Perimenopause, Menopause, and HRT at Synergy: A Personalized Integrative Approach
At Synergy, perimenopause, menopause, and hormone therapy care is an important part of our integrative proactive primary care. Our clinicians help women recognize what they are experiencing, evaluate potential contributors, validate their concerns, and discuss appropriate treatment options including hormone therapy (HT a.k.a. HRT/hormone replacement therapy), lifestyle interventions, and evidence-based holistic treatments.
Perimenopause and menopause are dramatic health transitions that affect far more than the menstrual cycle. Changes in sleep, mood, cognition, temperature regulation, sexual health, urinary health, and energy are among the many elements that may influence daily functioning and quality of life [1]. This transition is also accompanied by changes in blood sugar regulation, cholesterol, heart health, and brain health, making this a critical time to assess and support a woman's broader cardiovascular and metabolic health [2, 3].
Understanding the menopause transition
Perimenopause is the transitional period leading up to menopause. During this time, ovarian hormone production changes, estrogen levels fluctuate widely, menstrual cycles may become irregular, and symptoms across the body systems can develop even while periods are still occurring.
Menopause is reached after 12 consecutive months without a menstrual period (when there is no other medical explanation for this occurrence). However, perimenopause and menopause-related symptoms may begin several years before the final menstrual period, can last for many years afterwards, and manifest differently in each woman [1].
Because symptoms can emerge well before menstruation stops, women do not need to wait until they have officially stopped having periods or reached menopause to seek support. We evaluate, understand, and address symptoms and all aspects of a woman’s wellbeing during perimenopause. This includes a nuanced discussion of each woman’s health history, needs, lifestyle, and preferences and may include recommendations such as HT and other highly personalized pharmacological, lifestyle, or holistic treatment options.
Why has the conversation about Hormone Therapy evolved?
Much of the fear surrounding HRT began after the Women’s Health Initiative, a large national study of hormone therapy in postmenopausal women, released its initial findings in 2002. The results were widely interpreted to mean that HT was unsafe for nearly all women, regardless of their age, how close they were to menopause, their health history, or why treatment was being considered [4].
Continued research and long-term follow-up have shown that the benefits and risks of HT are more individualized. Current evidence indicates that, for most healthy women who are younger than 60 or within 10 years of menopause, HT has a favorable balance of benefits and risks when used to address perimenopause and menopause symptoms and can also help prevent bone loss [4, 5].
This more complete understanding is why we encourage women who are noticing changes, experiencing symptoms, or have questions about HT to bring the conversation to their PCP. This allows time for a thoughtful discussion of their health history, concerns, and goals, along with personalized guidance about all the hormonal and non-hormonal treatment options available to them.
An Integrative Approach
At Synergy, HT may be one part of a broader, personalized approach to perimenopause and menopause. Our approach to care also addresses sleep, nutrition, movement, muscle and bone health, cardiovascular and metabolic health, stress, mood, sexual and urinary health, as well as targeted herbs or supplements (when appropriate).
We also offer integrative therapies which may provide additional support. For example, research suggests that acupuncture may help reduce hot flashes, night sweats, and general sweating while also supporting menopause-related sleep disruption, emotional well-being, and physical symptoms. Its potential to address several symptoms at the same time may make it a valuable option for those seeking broader support during the menopause transition [6].
Similarly, Reiki is a gentle, noninvasive integrative therapy intended to promote relaxation and support overall well-being through light touch or hands held just above the body. Early research is encouraging, with a small randomized study finding improvements in overall menopause symptoms and depression scores among postmenopausal women receiving Reiki [7]. These findings suggest that Reiki may offer meaningful support for physical and psychological symptoms, in addition to supporting a healthy stress response and HPA-axis, as part of an individualized care plan.
Menopause care at Synergy
All our Synergy integrative primary care physicians have completed (men’s and women’s) hormone therapy and menopause-focused continuing medical education and / or certification through the Heather Hirsch Academy, along with Harvard Medical School’s Women’s Health and Menopause continuing education courses. We make it our priority to stay current as menopause research and clinical guidance continues to evolve.
Your PCP can evaluate symptoms, consider whether additional testing or evaluation is needed, discuss the potential role of HT, prescribe when clinically appropriate, and guide treatment and follow-up. For women already receiving HT through another clinician or program, their Synergy physician can continue to support the broader health conversation and help guide their integrative menopause care.
Our approach also recognizes that menopause care extends beyond medication alone. Acupuncture and Reiki are available through Synergy’s Integrative Services, holistic therapies may be part of a clinically advised treatment plan, and our Synergy Health Coaches offer personalized support for nutrition, fitness, and sustainable lifestyle changes. These options can be incorporated thoughtfully alongside primary care based on each woman’s symptoms, health priorities, preferences, and goals. The goal is to create an individualized care plan that addresses current symptoms while also supporting long-term health and well-being.
References
Duralde, E. R., Sobel, T. H., & Manson, J. E. (2023). Management of perimenopausal and menopausal symptoms. BMJ, 382, e072612. doi:10.1136/bmj-2022-072612.
Marlatt, K. L., Pitynski-Miller, D. R., Gavin, K. M., et al. (2022). Body composition and cardiometabolic health across the menopause transition. Obesity, 30(1), 14–27. doi:10.1002/oby.23289.
Mehta, J. M., & Manson, J. E. (2024). The menopausal transition period and cardiovascular risk. Nature Reviews Cardiology, 21, 203–211. doi:10.1038/s41569-023-00926-7.
Manson, J. E., Crandall, C. J., Rossouw, J. E., et al. (2024). The Women’s Health Initiative randomized trials and clinical practice: A review. JAMA, 331(20), 1748–1760. doi:10.1001/jama.2024.6542.
The North American Menopause Society Advisory Panel. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. doi:10.1097/GME.0000000000002028.
Lund, K. S., Siersma, V., Brodersen, J., & Waldorff, F. B. (2019). Efficacy of a standardised acupuncture approach for women with menopausal symptoms: A pragmatic randomised study in primary care (the ACOM study). BMJ Open, 9(1), e023637. https://doi.org/10.1136/bmjopen-2018-023637
Baransel, E. S., & Uçar, T. (2025). Reiki for decrease postmenopausal symptoms and depression: A randomized clinical trial. Revista da Associação Médica Brasileira, 71(7), e20250076. https://doi.org/10.1590/1806-9282.20250076