount of progesterone cream topically is also very helpful. i also rx accupuncture- i think linda gruber is absolutely fantastic- she's in sf and her number is 415-346-3126. h.

    Could I be Premenopausal at 41?

    Feb 2005

    I'm 41 and I've been experiencing some dramatic changes in my periods over the past nine months. I've always had very light periods, lasting only a few days, mild symptoms and always at a different time each month. For close to a year now, my periods have been extremely heavy; bleeding between periods; terrible night sweats (frequently but not every night) and much bloating and abdominal pain a few days prior to period. I just had a visit with my gyno and he says things look good but suggests I have an ultrasound to be safe. I'm worried I maybe pre- menopausal or even have signs of Ovarian Cancer? Sex is great so no problems there. Has anyone had any experience with these type of symptoms? My mom didn't go through menopause until late 50's. None of my older sisters have these symptoms (especially the sweating!). Concerned

    You could also have other things going on such as a cyst or fibroid, which is very common and not usually problematic. Finding out may cause you less distress. anon
    Acupuncture and herbs helped me with post-pregnancy night sweats..Not exactly what you are having but I think it would be worth a try. no longer sweating
    Check out hormone treatments for heavy menstrual bleeding. My periods got extremely heavy after I delivered my second child at age 39. I suffered for 10 years before the FDA approved an IUD (called Mirena) that releases tiny amounts of hormones to thin the uterine lining. It helped right away. I had light periods, no discomfort, and no side effects except a tiny bit of occasional bleeding. (I don't need it for birth control, although the IUD lasts for 5 years.) About the rest of your symptoms: Be sure your ob/gyn checks all your hormone levels and your iron level, and is up to date on hormone treatments and side effects. They now have an estrogen patch and are developing a testosterone patch, which avoid the nasty side effects of swallowing these meds. good luck

    Could this be perimenopause? I'm only 42

    Jan 2005

    Of course I already have an appointment scheduled with my gynecologist but: The last 6 months or so my period has only been for 1.5 days. This month, I literally only had one spot. Cycle length is 28-29 days as it's always been, and I know when I ovulate based on all the usual symptoms I've had for many years. I always ovulate on day 13 or 14. Is this perimenopause? I had my hormone levels checked about a year ago because of other issues, and all were well within the normal range (FSH, LH, estrogen, progesterone, TSH and others I don't remember). If it is the beginning of menopause, I'm not ready for this mentally - it makes me feel old, I don't know why. I'm only 42! Does anyone have any good books to recommend or any words of wisdom about how to ''deal'' with this, and also, what to ask my doctor??? anonamous

    For years my preiod would lighten and then stop altogether during the winter months, often hormone tests only test your hormones at whatever given time the blodd is being drawn so the lab work is not altogether an accurate assessment. I finally found relief with acupuncture, I couldn't take the teas I was prescribed but some gentle supplements and bi-weekly or monthly needle work kept me where i wanted to be, eventually my body learned to keep a regular cycle on its own. anon
    I recommend Before the Change - Taking Charge of your Perimenopause by Ann Louise Gittleman. She is an excellent resource on women's health and nutrition. Laura

    Ob/Gyn for menopause

    May 2004

    Hello, I have looked thru the archives to see if I could find anything about this but didn't see any info. I am a 50 year old woman who is still getting my period but getting alot of periomenopausal symptoms. I am looking for a OB/GYN who is very knowledgeable about alternative hormonal therapies; bio- identicals or ''Natural'' hormone therapy. If anyone knows of someone who fills this request please recommend. Thank you.


  • Risa Kagan (ObGyn Fertility Group)

    Other advice

    I know you requested an OB/GYN specifically, but it occurs to me that a medically trained person may know medicine and/or pharmaceuticals best (or only). I get all my GYN care from homeopath Christine Ciavarella at the Hahnemann Medical Clinic, 524-3117, in Albany. As well as doing Pap smears, she treats me as a whole person, hot flashes, insomnia, forgetfulness, and all! I also see Dr.Sada Anand Miller, a chiropractor in downtown Oakland, 208-3224, who knows a lot about Chinese herbs and nutritional supplements that really helped with the above symptoms. May I remind you that these days, OB/GYN docs are mainly (merely) surgeons? Good luck. Bonnie

    ObGyn for Over 40

    August 2003

    I'm in my 40s, and am starting to have the first symptoms of peri-menopause. At least I think that's what happening. My ob/gyn recently left the area, and for my well-woman visit this year I saw one of the new doctors in the practice. She was fine, but, well, so dewey-fresh and I felt a little like asking for a guided tour of a mysterious place from someone who had never been there. All her answers felt rather text-book. Can anyone recommend a woman ob/gyn who is over 40 and can be a good guide for this difficult landscape? feeling a little lost

    Recommendations received:

  • John Girard Berkeley-Orinda Women's Health
  • Marilyn Honegger Berkeley-Orinda Women's Health