Perimenopause is the transition period leading up to your final menstrual cycle—when hormones levels begin to fluctuate and symptoms such as hot flashes, sleep disturbances, anxiety, and mood changes can appear. During this time, personalized hormone therapy and lifestyle support can ease symptoms, and help improve sleep and mood.

Menopause marks the time when menstrual cycles have stopped for 12 months, and estrogen and progesterone levels continue to decline. This shift can bring symptoms such as hot flashes, night sweats, sleep disruption, weight changes, mood changes, and brain fog. Through individualized hormone therapy, nutrition and lifestyle guidance, CYRA Wellness can help you restore balance, improve symptoms, mood and protect long-term bone, heart and metabolic health.

Primary ovarian insufficiency (POI) is a disorder in women younger than 40 years old characterized by loss of ovarian function, resulting in reduced ovarian hormone production—including estrogen, progesterone and testosterone. Reductions of estrogen before the natural age of menopause is associated with increased risk of of osteoporosis, cardiovascular disease and possibly accelerated neurodegenerative aging and cognitive decline.

HRT should be initiated promptly after diagnosis of POI, at higher estrogen doses than those used for postmenopausal women, and continued until the average age of natural menopause. This is supported by expert consensus.

HRT use in POI is used to relieve low estrogen symptoms and to mitigate increased risks of osteoporosis, cardiovascular disease, and possibly cognitive decline associated with early estrogen loss.

Early menopause is defined by menopause between age 40-45 (vs. Primary Ovarian Insufficiency and premature menopause is defined as menopause before the age of 40) .

Early loss of estrogen can have significant health risks and is associated with increased risks of osteoporosis, cardiovascular disease, and possibly accelerated neurodegenerative aging and these can be mitigated with starting HRT early.

During perimenopause, erratic estrogen highs and lows, along with a decline/low progesterone levels can affect mood. This can lead to increased irritibility, anxiety, and depression. It may present as “not feeling like myself” as well.

During the perimenopausal period (the time before your last menstrual period), evidence has shown there is a “window of vulnerability” which refers to the period of time when women experience a significantly increased risk for depression and anxiety, primarily due to hormonal fluctuations.

Multiple studies and shown that the risk for depression is 2- to 5- fold higher during perimenopause compared to the years prior to perimenopause. This risk continues to rise and peaks into late perimenopause. Anxiety symptoms also increase during this transitional time. Those with a prior history of depression/mood disorders are at highest risk.

Estrogen therapy during this time in perimenopause shows it not only can be helpful for improving depression and anxiety, but also may prevent new-onset depression in perimenopausal women.

Weight gain during midlife and menopause is common and is primarily driven by declining estrogen, decreasing basal metabolic rate, declining muscle mass and decreased physical activity. The specific type of fat that accumulates in midlife is visceral fat and it accumulates around the mid-abdomen. This type of fat redistribution increases cardiometabolic risk—including heart disease, diabetes, hypertension and stroke.

We will work with you holistically and with very close follow up to help you optimize your weight with a goal of maximum fat loss and increases in muscle mass. We will help you reach your goals through lifestyle changes including—nutrition and strength training monthly plans and prescription medications including GLP-1s and HRT.

While HRT is not FDA-approved for weight loss, data shows that when HRT is combined with GLP-1s, there is increased weight loss.

At CYRA Wellness, we place a strong emphasis on nutrition and strength-training. You will be guided step-by-step throughout your journey on nutrition and strength-training plans customized for you. With regular check-ins, and access to direct-messaging with your doctor, you will have the knowledge and support to reach your goals.

At CYRA Wellness, we place a strong emphasis on nutrition and strength-training. You will be guided step-by-step throughout your journey on nutrition and strength-training plans customized for you. With regular check-ins, and access to direct-messaging with your doctor, you will have the knowledge and support to reach your goals.

Dyspareunia is pain with sexual intercourse. It can have several causes including low estrogen levels and GSM (genitourinary syndrome of menopause), which leads to thinning of vagina, dryness and pain with sexual intercourse, especially in menopausal women.

You can also be referred to a pelvic physical therapist for further treatment of your symptoms, to provide more relief.

This is not something that can or should be expected to just “accept” and live with. Vaginal estrogen, vaginal DHEA and oral ospemifene can reduce pain and provide relief. These treatments work by addressing the low vaginal estrogen levels, and improving vaginal tissue and lubrication. Vaginal DHEA acts as precursor for local estrogen and androgen hormones in the vaginal tissues. Ospemifene is an oral SERM that can by used to treat pain as well. These three options are all FDA-approved for this indication.

Low sexual desire also known as HSDD (hypoactive sexual desire disorder)

Vaginal dryness due to estrogen deficiency can lead to pain, urinary frequency, pain with urination and frequent UTIs. This can progress or worsen over time, but does not tend to get better on its own, without treatment. The good news is, with treatment, symptoms can be nearly reversed to restore healthy vaginal tissue.

Estrogen, as part of HRT, plays an important role in bone health. It is known that estrogen helps prevent the breakdown of bone and therefore reducing fracture risk in postmenopausal women.

Estrogen has been shown in large trials (WHI) to significantly reduce the risk of vertebral, hip and non vertebral fractures and increase bone mineral density (BMD) with reports of a 29-34% reduction in vertebral and hip fractures with menopausal hormone therapy.

At this time, in the United States, HRT is FDA-approved for the prevention, but not treatment of osteoporosis.