Menopause Treatment in Dallas: Feel Like Yourself Again and Protect the Decades Ahead
Menopause is natural. Natural doesn't mean harmless, and it doesn't mean you have to tough it out. At Living Well Dallas, we replace the hormones your body has stopped making, using bioidentical estrogen, bioidentical progesterone, and testosterone, and we build the rest of your care around your labs, your history, and your goals.
Perimenopause, Menopause and Postmenopause
Perimenopause is the transition, and for many women it starts in their early to mid-40s, sometimes earlier. It usually lasts four to eight years. Progesterone tends to fall first, while estrogen swings high and low. That is why so many women in their 40s feel anxious, sleep badly, get heavier periods, and wonder what is wrong with them while their labs come back "normal."
Menopause is a single point in time: 12 months without a period. The average age in the US is 51.
Postmenopause is every year after that. With estrogen and progesterone now low for good, and testosterone declining since your 20s, this is the stretch where the long-term health risks build. A woman who reaches menopause at 51 can expect to live 30 or more years without the hormones her bones, brain, and heart relied on.
We treat women in all three stages. You don't need to wait for your periods to stop to get help.
Menopause Symptoms Go Far Beyond Hot Flashes
Estrogen, progesterone, and testosterone have receptors in nearly every tissue in your body. When they fall, symptoms show up in places most women never connect to hormones:
- Temperature and sleep: hot flashes, night sweats, waking at 2 or 3 a.m. and not falling back asleep
- Brain and mood: brain fog, word-finding trouble, anxiety, depression, irritability and rage, loss of motivation
- Metabolism and weight: belly fat that won't move, rising blood sugar and insulin resistance, higher cholesterol, loss of muscle
- Joints and muscles: joint pain and stiffness, frozen shoulder, slower recovery from exercise
- Heart: palpitations and a racing heart, rising blood pressure
- Sexual health: low libido, vaginal dryness, painful sex
- Bladder: urgency, leaking, recurrent urinary tract infections
- Skin, hair and eyes: dry or thinning skin, hair thinning, dry eyes
- Cycle changes in perimenopause: heavier, closer together or skipped periods, worse PMS
- Energy: fatigue that sleep doesn't fix
The bladder and vaginal changes, called genitourinary syndrome of menopause, affect about half of women after menopause. Unlike hot flashes, they don't fade with time. They get worse without treatment.
The Long-Term Risks of Skipping Hormone Replacement
This is the part of the conversation women rarely hear from their doctor. Estrogen does protective work in the body every day. When it's gone and not replaced, three risks climb.
Osteoporosis and fractures
Women can lose up to 20% of their bone density in the five to seven years after menopause. About one in two women over 50 will break a bone because of osteoporosis, and a hip fracture after 65 often ends independent living. Estrogen therapy is FDA-approved to prevent postmenopausal osteoporosis, and testosterone supports the muscle that protects your bones. We measure where you stand with a DEXA bone density scan with TBS (trabecular bone score), which shows bone quality as well as density.
Alzheimer's disease and brain health
Almost two-thirds of Americans living with Alzheimer's are women. Longer lifespans don't explain the whole gap. Estrogen helps the brain use glucose for fuel, and as estrogen falls, the brain's energy metabolism changes. Many women first notice this as brain fog. Research suggests that women who start hormone therapy around the time of menopause may have a lower risk of Alzheimer's, while starting many years later doesn't show the same benefit. Timing matters.
Heart disease
Heart disease is the leading cause of death for women in the United States. Before menopause, women develop it years later than men do. After menopause, that advantage fades. LDL cholesterol and triglycerides rise, blood pressure climbs, fat shifts to the abdomen, and insulin resistance increases. Studies of women who begin estrogen within 10 years of menopause, or before age 60, show lower rates of heart disease and lower overall mortality than women who don't
Metabolism and muscle
Dr. Betty Murray’s research focuses on what estrogen loss does to metabolism: how mitochondria make energy, how cells respond to insulin, and where the body stores fat. Losing estrogen pushes fat into the abdomen around the organs, and that visceral fat drives inflammation and blood sugar problems. Losing muscle speeds it all up. Replacing hormones, along with strength training and the right nutrition, addresses these problems directly.
What Changed About Hormone Therapy
If you were told hormones cause breast cancer and heart attacks, you were told what most women heard after 2002. That fear came from the Women's Health Initiative study. The average woman in it was 63, more than a decade past menopause, and she took synthetic hormones (conjugated horse estrogens with a synthetic progestin) that we do not use.
