Question 1

What is Menopause?

Accepted Answer

The final menstrual period, which can be confirmed after 12 consecutive months without a period. This time marks the permanent end of menstruation and fertility. It is a normal, natural event associated with reduced functioning of the ovaries, resulting in lower levels of ovarian hormones (primarily estrogen).

Question 2

What is Perimenopause

Accepted Answer

A span of time that begins with the onset of menstrual cycle changes and other menopause-related symptoms and extends through menopause (the last menstrual period) to 1 year after menopause. Perimenopause is experienced only with spontaneous (natural) menopause, not induced menopause. Also called the menopause transition.

Question 3

What Is Hormone Therapy?

Accepted Answer

At the most basic level, hormone therapy replaces female hormones, primarily estrogen and progestogens, that are lost during the menopause transition. Hormone therapy is FDA-approved as a first-line therapy for the relief of bothersome hot flashes and is shown to be the most effective treatment. In particular, the benefits particularly outweigh the risks for HT when used in early menopause to relieve vasomotor symptoms (VMS), hot flashes, night sweats, and sleep disturbances.Estrogen plus progestogen therapy (EPT), also known as combination hormone therapy is the most common regimen. Estrogen is the hormone in this duo that provides the most relief for menopause-related symptoms. Progestogen is added to protect the uterus from estrogen stimulation and the increased risk of endometrial cancer.

Question 4

Is Hormone Therapy (HT) safe?

Accepted Answer

In general, systemic HT is a safe and effective option for treating menopause-related hot flashes, night sweats, and genitourinary symptoms in healthy women when started before age 60 or within 10 years of the onset of menopause. There is also evidence that HT offers some protection against bone loss. In those starting HT aged older than 60 years or more than 10 years past the onset of menopause, HT is associated with a greater absolute risk of heart attack, stroke, blood clot and dementia. In addition, the risks of HT use outweigh the benefits in those with a history of an estrogen-dependent cancer such as breast cancer and in those with a history of heart attack, stroke, blood clot, or severe liver disease. In rare circumstances, and with shared decision making in collaboration with a woman’s healthcare team, systemic HT may be used in women with a contraindication when nonhormone therapies have not alleviated symptoms. However, low-dose vaginal estrogen therapy can be started at any time and used for as long as needed in most women.

At Choose Healthy, Dr. Casian balances your individual benefits and risks based on your medical history. For example, if you don’t have a uterus and can take ET alone, your risks are different from those women who still have a uterus and must use EPT to protect against uterine cancer.

Question 5

What are the risks associated with HT?

Accepted Answer

Stroke — Both ET and EPT increase the risk of stroke. That risk goes away, however, soon after you stop taking hormones.Blood clots — Risk increases if you take hormones by mouth. The risk may be lower if you use a transdermal estrogen, such as a patch, gel, or spray.Uterine cancer — If you didn’t have a hysterectomy and still have a uterus, you need to take EPT. If you have already had uterine cancer (also called endometrial cancer), it’s not a good idea to take HT, although a progestogen by itself might be an option. Breast cancer — If you are wondering whether HT causes cancer, there is some good news for women who use ET. Women can use ET for 7 years before the breast cancer risk increases. The risk goes up after 3 to 5 years for women who use EPT. Their risk might be lower if they take micronized progesterone intermittently and start HT early.  Estrogen alone was not associated with an increase in breast cancer incidence.

Question 6

Can HT cause weight gain?

Accepted Answer

Although weight gain is a common problem for midlife women, associated with both aging and hormone changes, HT is not associated with weight gain. It may even lower the chance of developing diabetes. Dr. Casian uses a holistic approach to health. She integrates hormone therapy with supervised weight loss programs to support neuroendocrine and cardiometabolic balance, helping her patients reach their wellness goals.

Question 7

Bioidentical Hormone Therapy: Custom Compounded or FDA approved ?

Accepted Answer

Many types of hormone therapy are available to treat peri and menopause symptoms. These include hormones that are manufactured to be chemically identical to the naturally occurring hormones produced by the ovaries during the reproductive years, principally estradiol, progesterone, and testosterone. Many of these products are derived from natural sources, including yams or soy. Although the term bioidentical hormones often is used to refer to these identical copies of natural hormones, bioidentical hormones is a marketing term without clear scientific meaning. If hormones that are identical to the hormones produced naturally before menopause, Dr. Casian highly recommends for FDA-approved products containing estradiol and progesterone. There is no benefit to using custom-compounded hormones, and there may be additional risks.

Menopause Care & Hormone Therapy

“A woman is like a tea bag; you never know how strong it is until it’s in hot water”
-Eleanor Roosevelt

Our Clinical Approach

We offer a free 20-minute consultation to discuss how Choose Healthy can support your menopause transition and hormone therapy needs.

Please feel free to download and fill out this self-assessment peri- and menopause questionnaire before scheduling a 20-minute consultation with Dr. Casian.This visit will help determine if you are a good candidate for hormone therapy or other comprehensive programs offered at Choose Healthy.

Menopause Care & HT pricing

$399
INITIAL CONSULT
1-HOUR VISIT

$199
FOLLOW-UP VISITS
30-MINUTE VISIT

$300/MO
MENOPAUSE CARE

+ DIRECT PRIMARY CARE

Frequently asked questions

What is Menopause?

What is Perimenopause

What Is Hormone Therapy?

Is Hormone Therapy (HT) safe?

What are the risks associated with HT?

Can HT cause weight gain?

Bioidentical Hormone Therapy: Custom Compounded or FDA approved ?

Menopause Care & Hormone Therapy

“A woman is like a tea bag; you never know how strong it is until it’s in hot water” -Eleanor Roosevelt

Our Clinical Approach

We offer a free 20-minute consultation to discuss how Choose Healthy can support your menopause transition and hormone therapy needs.

Please feel free to download and fill out this self-assessment peri- and menopause questionnaire before scheduling a 20-minute consultation with Dr. Casian.This visit will help determine if you are a good candidate for hormone therapy or other comprehensive programs offered at Choose Healthy.

Menopause Care & HT pricing

$399 INITIAL CONSULT 1-HOUR VISIT

$199 FOLLOW-UP VISITS 30-MINUTE VISIT

$300/MO MENOPAUSE CARE

+ DIRECT PRIMARY CARE

Frequently asked questions

What is Menopause?

What is Perimenopause

What Is Hormone Therapy?

Is Hormone Therapy (HT) safe?

What are the risks associated with HT?

Can HT cause weight gain?

Bioidentical Hormone Therapy: Custom Compounded or FDA approved ?

“A woman is like a tea bag; you never know how strong it is until it’s in hot water”
-Eleanor Roosevelt

$399
INITIAL CONSULT
1-HOUR VISIT

$199
FOLLOW-UP VISITS
30-MINUTE VISIT

$300/MO
MENOPAUSE CARE