Symptom assessment – hot flashes, night sweats, irregular bleeding, mood changes, sleep disturbance, cognitive changes, vaginal dryness, libido concerns, weight changes.

• Individualized counseling on risks, benefits, and indications for systemic and local HT. 

• Prescription & titration of: 

  • Systemic estrogen ± progestogen (oral, transdermal) 

  • Local vaginal estrogen for genitourinary syndrome of menopause (GSM) 

  • Non-hormonal options when appropriate 

• Ongoing monitoring for efficacy, side effects and long-term safety 

• Evidence-based use of non-hormonal pharmacologic options for vasomotor symptoms (e.g., SSRIs/SNRIs, gabapentin, clonidine) 

• Discussion of lifestyle modifications (nutrition, exercise, sleep hygiene) 

• Guidance on complementary and alternative therapies with a focus on safety and efficacy 

• Management of GSM: vaginal estrogen, DHEA, selective estrogen receptor modulators, moisturizers/lubricants 

• Treatment of low libido, including biopsychosocial assessment and medical therapy when indicated 

• Address urinary symptoms (urgency, incontinence, recurrent UTIs) with targeted therapy or referral to urogynecology 

• Bone density screening and osteoporosis prevention/treatment per guidelines 

• Counseling on calcium/vitamin D, weight-bearing exercise, fall prevention 

• Integration of menopausal care with ongoing preventive health (e.g., mammography, colon cancer screening, cardiovascular risk assessment) 

• Screening for mood disorders, anxiety, sleep disturbances and cognitive changes during the menopausal transition 

• Short-term interventions, medication management, and/or referral to mental health professionals 

• Support for sexual wellbeing, body image and relationship concerns 

• Coordination with primary care, endocrinology, cardiology, psychiatry, urogynecology and pelvic physical therapy as needed 

• Hybrid care options (in-person and virtual visits) to improve access and continuity 

• Development of individualized care plans that evolve over time 

• Patient education on the natural course of perimenopause and menopause 

• Shared decision-making around all treatment options 

• Provision of trusted educational resources and support group information