Menopause is the point at which the ovaries stop releasing eggs and estrogen production falls to a low, steady level. It is confirmed after twelve months without a period and most often happens in the late forties to early fifties. The years leading up to it, when hormone levels swing unpredictably, are perimenopause; the years after are postmenopause.
The drop in estrogen affects far more than the reproductive system. Estrogen receptors sit in the brain's temperature center, in bone, in blood vessels, in bladder and vaginal tissue, and in skin. That is why the symptoms range so widely: hot flashes and night sweats, broken sleep, mood changes, brain fog, joint aches, vaginal dryness, bladder urgency, and a shift in cholesterol and body fat that raises cardiovascular risk over time.
At NYMD Center our gynecologists treat menopause as a medical transition to be managed, not a phase to be endured: individualized hormone therapy when it is appropriate, effective non-hormonal options when it is not, direct treatment of vaginal and urinary symptoms, and screening for the bone and heart changes that follow estrogen loss. Because gynecology, urology, and internal medicine share one office, the whole picture is handled in one place.
Who it affects and the symptoms that bring people in
Every woman who lives long enough goes through menopause, but the experience varies enormously. Some notice little beyond the end of periods; others have symptoms that disrupt work, sleep, and relationships for years. Women whose ovaries were removed or damaged by chemotherapy or radiation go through an abrupt menopause that is often more intense. Menopause before 40 is considered premature and deserves its own evaluation.
The symptoms that most often bring people in are hot flashes and night sweats, especially when they wreck sleep, followed by irritability or low mood, trouble concentrating, and persistent fatigue. Many women come in for vaginal dryness, pain with intercourse, or new bladder urgency and recurrent urinary infections. Some arrive after a bone density test or a cholesterol panel shows a change they did not expect.
How we evaluate it at NYMD Center
For a woman over 45 with typical symptoms and changing periods, menopause is a clinical diagnosis. Blood tests are not needed to confirm it and can be misleading, because hormone levels swing from week to week during the transition. We check labs when the picture is unclear or symptoms start unusually early, and to rule out thyroid disease, anemia, and depression, which can all mimic menopause. Our on-site lab handles this the same day.
The visit centers on a thorough history: your symptoms and how much they interfere, your periods, your personal and family history of breast cancer, blood clots, stroke, and heart disease, and your medications. We check blood pressure and do a pelvic exam, with in-office ultrasound if there is unexplained bleeding or pain, and confirm you are current on cervical, breast, and colon cancer screening.
Because estrogen loss accelerates bone loss and shifts cardiovascular risk, we tie in a bone density scan when indicated, a lipid panel and blood sugar, and cardiovascular risk assessment through our internal medicine team. When bladder symptoms are significant, our urology side can evaluate with urodynamics or cystoscopy before any treatment is chosen.
Treatment options
Our approach is to explain what is driving each symptom and then match the least invasive effective option to it. Not every symptom needs a prescription, and not every prescription needs to be a hormone. Reducing alcohol and late caffeine, keeping the bedroom cool, and exercising regularly rarely eliminate moderate symptoms on their own, but they make every other treatment work better and cost nothing in side effects.
Hormone therapy
Estrogen is the most effective treatment for hot flashes, night sweats, and the sleep and mood disruption that follow from them, and it preserves bone density. If you still have your uterus, estrogen is paired with progesterone to protect the uterine lining. After a hysterectomy, estrogen alone is usually appropriate.
The form matters. Transdermal estradiol as a patch or gel bypasses the liver and carries a lower risk of blood clots than oral tablets, so it is often our first choice, particularly for women with any clotting or migraine history. Hormone pellets placed under the skin release hormone steadily for months and suit women who want to avoid daily dosing, though the dose cannot be adjusted once placed. Progesterone is usually given as oral micronized progesterone at bedtime, which also helps sleep, or through a hormonal IUD.
We start low and adjust over the first few months. The risks are real but modest for most healthy women who begin within roughly ten years of menopause: a small increase in clot risk with oral forms, and a small increase in breast cancer risk with longer use of combined therapy. We weigh these against your own history and revisit the decision at each follow-up. See our hormone replacement page for details.
