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What is Perimenopause?

Perimenopause is the transition time before true menopause begins when periods are still occurring but become be irregular and inconsistent. It most commonly effects women in their late 40s or early 50s, but may be earlier than that. During this period the ovaries do not cycle regularly, so there are hormonal fluctuations which can cause unpleasant symptoms.

Common Symptoms of Perimenopause

  • Hot flashes
  • Irregular Periods (lasting for a long or
    short period of time)
  • Light or Heavy Bleeding
  • Cramping
  • Irregular or Intermittent Hot Flashes
  • Irritability, Depression, Anxiety
  • Insomnia
  • Intermittent Bloating and Breast
  • Weight Gain
  • Low Sex Drive/Low Libido

Bio-Identical Hormone Therapy for Perimenopause

Our customizable treatment programs have been developed by our internationally recognized physician, Khalid Mahmud, MD, FACP who is an expert in the field of Anti-Aging and bio-identical hormone replacement.

We complete a thorough evaluation including a comprehensive set of blood tests, exam, medical history and a complete assessment of health risks and symptoms, but always include the sex hormone levels. We then control symptoms by replacing the deficient hormones with bio-identical preparations given in a natural way. We replace intermittently deficient (fluctuating) hormone levels only when symptoms of deficiency occur.

Avoid under-treatment and over-treatment

It is like a moving target, and the management has to be adjustable and accurate to relieve symptoms and avoid over or under treatment, a fact not recognized by many hormone replacement programs.

Reducing the risk of heart disease and breast cancer

While managing the symptoms of perimenopause, we also take measures to reduce the risk of cardiovascular disease, osteoporosis, breast cancer and other chronic diseases (see Dr. Mahmud’s book, Keeping aBreast: Ways to stop breast cancer).

Leaping to full blown menopause

With time, perimenopause leaps into menopause, at which time the treatment program has to change to account for the hormonal changes that occur.

Click Here To View All Of Our Treatment Programs


“My energy level increased. I became less irritable and cranky. I was finally able to sleep through the night. Yes, I started to think about sex! Finally, I had the desire, intent, and even the energy to follow through. I finally feel as though I have the ‘zest’ that I once had years ago…I’m back!!!”
– Marie K., 43

“There is a lot of information from so-called experts about vitamins, supplements, diet, and exercise for optimal health. It is very difficult to know how to interpret this information. In addition, my mother got breast cancer when she was in her 40’s, about the age I am now, and I wanted to find out what things I could do to prevent this from happening to me.

After following Dr. Mahmud’s recommendations on diet, exercise, and supplements, I generally feel better at age 44 than I have most of my life. I am a lot more energetic and have a much better ability to pick up information and process it. Physically, I am very strong, fit, and much more confident in my appearance. I am very pleased and recommend Innovative Directions in Health to anyone who wants to optimize their health and be the best person, both physically and mentally, that they can be.” – Jenny S., 44