Perimenopause & Menopause Care

You Know Something Has Changed. We Help You Understand Why.

Maybe you’re suddenly sleeping poorly. Your periods are changing. You feel more anxious or irritable than you used to. You’re forgetting words, struggling to concentrate, developing headaches, or noticing changes in your weight and body composition despite doing all the things that used to work.

Sometimes blood work has been reported as “normal.” Sometimes symptoms have been attributed to stress, aging, or simply having too much going on.

For many women, these changes are part of perimenopause - the hormonal transition that can begin years before the final menstrual period.

At Integrated Health Clinic, our goal is to help you understand what is changing, determine what else may be contributing to your symptoms, and develop an individualized plan for both how you feel today and your health in the years ahead.

Our menopause physicians include Menopause Society Certified Practitioners (MSCPs) with advanced education and demonstrated expertise in menopause and midlife women’s health.

Appointments are available in person at our South Surrey/White Rock clinic, virtually, and by telephone throughout British Columbia.

Many women tell us the same thing when they come to see us:

"I just don't feel like myself anymore."

Perimenopause Can Begin Earlier Than Many Women Expect

Perimenopause doesn’t begin when periods stop. It is the transition leading up to menopause, and symptoms may begin while periods are still regular. As ovarian hormone production becomes more variable, estrogen and progesterone levels can fluctuate considerably from one month to the next.

This is one reason a single hormone blood test may not accurately reflect what is happening.

For women over 45, perimenopause is often identified primarily through symptoms, menstrual history, and clinical assessment, rather than relying on hormone levels alone. And because the symptoms can involve much more than hot flashes, the connection to perimenopause is sometimes missed.

What Is an MSCP?

MSCP stands for Menopause Society Certified Practitioner.

The Menopause Society is an international professional organization dedicated to promoting the health and quality of life of women through an understanding of menopause and healthy aging.

The Society developed its competency examination to establish standards for healthcare professionals providing menopause care. Licensed healthcare professionals who successfully complete the examination earn the designation Menopause Society Certified Practitioner (MSCP).

Certification demonstrates specific expertise in menopause and midlife women’s health beyond a practitioner’s primary professional training. Maintaining the MSCP credential also requires ongoing education. Certification is renewed every three years through re-examination or qualifying continuing education in midlife women’s health.

For patients, the MSCP designation provides another way to identify a healthcare professional who has made menopause medicine a focused area of clinical education and practice.

At Integrated Health Clinic, our MSCP-certified physicians combine this menopause-specific training with comprehensive medical assessment to provide individualized, evidence-informed care throughout perimenopause, menopause, and beyond.

Is This Perimenopause?

Perimenopause can look very different from one woman to another.
You may experience:

Changes in the timing or flow of your periods
Heavy or unpredictable bleeding
Hot flashes or night sweats
Difficulty falling or staying asleep
Waking during the night
New or worsening anxiety
Irritability or mood changes
Premenstrual symptoms that have become more pronounced
Brain fog or difficulty concentrating
Changes in memory or word finding
Headaches or migraines
Fatigue
Changes in weight or body composition
Joint or muscle discomfort
Reduced libido
Vaginal dryness or discomfort
Pain with intercourse
Recurrent urinary symptoms
Changes in skin or hair

You don’t need to have every symptom - and you don’t need to have hot flashes - for hormonal changes to be contributing to how you feel.

A Comprehensive Approach to Menopause Care

Good menopause care is about more than treating hot flashes or checking an estrogen level. Your first assessment gives us an opportunity to look at the whole picture.

Your menstrual history, perimenopause or menopause symptoms, sexual health, and whether menopausal hormone therapy may be appropriate.
Blood pressure, cholesterol, glucose regulation, insulin resistance, body composition, and cardiovascular risk.
Risk factors for osteopenia and osteoporosis and whether bone-density assessment or additional investigation is appropriate.
Other medical conditions can mimic or amplify menopause symptoms. Testing is recommended when it is clinically indicated rather than automatically ordering the same panel for every patient.
We review appropriate screening and investigate abnormal bleeding or other symptoms when necessary.
Vaginal dryness, painful intercourse, urinary symptoms, and changes in sexual function are common and often treatable parts of menopause care.
Sleep disruption, anxiety, mood changes, and cognitive concerns deserve to be addressed as part of the overall picture rather than considered in isolation.

Menopausal Hormone Therapy (MHT)

For appropriate patients, menopausal hormone therapy (MHT) can be one of the options considered for managing bothersome menopause symptoms.

