Navigating Menopause and Perimenopause

At Montgomery Gynecology, our goal is to provide clear, evidence-based care so you can stay healthy, confident, and in control through every life stage. Menopause is a normal, natural transition. With the right information and support, you can manage symptoms, protect your long-term health, and maintain your quality of life.

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Clinical Leadership and Credentials

  • Care led by Dr. Hema Jonnalagadda  M.D. 
  • Member, The Menopause Society (formerly North American Menopause Society)
  • Provides treatments that are FDA-approved and aligned with current U.S. clinical guidelines
  • Focus on evidence-based, individualized care for perimenopause and menopause

What Is Menopause?

Menopause is confirmed after 12 consecutive months without a menstrual period. It reflects a natural decline in ovarian hormone production, especially estrogen and progesterone.

  • Average age: 51 in the United States
  • Typical range: 45–55
  • Early menopause: before age 45 (evaluate for underlying causes)
  • Induced menopause: after surgery (removal of ovaries), chemotherapy, or certain medical treatments


                                 What Is Perimenopause?


Perimenopause is the transition phase leading up to menopause, often beginning in the late 30s to 40s and lasting several years.

Common patterns:

  • Cycle length changes (shorter, longer, or skipped periods)
  • Heavier or lighter bleeding than usual
  • New or worsening PMS-like symptoms

Important: Any heavy bleeding, bleeding between periods, or bleeding after sex should be evaluated promptly.

Common Symptoms

Symptoms vary in type and intensity.

Many women experience several at once

  • Vasomotor Symptoms

    • Hot flashes and night sweats
    • Sudden heat in the face, neck, and chest

    • Sleep disruption from nighttime symptoms

  • Sleep and Mood

    • Difficulty falling or staying asleep
    • Early morning awakenings
    • Mood changes, irritability, anxiety, or low mood

    • Brain fog or concentration changes

  • Genitourinary Syndrome of Menopause (GSM)

    • Vaginal dryness, irritation, or burning
    • Pain with intercourse
    • Recurrent urinary tract infections

    • Urgency or frequency of urination

  • Other Physical Changes

    • Joint aches and stiffness
    • Changes in skin and hair
    • Weight distribution shifts (more central/abdominal)

  • Heart Health After Menopause

    Estrogen has protective cardiovascular effects before menopause. After menopause, risk for heart disease and stroke increases.


    What matters most in 2026 care:


    • Regular blood pressure, cholesterol, and glucose screening
    • Weight management and physical activity
    • Smoking cessation
    • Sleep quality and stress control

  • Bone Health and Osteoporosis Risk

    Bone loss accelerates in the first 4–8 years after menopause due to lower estrogen.


    • Protect your bones:
    • Weight-bearing and resistance exercise
    • Adequate calcium and vitamin D
    • Fall prevention strategies
    • Bone density (DEXA) testing when indicated
    • Untreated bone loss can lead to osteoporosis and fractures of the hip, spine, or wrist.

Evidence-Based Treatment Options

Treatment is individualized based on symptoms, health history, and preferences.

Hormone Therapy

 (HT / MHT)



Most effective treatment for moderate to severe hot flashes and night sweats.

  • Estrogen alone (after hysterectomy) or estrogen + progesterone (if uterus present)
  • Also improves vaginal symptoms and helps prevent bone loss
  • Best started within 10 years of menopause onset or before age 60 in appropriate candidates


Non-Hormonal Prescription Options

For those who cannot or prefer not to use hormones:

  • SSRIs/SNRIs (for hot flashes and mood)
  • Gabapentin or clonidine in select cases
  • Newer non-hormonal therapies targeting hot flashes may be considered


Vaginal Estrogen and Local Therapies

  • Low-dose vaginal estrogen (cream, tablet, or ring)
  • Non-estrogen options such as moisturizers and lubricants
  • Highly effective for GSM with minimal systemic absorption

Lifestyle and Preventive Care

  • Regular exercise (cardio + strength)
  • Balanced nutrition (protein, fiber, calcium, vitamin D)
  • Sleep hygiene and stress management
  • Limiting alcohol and avoiding tobacco

When to Contact Your Gynecologist

Seek medical care if you experience:

  • Heavy or prolonged bleeding
  • Bleeding after menopause
  • Severe or disruptive hot flashes
  • Pain with intercourse or recurrent UTIs
  • Significant mood changes or sleep problems
  • Concerns about heart or bone health


How Montgomery Gynecology Supports You


We provide:

  • Individualized menopause and perimenopause care plans
  • Hormone and non-hormone treatment options
  • Preventive screenings for heart and bone health
  • Counseling on lifestyle, sexual health, and long-term wellness

If you have questions about menopause or want to discuss your symptoms and options,

contact our office to schedule a visit. Your comfort, safety, and long-term health are our priority.