Menopause and Perimenopause Care
You are not imagining it. And you do not have to wait it out.
You are sleeping badly. Your temper has a shorter fuse than it used to. Your periods are unpredictable, your joints ache, sex hurts, and the word you wanted has gone missing mid-sentence again. Maybe you have already mentioned it to a doctor and been told your labs look fine, you are still too young, or this is simply what happens.
Here is what is actually happening: your hormones are changing, those changes affect nearly every system in your body, and there is a great deal that can be done about it.
At IvanaMD, menopause is not a five-minute add-on at the end of a pap smear. It is a conversation we make room for — with a board-certified gynecologist who will sit down, hear the whole picture, and build a plan with you.
Book Your Menopause Consultation or call 346-585-4077
The three stages, in plain language
Perimenopause is the transition — and it is where most women are when they first suspect something has shifted. It often begins in the 40s, sometimes earlier, and can last several years. Your ovaries are still working, but erratically. Estrogen does not glide downward; it swings. That is why perimenopause can feel more turbulent than menopause itself, and why you can still be having periods while feeling thoroughly unlike yourself.
Menopause is a single point in time: the day you reach twelve consecutive months without a menstrual period, with no other explanation. It is diagnosed looking backward. In the United States, the average age is around 51.
Postmenopause is every year that follows. Symptoms may ease — but the health changes that come with lower estrogen, particularly for bone, heart and genitourinary health, deserve ongoing attention rather than silence.
Menopause before 45 is considered early, and before 40 it is called primary ovarian insufficiency. Both warrant prompt evaluation, because the long-term effects on bone and cardiovascular health are different — and treatable. If your periods stopped early, or stopped after chemotherapy, radiation, or removal of your ovaries, please make an appointment.
Symptoms we treat
Most women know about hot flashes. Far fewer are told about the rest of the list — which is why so many symptoms get treated in isolation, or attributed to stress and aging.
Temperature and sleep
Hot flashes, night sweats, waking at 3 a.m., difficulty falling back asleep, exhaustion that sleep does not fix.
Mood and mind
Irritability, anxiety that feels new or out of proportion, low mood, tearfulness, brain fog, word-finding trouble, difficulty concentrating.
Menstrual changes
Cycles that shorten, lengthen, skip, or turn unusually heavy. Heavy or prolonged bleeding, bleeding between periods, or any bleeding after menopause should always be evaluated — these are not symptoms to wait out.
Sexual and genitourinary symptoms
Vaginal dryness, burning or irritation, pain with penetration, tearing, loss of desire, difficulty with arousal or orgasm, urinary urgency, and recurrent urinary tract infections. Together these are known as genitourinary syndrome of menopause (GSM). Unlike hot flashes, GSM does not improve on its own — it tends to progress without treatment, and it responds very well to treatment.
Body and metabolism
Weight gain around the middle, loss of muscle, joint and muscle aches, hair thinning, skin dryness, palpitations, headaches.
If several of these are on your list, they are most likely connected. We treat them that way.
What your visit looks like
We start with your story. Your symptoms, how long they have been going on, what they are costing you at work, at home, and in your relationships. Your medical history, family history, medications, and what you have already tried.
We confirm where you are. For most women over 45, the menopause transition is a clinical diagnosis based on symptoms and menstrual pattern — hormone levels swing so widely during perimenopause that a single blood test can be misleading. Testing is genuinely useful in specific situations: unexplained absent periods, suspected early menopause, or ruling out other causes such as thyroid disease, anemia, or pregnancy. We order tests when they will change the plan, and explain why when they will not.
We screen for what else is going on. Menopause overlaps with the years when blood pressure, cholesterol, blood sugar, bone density and cancer screening all deserve attention. We look at the whole picture, not just the symptom that brought you in.
We build the plan together. You will leave understanding your options — including the trade-offs of each — and knowing what to expect and when to follow up. Several of our patients say the same thing about their first visit: no one had ever taken that much time. That is deliberate.
Treatment options
There is no single right answer in menopause care. There is a right answer for you, and it depends on your symptoms, your medical history, your risk factors and your preferences.
Hormone therapy
For hot flashes and night sweats, hormone therapy remains the most effective treatment available, and it also prevents the bone loss that accelerates around menopause. For healthy women who begin treatment before age 60 or within ten years of their final period, the benefits generally outweigh the risks.
Hormone therapy is not one drug. It comes as pills, skin patches, gels and sprays, and the route matters — transdermal estrogen, for example, carries a different risk profile than oral. Women who still have a uterus also need progesterone alongside estrogen to protect the uterine lining. We will walk you through which formulation fits your history and why.
A note on what changed recently: in November 2025, following an expert panel review, the FDA announced it would remove the long-standing boxed warning regarding cardiovascular disease, breast cancer and dementia from estrogen-containing menopause products, with updated labeling emphasizing the importance of when therapy is started. This does not mean hormone therapy is right for every woman — it is not, and some conditions still rule it out. It does mean the fear that kept a generation of women from even asking the question deserves an honest, individualized re-examination. We are glad to have that conversation with you.
Non-hormonal prescription options
If hormone therapy is not safe for you, or you simply prefer not to use it, effective options exist — and more of them than there were two years ago.
- Fezolinetant and elinzanetant, approved by the FDA in 2023 and October 2025, are hormone-free medications that work on the brain's temperature-regulating pathway rather than by replacing estrogen. Both require liver monitoring and are not appropriate for everyone.
