01First Visit
The Foundation ResetBloods, 360 Longevity consultation, 4D assessment, written plan within 24 hours.
Investigated, Then Supported
Menopause & Perimenopause
Not a single event but a transition. Oestrogen, progesterone, and sometimes testosterone shift in ways that affect almost every system in the body.
Your Concerns
What Is It?
Perimenopause and menopause are not single events but a transition — often beginning in the late 30s or early 40s and continuing into the 50s — during which oestrogen, progesterone, and sometimes testosterone shift in ways that affect almost every system in the body. Hot flushes are the symptom most patients associate with menopause; sleep, mood, weight, skin, joints, and energy are often more clinically interesting. At 23MD Longevity, perimenopausal change is investigated holistically — by Dr Martin Galy — before any treatment is recommended.
Recommended Pathway
Treatments for Menopause & Perimenopause
The treatments our doctors most often recommend for this concern. Your consultation confirms the right combination and sequence for you.
02Hormones · Women
Bio/bodyidentical Hormone TherapyFirst-line where bloodwork and clinical picture indicate.
04Diagnostics
Metabolic AssessmentRelevant where the picture includes weight or insulin sensitivity changes. Topical and vaginal therapies discussed at consultation; specific products not advertised here.
Unsure which pathway suits you?
Wondering whether your hormones could be contributing to your symptoms?
23MD DigitalBHRT Expert
A hormone optimisation assistant that helps you understand common hormone symptoms and prepare questions for your consultation.
Speak to the BHRT ExpertCommon Causes
What Could Be Causing It
Oestrogen Decline
Affects vasomotor stability (hot flushes, night sweats), sleep, mood, skin quality, bone, vaginal health.
Progesterone Decline
Affects sleep, anxiety, mood regulation, cycle changes.
Testosterone Decline
Affects libido, energy, muscle, motivation — relevant in women too, not only men.
Thyroid Interaction
Perimenopausal shifts often unmask subclinical thyroid imbalance.
Cortisol Patterns
Sleep disruption and life-stage stress amplify the picture.
FAQs
Your Questions, Answered
Perimenopause is the transition — often beginning in the late 30s or 40s — during which hormone levels fluctuate. Menopause is technically the point at which periods have stopped for 12 consecutive months. The symptomatic experience usually peaks in perimenopause, when fluctuation is sharpest.
Both are forms of hormone replacement therapy. Bio/bodyidentical hormone therapy uses hormone preparations that are structurally identical to those the body produces. The clinical evidence base is large but evolving; what is appropriate for any patient depends on bloodwork, symptoms, history, and goals. The decision is made at consultation, not before.
Yes. At 23MD, no hormone therapy is recommended without a clinical consultation and bloodwork. Treating a hormonal picture without measuring it is not how this practice works.
Depends on the individual picture. Some patients use hormone therapy across years; others step down sooner. The plan is reviewed annually at minimum, regardless of treatment frequency — that's a 23MD standard.
The safety profile depends on the formulation, the dose, the duration, and the patient. A blanket 'yes' or 'no' is not honest. Dr Galy will discuss the relevant evidence in consultation — including recent shifts in expert consensus — and a written summary of the discussion follows within 24 hours.
Medically reviewed by Dr Martin Galy, MB BCh BAO LRCP&SI, GMC-registered since 2001.
