Hormone imbalance shows up differently for every woman, but the most common signs include persistent fatigue, brain fog, weight gain (especially around the midsection), low libido, mood swings, irregular periods, hot flashes, night sweats, sleep disturbances, hair thinning, vaginal dryness, and joint pain.

Many women are told these symptoms are "just part of aging" — but they're often signs that estrogen, progesterone, testosterone, or thyroid hormones are out of balance and can be addressed.

Perimenopause can begin as early as age 35 and typically lasts 4–10 years before menopause itself. Symptoms include:

Irregular or changing menstrual cycles, heavier or lighter bleeding, hot flashes, night sweats, mood changes (anxiety, irritability, low mood), sleep disruption, brain fog and memory lapses, weight gain that's resistant to diet and exercise, breast tenderness, headaches or migraines, and changes in libido.

Many women are surprised to learn perimenopause is happening to them in their late 30s or early 40s — it's far more common than mainstream conversations suggest.

Menopause is defined as 12 consecutive months without a menstrual period, typically occurring between ages 45 and 55. Common symptoms include hot flashes and night sweats, vaginal dryness and painful intercourse, urinary changes and increased UTI frequency, sleep disturbances, mood changes, weight gain, joint pain, hair thinning, skin changes, and reduced bone density.

Symptoms can last for years after the final period. Effective treatment is available, and starting hormone replacement therapy within 10 years of menopause offers the most benefit.

Common signs of low estrogen include hot flashes, night sweats, vaginal dryness, painful intercourse, urinary symptoms, mood changes, sleep disturbances, joint pain, headaches, brain fog, and skin changes (drier, thinner, more prone to wrinkles).

Estrogen levels can be measured through blood testing, but symptoms often tell the more accurate story. We use both labs and your symptom picture to determine if estrogen support is appropriate.

Low progesterone often shows up as anxiety, insomnia (especially trouble staying asleep), PMS that's getting worse, heavier or irregular periods, breast tenderness, headaches around your period, and feeling "wired but tired."

Progesterone is often the first hormone to decline in perimenopause, sometimes years before estrogen levels change. This is why many women in their late 30s feel "off" without any obvious cycle changes.

Yes — testosterone is essential for women, not just men. Women's testosterone levels peak in their 20s and decline steadily afterward. By the time many women reach perimenopause, levels can be significantly low.

Symptoms of low testosterone in women include low libido, low energy and motivation, difficulty building or maintaining muscle, brain fog, mood changes, and reduced sense of well-being. Restoring testosterone to an optimal range can significantly improve quality of life.

Weight: Declining estrogen shifts fat storage to the midsection, lowers metabolic rate, and increases insulin resistance — which is why so many women find that what used to work (diet, exercise) no longer does.

Sleep: Low progesterone disrupts the ability to stay asleep. Low estrogen contributes to hot flashes and night sweats that fragment sleep. Cortisol dysregulation makes it harder to fall asleep.

Mood: Estrogen and progesterone both interact with serotonin, dopamine, and GABA — the neurotransmitters that regulate mood, anxiety, and motivation. When these hormones shift, mood often shifts with them.

Bioidentical hormones have the exact same molecular structure as the hormones your body naturally produces. They include FDA-approved options (like estradiol patches and oral micronized progesterone) and compounded options customized to your needs.

Synthetic hormones (like medroxyprogesterone or conjugated equine estrogens) have a different molecular structure than what your body makes. The earlier studies that raised concerns about HRT used these older synthetic formulations.

At Bloom, we primarily prescribe bioidentical hormones, supported by current research and the latest guidelines from The Menopause Society.

For most healthy women under 60 or within 10 years of menopause, modern hormone replacement therapy is safe and offers significant benefits — including reduced risk of osteoporosis, cardiovascular disease, type 2 diabetes, and dementia.

The breast cancer concerns from the 2002 Women's Health Initiative study have been re-examined extensively. That study used older synthetic hormones in older women and the absolute risk increase was small. More recent research and updated guidelines from The Menopause Society support HRT as a first-line treatment for menopausal symptoms in appropriate candidates.

Every patient is different. We review your personal and family history thoroughly and individualize your treatment plan.

Your first step is the $99 initial consultation. During this visit, we review your symptoms, medical history, and goals. If hormone testing is appropriate, we'll order a comprehensive lab panel that goes well beyond what most primary care offices run.

Once your results are back, we build your personalized protocol — and the $99 consultation fee is applied toward your first month's membership.

Schedule your initial consultation →

Both are weight loss medications used for weight loss and metabolic health, but they work slightly differently.

Semaglutide (the active ingredient in Ozempic and Wegovy) targets one receptor — GLP-1. It's been studied extensively, has strong real-world data, and is typically very effective.

Tirzepatide (the active ingredient in Mounjaro and Zepbound) is a dual agonist — it targets both GLP-1 and GIP receptors. Studies show somewhat greater average weight loss and stronger metabolic effects than semaglutide.

The right choice depends on your goals, tolerance, and clinical picture. We'll help you decide during your initial consultation.

Your monthly membership includes the medication itself (shipped directly to your home), all scheduled follow-up visits, dose adjustments, side effect management, and complimentary nutrition and movement guidance to support your results.

There are no hidden fees — what you see is what you pay.

When you pay for 3 months upfront on weight loss medications, you save 10%.

Examples: Semaglutide $269/mo becomes $726 prepaid (saving $81). Tirzepatide $369/mo becomes $996 prepaid (saving $111). Bundle members also save 10% on the weight loss medication portion.

This option is available at signup or at any monthly renewal. It locks in your pricing for the quarter and is fully eligible for HSA/FSA reimbursement.

You can cancel anytime — no contracts, no penalties. We just ask for written notice before your next billing date.

If you need to pause for travel, surgery, pregnancy, or any other reason, just let us know and we'll work with you. Your care is yours to direct.

Yes. If we determine clinically that switching makes sense — for tolerance, response, or any other reason — we'll adjust your protocol and your membership pricing accordingly. There's no fee to switch.

Hormone therapy: Many of the hormones we prescribe (estradiol patches, oral micronized progesterone, testosterone) are FDA-approved. For patients who benefit from customized strengths or combinations, we use compounded bioidentical hormones from licensed 503A compounding pharmacies.

GLP medications: Brand-name semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are FDA-approved. The compounded versions we prescribe are made by licensed 503A compounding pharmacies and require an individualized prescription for each patient.

Bloom is a cash-pay, membership-based practice. We don't bill insurance directly, but we do provide a superbill on request that you can submit to your insurance or HSA/FSA for potential reimbursement.

For HRT, we offer an Insurance Rx option ($149/month) where the medication is sent to your retail pharmacy and you fill it through your insurance. The membership fee covers your care; insurance covers the medication.

The Tirzepatide Program covers doses up to 10mg per week, which is effective for the majority of patients. If you and your provider determine that a higher dose (12.5mg or 15mg per week) is medically appropriate, your monthly investment is $449 to cover the higher-strength medication.

We'll always have this conversation with you in advance — no surprises.