Non-hormonal medications
For women who cannot take estrogen, such as those with a history of breast cancer or a prior clot, or who prefer not to, several medications reduce hot flashes meaningfully. Low doses of certain antidepressants act on the brain pathways that regulate temperature, without requiring that you are depressed. Gabapentin helps particularly with night sweats and sleep. A newer class of medication blocks the neurokinin receptor in the brain's temperature center directly. Each has its own side effects, and we go through them with you.
Treating genitourinary syndrome of menopause
Vaginal dryness, pain with intercourse, urinary urgency, and recurrent urinary infections after menopause share one cause: thinning of estrogen-dependent tissue. Low-dose vaginal estrogen, as a cream, tablet, or ring, restores that tissue with very little absorption into the bloodstream. It is safe for most women, including many with a breast cancer history after discussion with their oncologist, and it is the treatment we reach for first. Moisturizers and lubricants help with comfort but do not reverse the underlying change. We no longer offer vaginal laser treatment; the evidence did not justify the cost and discomfort compared with local estrogen.
When bladder leakage is significant, we bring in our urology colleagues. Options range from pelvic floor rehabilitation with biofeedback to the Emsella chair and, for overactive bladder that does not respond to medication, PTNS or bladder Botox. Our urinary incontinence page explains how these fit together.
Protecting bone
Bone loss speeds up in the first years after menopause. Calcium, vitamin D, and weight-bearing exercise are the foundation; when density is already low, we discuss whether hormone therapy or a bone-specific medication is the better fit.
What to expect at your visit
Plan on a longer first appointment than a routine annual exam. Bring a list of your symptoms, your medication list, and the dates and results of your last mammogram, Pap test, and bone density scan if you have had one.
After the history and exam, we explain what we think is happening and lay out the options that fit your situation, including doing nothing for now. If we start a treatment, we schedule a follow-up within a few months to adjust the dose and check on side effects; telehealth follow-ups are available once a plan is established.
Dr. Guichard and her colleagues see menopause patients at both our Midtown Manhattan and Forest Hills offices. Dr. Guichard conducts visits in French, Haitian Creole, American Sign Language, and medical Spanish.
Questions patients ask
Is hormone therapy safe?
For most healthy women who start within about ten years of their last period and before age 60, the benefits of hormone therapy for troublesome symptoms outweigh the risks. Risk depends on your age, how long you have been past menopause, your personal and family history, and the type and dose of hormone. We go through your history carefully, choose the lowest effective dose, and revisit the decision at every follow-up rather than treating it as permanent.
Do I need progesterone if I take estrogen?
If you still have your uterus, yes. Estrogen on its own thickens the uterine lining over time, which raises the risk of abnormal growth. Progesterone protects the lining. Women who have had a hysterectomy usually take estrogen alone. Local vaginal estrogen at standard doses is absorbed so little that progesterone is generally not needed with it.
What if I cannot or do not want to take hormones?
There are effective non-hormonal options. Certain low-dose antidepressants, gabapentin, and a newer class of medications that act on the brain's temperature center all reduce hot flashes for many women. Sleep, weight, alcohol, and exercise also affect symptoms more than most people expect. We help you choose based on your symptoms and any conditions that make estrogen a poor fit, such as a history of breast cancer or blood clots.
How long can I stay on hormone therapy?
There is no fixed cutoff. Many women use it for several years and then taper as symptoms settle; some continue longer because the benefits for them are clear. What matters is that the decision is reviewed regularly, with attention to your blood pressure, breast screening, and any new health issues. We do not stop therapy simply because a certain birthday has passed.
Why does menopause cause bladder and vaginal symptoms?
The tissues of the vagina, urethra, and bladder base all carry estrogen receptors. When estrogen falls, these tissues become thinner, drier, and less elastic, which leads to irritation, pain with intimacy, urgency, and more frequent urinary infections. This is called genitourinary syndrome of menopause. Unlike hot flashes, it does not improve on its own, but low-dose vaginal estrogen reverses it in most women.
Do you offer hormone pellets?
Yes, for women who are good candidates. Pellets are placed under the skin in the office and release hormone steadily for several months. They are convenient, but the dose cannot be adjusted once placed, so we usually start with a form that can be changed easily and consider pellets once we know what works for you. You can read more on our hormone pellets page.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.