Menopause Care in Seattle - The KPM Approach

We have mastered the art and science of supporting women through menopause transitions with solutions that provide real relief.

Menopause Medicine

Menopause is marked by gradually declining hormone production at the end of a woman’s reproductive years. It is officially defined as the point at which menstruation has stopped for 12 months. The clinical definition does not capture the reality that many women experience during the menopause transition. Perimenopausal and menopausal symptoms can start as early as your early 40s and continue beyond your 50s. Some lucky women sail through this transition with minimal symptoms. However, for many, this unpredictable hormone fluctuation and decline can precipitate emotional and physical turmoil.

Some symptoms are easy to identify as menopausal. Think hot flashes and night sweats. However, there are other less-discussed and poorly recognized symptoms such as changes in mental acuity, declining moods and sense of well-being, sleep disruption, and changes in metabolism.

Often, an annual visit with a primary care physician or OB-GYN compounds a woman’s distress. Doctors are often poorly experienced and lack training in recognizing menopause symptoms. Providers frequently feel more comfortable offering birth control or antidepressants than discussing hormone replacement. It is an exceedingly common experience that women are told that if they are still having periods, they can’t be having menopausal symptoms. This is simply not true.

Understanding menopause means more than recognizing it as a medical condition, it means recognizing it as an important life stage that deserves expert support and targeted intervention.

Recognizing Perimenopausal and Menopausal SymptomS

Women may experience some or many of the following symptoms - both during perimenopause and menopause:

  • Night Sweats

  • Vaginal Dryness

  • Loss of or Lowered Libido / Decreased Sex Drive

  • Sleep Disturbances / Decline in Sleep Quality

  • Erratic Periods (loss of, unpredictable, heavier, lighter, or more frequent … it’s all possible!)

  • Brain Fog / Trouble with Word Recall

  • Cognitive Changes (such as poor concentration)

  • Moodiness, Depression, Anxiety, or Flat Mood

  • Weight Gain

  • Changes in Fat Distribution (i.e., more belly and back fat)

  • Changes in Skin and Hair

  • Painful Intercourse

  • Urine Leakage

  • Frequent Urinary Tract Infections

  • Low Self-esteem, Lack of Confidence

  • Changes in Threshold for Managing Stress

  • Heart Palpitations

  • Osteoporosis

  • Osteopenia

  • Increased Cholesterol Levels

Personalized Diagnostics

Many women want to have a definitive lab test stating that they are in perimenopause or menopause. Unfortunately, no single lab test is definitive for perimenopause. A woman is officially in menopause when you have been without a period for 12 months. Everything leading up to this point is considered perimenopause and is a diagnosis based primarily on symptoms. Clinical presentation and some lab tests guide diagnoses and treatment. Menstrual history, age, and characteristic symptoms all provide clues.

The following labs can be helpful, but are imperfect:

  • FSH & LH  -  signals from the brain to the ovaries that increase as you get closer to menopause. FSH  > 25 indicates menopause.  LH gets higher closer to menopause, less sensitive than FSH.

  • Inhibin B & AMH - these decline earlier and more consistently, but are not routinely measured. 

  • Estradiol - levels are variable, but eventually decrease closer to menopause. They can fluctuate widely from month to month.

 “Normal” or in-range levels of these hormones do not necessarily exclude perimenopause.

KPM generally runs comprehensive lab work on menopausal patients to not only inform menopause diagnoses to rule out other medical issues that can mimic menopausal symptoms and preempt any health risks that come with aging.

COMMON WORKUPS AND PATIENT EVALUATIONS

A comprehensive lab typically includes:

  • FSH

  • Estradiol

  • Progesterone

  • Inhibin B

  • Thyroid - TSH, free T3, free T4, thyroid antibodies (for appropriate patients)

  • Lipid panel with lipid particles (cholesterol)

  • LpPLA2

  • Apolipoprotein B 

  • Homocystiene

  • HS-CRP

  • HgA1C

  • Insulin

  • Vitamin D

  • DHEA

  • CBC

  • CMP

  • B-12 & Folate

  • MTHFR (for appropriate patients)

PREVENTATIVE SCREENING AND IMAGING 

We require standard preventative screenings, and may add additional screenings for women with specific risk factors or family histories:

  • Cardiac calcium score

  • CIMT (carotid intima-media thickness)

  • DEXA scores (bone density)

  • Mammograms and Breast US

  • Home sleep studies

  • Body composition testing

For patients wanting to explore a proactive approach,
Visit our Personalized Diagnostics page

Perimenopause & MEnopause Treatments

Below are the most effective solutions, but remember that some of the symptoms may be associated with other serious conditions and need to be discussed with your doctor.

