What Should I Expect at My First Menopause Appointment?

Jun 22

Making that first menopause or perimenopause appointment can feel intimidating. Many women come to me after months or years of wondering what is happening to their bodies. Some have been told that their labs are normal. Others have been told that they are just getting older, stressed, or anxious. Many are worried they won't be taken seriously.

I want you to know that when you come to see me, my goal is for you to feel heard, respected, and safe.

I want you to know that your symptoms matter. Your story matters. Your concerns, your experiences, your ideas, and your goals all deserve to be taken seriously.

Menopause care is not about rushing to a prescription. It is about understanding the whole person and creating a thoughtful plan together.

Before Your Appointment

Scheduling is simple and can be done directly through my website. You can view my availability, learn more about appointment options and pricing, and select a time that works best for you.

Because my practice is entirely virtual, many women are surprised by how comprehensive telehealth menopause care can be and how effectively most menopause concerns can be managed from home.

Before your appointment, you'll complete:

Standard consent forms and clinic paperwork
A detailed medical history
Questions about your symptoms
Information about your lifestyle, sleep, nutrition, and overall health
Past medical and surgical history
Current medications and supplements

Because I review this information before we meet, I already have a foundation to work from. That allows us to spend our time together focusing on what matters most to you rather than rushing through paperwork.

What Happens During the First Visit?

My initial appointments are scheduled for one hour. Although some women initially wonder whether this type of visit can really be done virtually, I have found that thoughtful telehealth menopause care allows for the same deep conversations and individualized approach that women deserve.

That time allows me to do what I believe women deserve: listen carefully and ask thoughtful questions.

Most women are surprised by how much we cover.

We discuss:

Your symptoms and how they are affecting your life
Menstrual history and cycle changes
Sleep quality
Mood, anxiety, and stress
Brain fog and memory concerns
Sexual health and libido
Vaginal and urinary symptoms
Bone health
Cardiovascular risk factors
Family history
Previous medications and hormone treatments
Nutrition and lifestyle
Other possible causes of symptoms

I want to understand not only what symptoms you are having, but also what is most important to you.

You drive the priorities of the visit. My role is to help make sure we are moving forward safely and thoughtfully.

My Philosophy: Accompany, Don't Control

My background as a nurse midwife, family nurse practitioner, and menopause practitioner has shaped how I practice. You can learn more about my experience and philosophy of care on my About page.

Midwifery taught me that women have tremendous wisdom about their own bodies. My job is not to overpower or dictate. My role is to accompany, educate, advocate, and maintain safety.

I believe deeply in shared decision-making.

That means:

Listening first
Explaining risks and benefits clearly
Providing evidence-based recommendations
Respecting your preferences
Individualizing care
Avoiding a one-size-fits-all approach

I want women to understand why I recommend certain tests or treatments, not simply follow instructions without understanding them.

Menopause Symptoms Are Not Always Hot Flashes

Many women assume they cannot be in perimenopause because they still have regular periods.

That simply isn't true.

Often, the earliest symptoms are:

Brain fog
Anxiety
Irritability
Difficulty sleeping
Poor stress tolerance
Fatigue
Changes in libido
Trouble multitasking
Feeling unlike yourself

Women frequently tell me:

"I don't know what's wrong. I just don't feel like myself anymore."

They are often juggling many responsibilities, but nothing more than usual. Yet somehow, they no longer have the same energy, resilience, or ability to manage stress.

That feeling deserves attention.

Looking Beyond Hormones

Not every symptom is caused by hormones.

Part of my job is thinking broadly and looking for other contributors.

Depending on your history, I may evaluate:

Thyroid function
Iron deficiency
Ferritin levels
Vitamin B12 deficiency
Nutritional issues
Depression or anxiety
Sleep disorders
Cardiovascular risk factors
Osteoporosis risk
Other medical conditions

Sometimes what appears to be menopause turns out to be something else.

And sometimes menopause is only part of the picture.

Primary care training has taught me to think broadly, and I believe that approach serves women well.

