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Medical Definitions

Perimenopause is a time of fluctuating levels of progesterone, estrogen, and testosterone. Progesterone deficiency is the most common hormonal change. Perimenopause generally starts in woman’s early to mid 40s and can last as long as a decade before menopause.

This is a time when hormones can be out of balance and signs of estrogen dominance, estrogen deficiency, or both are possible at various times during the month.





An imbalance in hormones. Estrogen, progesterone & testosterone all play a role in the symphony of desire and the ability for women to orgasm. When one or more of these hormones is low, it can have unfavorable effects on desire.

Mood swings are common in perimenopause due to hormonal fluctuations. These can have negative consequences on marital relationships as well interest in sexual activity.

Women may experience a decrease in lubrication due to a decrease in estrogen which can make sex painful or uncomfortable.

50% of women report a loss of their libido during perimenopause. Many factors contribute to this occurrence:

Irregular menstrual cycles

Shorter or longer periods

Lighter or heavier flow

Vaginal dryness

Mood swings

Hormonal migraine headaches

Symptoms vary but some of the more common telltale signs of fluctuating estrogen and progesterone are:

Treatment options for perimenopause symptoms include BHRT, lifestyle changes, and other natural remedies including drainage and detox.  

Menopause is a time of ovarian estrogen depletion and marks the end of a woman's reproductive years. It is a time in a woman’s life, usually between ages 45-55, when her menstrual periods stop permanently. Menopause can also be the result of a hysterectomy (“surgical menopause”).


Hot flashes

Night sweats

Mood swings

Difficulty sleeping

Vaginal dryness

Decreased libido

Weight gain

Menopause symptoms can vary from woman to woman, but some of the most common symptoms include:

Other symptoms may include fatigue, headaches, joint pain, and changes in hair and skin (dryness and wrinkling).

Treatment options for menopause symptoms include BHRT, lifestyle changes, and other natural remedies including drainage and detox.  

Part of the endocrine system, the thyroid is a butterfly shaped gland at the front of the neck that makes hormones that regulate how our body utilizes energy. These hormones influence metabolism, body temperature, cognitive function, digestion, hair and nail growth. 

Thyroid issues can have a significant effect on our health and according to the American Thyroid Association, one in eight women will experience some type of thyroid disorder or disease in her lifetime. Thyroid issues can have a significant impact on both our health and well-being.

Treatment options vary according to whether the thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism).


Hyperthyroidism is the overproduction of thyroid hormones in the thyroid gland. It can lead to fatigue, hair loss, irritability, anxiety, unexplained weight loss, fast heart rate and excessive sweating.


Hypothyroidism is an underactive thyroid that is unable to produce the amount of thyroid hormones your body requires. Low thyroid hormone levels cause the body’s functions to slow down, leading to symptoms like fatigue, dry skin, constipation, and memory problems. It can also cause weight gain, the feeling of being cold, muscle weakness, high cholesterol, joint pain or stiffness, and in some; depression.

Your thyroid gland is intimately involved with the regulation of blood sugar. In fact, it directly affects hunger and satiety sensation. Along with insulin and leptin resistance, low thyroid hormone can make losing weight quite challenging, if not impossible.


Autoimmune inflammation (Hashimoto’s thyroiditis) disrupts the thyroid gland’s hormone production, most common cause of hypothyroidism. This disease occurs when the body’s immune system mistakenly attacks and slowly destroys the thyroid gland and its ability to produce hormones. Hashimoto’s disease affects nearly 14 million people in the United States, most commonly middle-aged women.

Surgery: partial or complete removal of the thyroid gland disables thyroid hormone production


Low estrogen, low testosterone, and low progesterone.

Causes of hypothyroidism include:

Treatment options: Bioidentical thyroid replacement, nutraceuticals, and stress management techniques. 
Graves disease: an autoimmune dysfunction that causes overproduction of thyroid hormones

Thyroiditis: thyroid gland inflammation can stimulate excessive hormone production

Growths: thyroid nodules and thyroid cancer are less common causes of an overactive thyroid.

Hyperthyroidism causes include:

Treatment options: I am trained to assist those with hyperthyroidism using techniques for stress management and select pharmaceuticals used in collaboration with an endricrinologist.
The body prioritizes and favors the production of cortisol above all other steroid hormones (estrogen, testosterone, and progesterone.) If cortisol is depleted, it can be difficult to get all of the steroid hormones as well as the thyroid into consistent balance.

Treatment options: reducing systemic inflammation, blood sugar regulation through lifestyle changes, circadian rhythm entrainment, depending on the severity, medications are available.


Suppressed immune function


High blood sugar and insulin resistance

Metabolic syndrome

Increased visceral fat around the vital organs

Reduced libido

Bone loss

Neurodegenerative effects; brain fog, difficulties with cognition, difficulties with word recall and memory

Symptoms of cortisol depletion may include:




Regulates your body's response to stress and fight-or-flight response. 

Blood sugar regulation

Helps control blood pressure and blood circulation

Cortisol has three main functions:

Corticosteroids are essential for life. Cortisol is the principle corticosteroid produced and released by the adrenal glands. When cortisol is dysregulated (too high or too low), we refer to this as HPA-D or Hypothalamic–Pituitary–Adrenal Axis Dysfunction. This symphony of hormones governs our short and long-term stress response.

At present, there are no insurance billing codes for bioidentical hormone therapy (BHRT). Some insurance companies cover selected labs, and in some instances, you can use your health savings accounts to pay for services not covered by insurance.

Individualized medicine requires adequate time with each patient. Comprehensive, personalized care is effective.

RH COLLABORATIVE is a Membership Practice

new patient details

If you are interested in more details of how a new patient process works, please read more.

This comes two weeks after you begin your protocol. We will review a new questionnaire and discuss any follow-up needs.

Subsequent Consultation

We will review your forms and talk about your history, symptoms and health goals. If necessary we will requisition additional lab work and provide your first prescription.

Initial Consultation

Your first step is to book a discovery call with me. After booking, a staff member will contact you with a questionnaire.

Discovery Call

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