In November 2025, the FDA began removing the "black box" warning about heart disease, breast cancer, and dementia from menopause hormone therapy labels. The updated guidance encourages starting systemic therapy when symptoms begin and ideally within 10 years of menopause. But that does not mean that a woman over 60 cannot take hormone replacement therapy. There is no age limit to considering hormone replacement therapy. Every woman deserves to examine hormone replacement therapy for themselves regardless of age. Hormone therapy is safe for far more women than they were told, and it does the most good when it starts early and continues long-term.
How We Treat Menopause at Living Well Dallas
Bioidentical hormones only
Bioidentical hormones have the same molecular structure as the hormones your ovaries made. Your body recognizes them and uses them as designed.
Estrogen
Estradiol is the main estrogen your ovaries made before menopause. We usually prescribe estradiol and estriol through the skin, as a patch, oil, or cream. Transdermal estradiol skips the first pass through the liver, and research links it with a lower risk of blood clots than estrogen pills.
Bioidentical progesterone, never synthetic progestins
We never use synthetic progestins. These are lab-made compounds such as medroxyprogesterone acetate, the one used in the WHI study that increased risk. They act differently in the body from the progesterone you make yourself, and much of the breast cancer and cardiovascular concern around hormone therapy traces back to them.
We use only bioidentical oral micronized progesterone or topical progesterone in jojoba oil. It protects the lining of the uterus when you take estrogen, and large studies have found it carries a lower breast cancer risk than synthetic progestins. It also calms the nervous system and helps with sleep, so many women notice better nights within the first few weeks. Even women who have had a hysterectomy often benefit from it for sleep and mood.
Testosterone: the hormone most women are missing
Testosterone isn't only a male hormone. Your ovaries and adrenal glands make it, and levels fall steadily from your 20s on. Most programs ignore it. We don't. In our experience, most women need testosterone to feel fully well. It supports libido, muscle mass, bone strength, motivation, confidence, and mental sharpness. We dse testosterone for a woman's body and monitor blood levels so you get the benefits without side effects.
Vaginal and bladder care
Low-dose vaginal estrogen or DHEA treats dryness, painful sex, urgency, and recurrent UTIs right at the tissue. Very little reaches the bloodstream.
Testing, not guessing
Your plan starts with a detailed history and advanced labs. We look at your sex hormones and how your body breaks them down, along with thyroid, insulin and blood sugar, cholesterol and inflammation markers. After you start, we retest and adjust. Hormone care isn't a single prescription. It changes as you do.
The rest of the picture
Hormones work best on a strong foundation. As a functional medicine clinic for more than 20 years, we also address nutrition, strength training, sleep, gut health, thyroid and stress. For women who want to go further, our Longevity program adds DEXA bone density with TBS, body composition, resting metabolic rate, VO2 max, qEEG brain mapping, and advanced blood testing.
Is Hormone Therapy Right for You?
Most women in perimenopause and menopause are candidates. Your provider will review your personal and family history, including breast cancer, blood clots, stroke, liver disease and unexplained bleeding, and will tell you plainly what is safe for you. If hormones aren't the right fit, we have other options for symptoms and long-term health.
Our team of physicians and nurse practitioners provides your care, led by a board-certified OB/GYN medical director trained and certified in hormone and functional medicine.
Frequently Asked Questions
Are bioidentical hormones safer than synthetic hormones?
Transdermal estrogen and micronized progesterone have a better safety record in research than the oral conjugated estrogens and synthetic progestins used in the WHI study, especially for blood clots and breast cancer risk. That is why they are all we use.
Do women really need testosterone?
Women make testosterone their whole lives, and it falls with age. In our practice, most women do better with it as part of their hormone plan, especially for libido, energy, muscle, and mental sharpness.
Am I too old to start hormones?
The greatest heart and brain benefit comes from starting before 60 or within 10 years of menopause. Women outside that window can still benefit from systemic hormone replacement therapy - estrogen, progesterone, and testosterone. We'll go through your options at your consultation.
Do you treat perimenopause?
Yes. You don't need to wait until your periods stop. Many of our patients come to us in their early 40s.
How soon will I feel better?
Many women sleep better within a few weeks. Hot flashes, mood, and energy usually improve over the first two to three months as we fine-tune your doses.