There is no single hormone prescription that is appropriate for every woman. The decision to use MHT - and the type, dose, and route used - should take into account your symptoms, age, stage of menopause, whether you have a uterus, medical history, family history, personal preferences, and individual risk factors.

When MHT is appropriate, treatment may include topical, vaginal or oral estrogen. This prescription may be accompanied by oral, vaginal, or intrauterine progesterone. Treatment is individualized and reassessed over time.

Our role is to explain the potential benefits, risks, and alternatives so that you can make an informed decision about what is right for you.

What If I Don’t Want - or Can’t Use - Hormone Therapy?

Menopause care does not automatically mean hormone therapy. Some women prefer not to use MHT, while others have medical circumstances that require a different approach. Depending on your symptoms and health history, your treatment plan may include:

Non-hormonal prescription treatments
Vaginal and genitourinary therapies
Sleep support
Nutrition and metabolic health strategies
Exercise and resistance-training recommendations
Bone-health strategies
Targeted nutritional supplementation when appropriate
Management of contributing thyroid, iron, metabolic, or other medical concerns

Your treatment plan should reflect your health, your symptoms, and your preferences.

Testing Is Individualized

We don’t believe every woman needs the same laboratory panel. Testing is selected according to your age, symptoms, medical history, medications, and individual risk factors.

When clinically appropriate, investigations available through IHC may include assessment of:

Thyroid function
Glucose, insulin, and HA1C
Lipids and cardiovascular risk markers
Iron and nutritional status
Bone health
Liver health
Hormonal testing when it will meaningfully contribute to diagnosis or management
Pelvic or endometrial ultrasound when indicated
Additional specialized testing when clinically appropriate

This allows testing to answer a clinical question rather than simply generating more numbers.

FAQs

Perimenopause often begins while you are still having periods. Changes in your menstrual cycle together with symptoms such as hot flashes, sleep disruption, mood changes, brain fog, or heavier bleeding may all suggest you are entering this transition. A comprehensive assessment is often more informative than hormone blood tests.
For most women over age 45, hormone blood tests are not routinely required to diagnose perimenopause or menopause because hormone levels fluctuate considerably. Your physician will recommend testing only when it is clinically appropriate or when another condition needs to be ruled out.
For many healthy women who begin treatment before age 60 or within 10 years of menopause, MHT is considered a safe and effective treatment for bothersome menopausal symptoms. Whether it is appropriate for you depends on your personal medical history, family history, and treatment goals.
Beginning of March 2026, eligible menopause hormone therapy prescriptions are covered under BC PharmaCare for qualifying BC residents with MSP and a valid prescription.
There are effective non-hormonal treatment options available. Depending on your symptoms, these may include prescription medications, lifestyle changes, nutrition, exercise, sleep strategies, and other evidence-based approaches.
Yes. Hormonal fluctuations during perimenopause can affect mood, concentration, memory, and emotional well-being. These symptoms are common, real, and often improve with appropriate treatment.
Changes in hormones, aging, sleep quality, stress, and muscle mass can all influence metabolism and body composition during midlife. Our physicians can help you develop practical strategies to support healthy weight and overall metabolic health.
GSM describes changes to the vaginal and urinary tissues caused by declining estrogen. Symptoms may include vaginal dryness, discomfort during intimacy, urinary urgency, recurrent urinary tract infections, or bladder leakage. Effective treatments are available.
Follow-up depends on your symptoms and treatment plan. Many women benefit from an initial follow-up within a few months of starting treatment, followed by periodic reviews to ensure therapy continues to meet their needs and health goals.

IHC Clinical Insights

The following insights align with current recommendations from the Society of Obstetricians and Gynaecologists of Canada (SOGC), the Canadian Menopause Society, and The Menopause Society.

Menopausal Hormone Therapy
Physical exams- including breast and pelvic
Iron Infusions
IV/ Injection therapy
Targeted Supplementation
Endometrial ultrasound monitoring

Services Offered:

Comprehensive blood hormone panel testing (estrogen, progesterone, FSH, LH, testosterone, DHEA)
Thyroid function assessment (TSH, Free T3, Free T4, antibodies)
Metabolic health markers (insulin, glucose, A1C)
Adrenal hormone evaluation (cortisol rhythm testing)
Osteoporosis serum CTX
PLACÒ test
DUTCH Complete Urine
Love My Health Pro (Genetics)
Comprehensive Nutritional Panels
Omega 3 fatty acid testing
Enhanced Liver fibrosis (ELF)