Perimenopause is the transition before menopause, when menstrual cycles and symptoms can change as ovarian hormone production becomes less predictable. David Nazarian, M.D., Board-Certified in Internal Medicine, provides individualized evaluation for hot flashes, night sweats, sleep disruption, mood changes, brain fog, vaginal symptoms, libido changes, cycle changes and other concerns during this transition.
Because these symptoms can overlap with thyroid disease, anemia, sleep disorders, medication effects and other conditions, treatment begins with a broader medical assessment—not a hormone level alone.
Cycles may become shorter, longer, heavier, lighter or less predictable. Symptoms can begin even while periods are still occurring, and the experience varies considerably from one woman to another.
Symptoms during midlife are not automatically caused by hormone changes. A medical assessment can help identify other contributors and determine which treatments are appropriate.
Symptoms can vary from woman to woman and may overlap with other conditions.
Changes in timing, flow, or cycle length.
Sudden heat, flushing, and nighttime sweating.
Difficulty falling asleep or staying asleep.
Irritability, anxiety, or low mood.
Trouble concentrating or forgetfulness.
Dryness, discomfort, or pain with intimacy.
Changes in sexual desire.
Shifts in body composition and midsection weight gain.
Important: A medical evaluation can help determine whether symptoms are related to perimenopause or another condition.
Changes in menstrual timing, frequency, duration or flow.
Hot flashes, night sweats, disrupted sleep and fatigue.
Mood changes, irritability, anxiety, brain fog or difficulty concentrating.
Vaginal dryness, discomfort with intercourse, urinary symptoms or changes in libido.
Important: New or unusually heavy bleeding, bleeding after intercourse, severe symptoms, or symptoms beginning unusually early may require additional evaluation and should not automatically be attributed to perimenopause.
Cycle changes, symptoms, gynecologic and pregnancy history, medications, prior treatments, sleep, lifestyle, family history and personal goals.
Cardiovascular and metabolic health, thyroid symptoms, breast and gynecologic history, clotting risk, bone health and age-appropriate screening.
Testing is chosen according to the clinical question. A routine hormone panel is not automatically required for every woman with a typical perimenopause history.
Treatment depends on the symptoms that matter most, bleeding pattern, whether contraception is still needed, medical history, personal risks and preferences.
Selected patients may be candidates for hormonal contraception or menopausal hormone therapy depending on symptoms, cycle pattern, uterine status and risk factors.
Evidence-based nonhormonal medications, sleep treatment, behavioral approaches, vaginal moisturizers and lubricants, and treatment of contributing conditions may be appropriate.
Targeted vaginal treatment may be considered when dryness, discomfort or selected urinary symptoms are the primary concerns.
Exercise, nutrition, resistance training, sleep, bone health, cardiovascular risk reduction and recommended screening remain important whether or not hormone therapy is used.
Hormone therapy can be effective for selected menopause-transition symptoms, but it is not a universal treatment for every symptom and is not a weight-loss or anti-aging therapy. Treatment should be chosen after reviewing expected benefits, alternatives, route of administration, uterine status, bleeding history, potential risks and monitoring.
The treatment plan should be revisited over time as symptoms, goals and health risks change.
More detailed assessment or specialist coordination may be needed with unexplained vaginal bleeding, certain hormone-sensitive cancers, prior blood clots, stroke, heart attack, significant liver disease or other complex medical conditions.
Menopause Treatment · Progesterone Therapy · Estrogen Therapy · GSM & Vaginal Atrophy
Often not for a typical menopause transition. Testing is more useful when the presentation is atypical, symptoms occur unusually early, or another diagnosis is being considered.
No. Treatment depends on the symptoms, medical history, risks and patient preferences. Some women do not need medication.
Some women with bothersome symptoms may be candidates for hormone therapy during perimenopause. The appropriate regimen depends on symptoms, bleeding pattern, uterine status and individual risk factors.
Body composition and fat distribution can change during midlife, but hormone therapy is not a weight-loss treatment. Sleep, activity, nutrition, medications and metabolic health should also be considered.
Targeted local therapies may be appropriate and can differ from systemic hormone therapy. See our GSM and vaginal atrophy guide.
Our Beverly Hills office serves patients from across greater Los Angeles seeking individualized perimenopause and women’s hormone care.
Commonly served areas include: Beverly Hills, West Hollywood, Century City, Brentwood, Santa Monica, West Los Angeles, Bel Air, Culver City, Hollywood and Pacific Palisades.
Discuss your symptoms, cycle changes, medical history and treatment preferences with David Nazarian, M.D., in Beverly Hills.
David Nazarian, M.D., is Board-Certified in Internal Medicine by the American Board of Internal Medicine and has completed advanced bioidentical hormone replacement therapy training through WorldLink Medical. He provides physician-led hormone evaluation and individualized care for women and men, with an emphasis on comprehensive assessment, patient education, safety, and ongoing follow-up.
Hormone Replacement Therapy LA provides physician-led hormone evaluation and individualized care with David Nazarian, M.D.
Serving Los Angeles & Surrounding Communities
Our Beverly Hills hormone clinic serves patients throughout Greater Los Angeles, including Beverly Hills, West Hollywood, Santa Monica, Brentwood, Century City, Bel Air, Westwood, Hollywood, Culver City, Pacific Palisades, Marina del Rey, Venice, Encino, Sherman Oaks, Studio City, Calabasas, Malibu and surrounding Southern California communities.
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