Why I Often Order Labs

I generally prefer to order labs after we meet rather than automatically before the appointment.

That allows me to tailor testing to your specific situation.

Common tests may include:

Blood counts
Iron studies and ferritin
Thyroid function
Vitamin B12
Metabolic testing
Liver and kidney function
Hormone levels
Additional testing based on your history and risk factors

I believe hormone testing has limitations, especially during perimenopause, where hormone levels naturally fluctuate.

However, I also believe lab work can provide valuable information and can sometimes be very validating.

For women using testosterone therapy, monitoring hormone levels is especially important to maintain safe, physiologic ranges.

A Story I See Often

One of the most common stories I hear goes something like this:

"My periods are still regular, so I can't be in perimenopause."

But when we dig deeper, we find:

Cycles are changing
Sleep has become poor
Anxiety is worse
Libido has disappeared
Concentration is suffering
Stress feels overwhelming

Perimenopause does not begin the day periods stop.

For many women, it starts years earlier.

Sometimes the Answer Isn't What We Expected

I've cared for women whose fatigue turned out to be severe iron deficiency despite a normal blood count.

I've seen women whose symptoms were actually related to thyroid disease.

I've seen women struggling with weight changes who later discovered they had lipedema, and the hormonal transition had simply unmasked it.

I've helped women whose previous hormone regimens were leaving them exhausted, poorly balanced, or inadequately protected.

Hormone therapy can be a powerful tool, but it isn't magic, and it isn't the answer to everything.

Good menopause care requires curiosity and nuance.

Will I Start Treatment Right Away?

That depends.

Sometimes I prefer to wait for lab results before starting systemic hormone therapy.

If symptoms clearly point toward genitourinary syndrome of menopause, such as vaginal dryness or painful intercourse, I may start vaginal estradiol earlier while we continue the evaluation.

Not every woman wants hormones, and not every woman is a candidate for them.

Fortunately, there are many non-hormonal options available.

Sometimes menopause hormone therapy dramatically improves symptoms.

Sometimes additional support is needed.

Treatment may include:

Hormone therapy
Testosterone therapy for carefully selected women
Vaginal estrogen
Sleep support
Anxiety and depression treatment
Antidepressants when appropriate
Lifestyle modifications
Collaboration with specialists

Menopause care is rarely a one-time prescription.

It is a process.

We Continue the Journey Together

After the appointment:

Prescriptions are sent electronically to your pharmacy.
Lab orders are provided for the laboratory of your choice.
Preventive screenings are addressed.
Referrals are made when needed.
You have access to a secure patient portal for questions and updates.

I encourage women to reach out through the portal rather than email or text because protecting your privacy matters.

Most importantly, you are not left to figure everything out alone.

Menopause care often involves adjustments and follow-up, and I consider that ongoing relationship a privilege.

The Comments That Mean the Most to Me

Over the years, some of the comments that have touched me most have been:

"Thank you for really listening."
"I finally feel calm."
"I feel like I'm in good hands."
"I don't feel so scared anymore."
"Thank you for taking me seriously."

Those words mean everything to me.

Because that is exactly how I hope women leave our appointments:

Calmer.

Safer.

Heard.

Respected.

And hopeful.

You Don't Have to Figure This Out Alone

If you are wondering whether what you're experiencing could be perimenopause or menopause, know this:

You deserve to be heard.

You deserve thoughtful, evidence-based care.

You deserve someone who will listen with curiosity and compassion.

And you deserve a partner who will walk alongside you as you navigate this transition. Learn more about my perimenopause and menopause care and how we can work together to create an individualized plan that fits your needs.

Menopause is not something you simply have to endure.

And you do not have to navigate it alone.

Is Telehealth Menopause Care as Effective as In-Person?

Because my practice is entirely virtual, one of the most common questions I hear is whether telehealth can provide the same level of care as an in-person visit. In my experience, the answer is yes for most women, and I've written more about why telehealth menopause care works so well and when an in-person evaluation is still important.

Marissa Cortes Mendez