Medical Interventions

As we discussed above, perimenopause can be a murky diagnosis, and women in their 40s who are not clearly displaying classic menopausal symptoms (i.e., having hot flashes and large periods of time without a menstrual cycle) are often given non-HRT interventions.

Birth control

Oral birth control containing synthetic estrogens and progestins can relieve some perimenopause symptoms like menstrual irregularity, heavy bleeding, menstrual pain, and vasomotor symptoms. Progestin IUDs are often suggested as a way to manage heavy or irregular bleeding.

Off-Label Medications

Antidepressant prescription medications are frequently used off-label for menopause and have shown some efficacy in treating select perimenopausal symptoms. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and low-dose gabapentin are all shown to improve hot flashes.

Anticholinergic medications like oxybutynin can be prescribed to address hot flashes.

Every medication can have side effects. Specifically, antidepressants and birth control might help with some symptoms but frequently reduce libido and decrease a woman’s ability to achieve orgasm, along with other potential side effects. The cost-benefit of these versus hormone therapy should be discussed with your doctor, ideally one who is educated in all the treatment options.

Hormone Replacement Therapy (HRT)

Sometimes referred to as menopausal hormone therapy or MHT, this is a treatment used during perimenopause and menopause to replenish estrogen and progesterone that naturally decline as your reproductive years wind down.

HRT is the most effective treatment for managing menopause symptoms that result from declining estrogen and progesterone (i.e., hot flashes and vaginal dryness). Standard HRT includes progesterone and estrogen. When a woman with a uterus is prescribed estrogen, she must also take progesterone to protect the uterine lining from becoming too thick (a potential risk factor for endometrial cancer). Also, these medications together generally provide the most thorough symptom relief as they both perform important biologic and neurochemical tasks.

However, if a woman does not have a uterus, it is not standard of care to prescribe progesterone. Standard of care suggests progesterone is only needed to protect the uterine lining. However, for those with no uterus (i.e., had a hysterectomy), certain forms of progesterone may still be recommended off-label to help improve symptoms like sleep issues, night sweats, and mood changes.

While not every woman is a candidate for HRT, most can safely take it, according to the Menopause Society, which is the leading organization in understanding and researching the health of mid-life women. Discuss HRT with your doctor so you can make the right decision for you, your symptoms, and your approach to health.

HRT can frequently help with the following symptoms:

  • Irregular periods

  • Breast tenderness

  • Mood swings

  • Bloating

  • Sleep disturbances

  • Mood changes

  • Hot flashes and night sweats

  • Vaginal dryness

  • Discomfort during sex

  • Frequent UTIs

  • Brain fog/poor word recall - mental clarity

Lifestyle Interventions

There is some evidence to suggest that lifestyle factors can mitigate the experience of perimenopause to some degree. Super annoying because perimenopause also contributes to weight gain. That said, studies have shown that carrying extra weight, overconsumption of alcohol, and lack of exercise are all associated with more severe symptoms. For what it’s worth, the following are some lifestyle targets to keep in mind:

  • Get enough exercise. A general target is 150 minutes a week of some kind of physical activity, ideally combining cardio and strength training.

  • Perform weight-bearing exercises such as hiking, walking, or strength training.

  • Eat a whole foods-focused diet centered on vegetables, slow-burn carbs, lean proteins, and healthy fats.

  • Stress - to the best of your ability, minimize your life stressors because high cortisol can make symptoms worse.

  • Botanicals - there are a few supplements like black cohosh, Vitex, and maca that can provide modest support.

The KPM Approach

Our expertise lies in identifying perimenopausal and menopausal changes and supporting women with effective solutions. Dr. Kass has pursued numerous advanced certifications and hundreds of hours of menopause-specific continuing education with the goal of providing safe, results-driven, and evidence-based hormone treatments.

KPM believes in precision. We focus on your symptom presentation, comprehensive labs, and proactive diagnostics to track progress and adjust goals accordingly. Our menu of labs often extends beyond standard primary care protocol with an emphasis on the early detection of potential future problems.

For further information, please visit these pages: (hyperlinks):

When to See a Doctor for Menopausal Symptoms

If you are struggling with what you think might be perimenopausal symptoms, do your research and seek out a doctor who specializes in perimenopause/menopause so you can explore the most appropriate treatment option for you.

IF YOU’D LIKE TO DISCUSS YOUR MENOPAUSE SYMPTOMS WITH KPM, CALL 425-230-6893.