- Low-dose paroxetine is FDA-approved for hot flashes, and several other antidepressants, as well as gabapentin and oxybutynin, are used off-label with good evidence behind them.
- Cognitive behavioral therapy and clinical hypnosis have evidence for reducing the burden of hot flashes and improving sleep, and pair well with medication.
For vaginal, sexual and urinary symptoms
This is where too many women quietly give up, and where treatment is often the most straightforward.
Local vaginal estrogen delivers a very small dose directly to the tissue with minimal absorption into the bloodstream, which makes it appropriate for many women who cannot take systemic hormones. Vaginal DHEA and an oral non-estrogen option are also available, alongside non-hormonal moisturizers and lubricants, pelvic floor therapy, and treatment for pain with intercourse.
Because sexual health is a core part of this practice, low desire, arousal difficulty, orgasmic disorders and painful sex are evaluated here properly rather than deflected. Dr. Ivana will ask, and she will not make it awkward.
Learn more: Sexual Health
Weight, metabolism and long-term health
The weight that settles around the abdomen in midlife is driven by shifting hormones, muscle loss and disrupted sleep — not a failure of willpower. Our physician-supervised weight management program addresses it medically. We also use these years to get ahead of the conditions that become more likely after menopause: osteoporosis, heart disease, and changes in cholesterol and blood sugar.
Learn more: Medical Weight Loss
Why women in Fort Bend County choose IvanaMD
Time. Appointments here are built for real conversation. Menopause cannot be sorted out in a rushed visit, and we do not pretend otherwise.
A gynecologist with depth. Dr. N. Ivana Amajoh Anunobi is a Fellow of the American College of Obstetricians and Gynecologists who completed her OB/GYN residency at UTHealth in Houston, practiced as a partner in one of the largest OB/GYN groups in Sugar Land, and served as a Clinical Assistant Professor at UTHealth's McGovern Medical School, training the next generation of OB/GYNs.
Symptoms taken seriously — for every woman. Research from the Study of Women's Health Across the Nation found that frequent hot flashes and night sweats lasted a median of 7.4 years overall, and a median of 10.1 years among Black women — the longest of any group studied. Symptoms that last a decade are not something to be told to ride out.
Care that fits your life. In-office visits in Missouri City, plus secure telehealth for follow-ups and medication management. We accept insurance.
A woman like myself in menopause, have been looking for the right doctor to assist with hormonal changes, hot flashes etc. Dr. Ivana will sit you down & talk with you, examine you, she wants to know what's going on in your life. She wants what's best for you & in doing so she listens. Every woman going through menopause, needs to see Dr. Ivana!!!
— Kathyann B.
Frequently asked questions
How do I know if I am in perimenopause?
The most common signs are a change in your menstrual pattern along with new symptoms such as night sweats, disrupted sleep, mood changes or vaginal dryness. You can be in perimenopause while still having regular periods. If your cycle or your sense of yourself has changed, that is reason enough to come in.
Do I need a blood test to diagnose menopause?
Usually not. For women over 45, diagnosis is based on symptoms and menstrual history, because hormone levels fluctuate too much during perimenopause for one test to be meaningful. Testing is helpful when menopause may be occurring early, when periods have stopped unexpectedly, or when we need to rule out other causes.
Am I a candidate for hormone therapy?
Many women are. Candidacy depends on your age, how long since your final period, and your personal and family history — particularly of breast cancer, blood clots, stroke, heart disease, liver disease, or unexplained vaginal bleeding. Some of these rule out systemic hormone therapy; many do not rule out local vaginal treatment. This is exactly the conversation to have at a consultation.
Is it too late to start hormone therapy?
Starting systemic hormone therapy more than ten years after menopause, or after age 60, shifts the risk-benefit balance and calls for careful individual assessment. But it does not leave you without options — non-hormonal treatments and local vaginal therapy remain available at any age.
What about bioidentical hormones?
Several FDA-approved hormone therapies, including estradiol and micronized progesterone, are structurally identical to the hormones your body makes. These are regulated products with known doses and established safety data. Custom-compounded hormone preparations are not FDA-regulated, and dose consistency and purity are not guaranteed. We will explain the difference and what we recommend for you.
I had breast cancer. Can anything help?
Yes. Hormone-free medications for hot flashes, including the newer non-hormonal options, and specific approaches to vaginal dryness and painful sex can often be used. We coordinate with your oncologist.
How long will my symptoms last?
Longer than most women are told. In the largest study of its kind, frequent hot flashes and night sweats lasted a median of 7.4 years, and continued for a median of 4.5 years after the final period — with considerable variation from woman to woman.
Is menopause care covered by insurance?
We accept insurance. Coverage for specific medications and services varies by plan, and our team will help you understand your benefits before we proceed.
Do you offer telehealth for menopause?
Yes. Many follow-up visits and medication adjustments can be handled by secure video or phone.
Take the next step
You have likely spent a while telling yourself this is manageable, or that it will pass. You deserve a real evaluation and a plan built for you.
Schedule your menopause consultation with Dr. Ivana.
Book an Appointment or call 346-585-4077
4220 Cartwright Rd., Suite 201, Missouri City, TX 77459
Monday–Friday, 9am–5pm, by appointment
Serving Missouri City, Sugar Land, Pearland, Katy, Richmond and the greater Houston area