Conditions · Perimenopause & Menopause

Perimenopause & menopause care that listens

Hot flashes, broken sleep, weight that won’t move, mood swings, brain fog, low libido — and a system that shrugs and calls it “normal.” In Fredericksburg, VA, we test thoroughly and optimize with bioidentical hormones. Start with an initial appointment.

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This transition deserves more than “you’re fine”

Perimenopause can begin years before your last period, as shifting estrogen and progesterone quietly drive sleep, mood, metabolism, and libido changes. Too many women are told it’s just age and sent on their way.

At True You, Dr. Hoff takes a root-cause approach: comprehensive hormone testing and a personalized, physician-guided plan — often bioidentical hormone therapy — to help you feel steady, clear, and like yourself again.

Why “it’s just age” isn’t an answer

Why you feel awful while being told it’s “normal”

The difference is what gets tested — and whether your symptoms are taken seriously.

The conventional menopause visit

“You’re just getting older”
An antidepressant for the mood changes
One estrogen dose for everyone
Thyroid rarely checked
A rushed visit

The True You approach

Your symptoms are taken seriously and fully worked up
Treat the hormone shift driving mood, sleep, and libido
Bioidentical estrogen, progesterone, and testosterone, dosed to your labs
Full panel — estradiol, progesterone, testosterone, thyroid
Unhurried time with a physician who monitors over time

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Hormones that read “normal for your age” can still leave you feeling awful — an age-based range isn’t the same as optimal.

Do these sound familiar?

Hot flashes & night sweats

Temperature swings that wreck your sleep and your day.

Sleep that won’t hold

Waking at 3am, unrefreshed even after a full night.

Mood, anxiety & fog

Irritability, low mood, and cloudy thinking that isn’t you.

Weight & low libido

Midsection weight that resists effort, and lost desire.

Our approach

Bioidentical Hormone Therapy

Precisely dosed BHRT to restore estrogen, progesterone, and testosterone balance.

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Functional Medicine

The full root-cause picture — thyroid, metabolism, and stress that shape the transition.

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Perimenopause vs. menopause: what’s actually happening

Perimenopause is the transition leading up to menopause. It often begins in your 40s, sometimes earlier, and can last several years. Estrogen and progesterone don’t simply decline — they fluctuate, sometimes sharply, which is why symptoms can come and go and periods can become irregular, heavier, or lighter.

Menopause is the point when you’ve gone 12 months without a period. After that, hormone levels stay lower, and some symptoms — hot flashes, sleep disruption, vaginal dryness, changes in body composition — may continue. Both stages are normal. Feeling miserable through them isn’t something you have to accept.

Symptoms beyond hot flashes

The transition affects more than temperature — and many women don’t connect these to hormones.

Changing cycles

Periods that are irregular, heavier, lighter, or closer together.

Anxiety & brain fog

New anxiety, forgetfulness, and trouble finding words.

Aches & stiffness

Joint aches and slower recovery from exercise.

Intimacy changes

Vaginal dryness, discomfort, and lower desire.

Skin & hair

Drier skin and thinning or shedding hair.

Metabolic shifts

Weight moving to the midsection and changes in blood sugar.

Sleep, mood, and the menopause transition

For many women, broken sleep is the symptom that makes everything else harder. Night sweats wake you, falling progesterone can make sleep lighter, and blood-sugar swings and stress add 3am wake-ups. Poor sleep then worsens mood, cravings, focus, and patience.

We treat sleep as a priority, not an afterthought — looking at hormones, blood sugar, stress, and habits together. The same goes for mood. New anxiety or low mood in your 40s deserves a real work-up, not an automatic prescription, and when hormones are a driver, treating them can make a meaningful difference.

Menopause treatment options

Treatment starts with understanding your hormones, symptoms, and health history. For many women, bioidentical hormone therapy — estrogen, progesterone, and sometimes testosterone, dosed to your labs — can ease hot flashes and night sweats, improve sleep, steady mood, and support libido. Dr. Hoff explains the benefits and risks for you specifically and monitors closely once you start.

Hormones are only part of the plan. We also check the thyroid, address sleep and stress, and give nutrition and strength guidance to protect metabolism, muscle, and bone. If hormone therapy isn’t right for you — or you’d rather not use it — we’ll work on the other drivers and talk through non-hormonal approaches.

How it works

What to expect at your first visit

A clear plan, built around you.

01

Step 1

Initial appointment

An in-person visit at our Fredericksburg office to talk through symptoms, cycles, sleep, mood, and goals.
02

Step 2

Comprehensive labs

Estradiol, progesterone, testosterone, thyroid, and metabolic markers.
03

Step 3

Your plan

Dr. Hoff reviews your results and recommends options, including whether BHRT is a good fit.
04

Step 4

Follow-up

Check-ins and repeat labs to fine-tune — many of them virtual.

Perimenopause & menopause — common questions

I’m still getting periods — is it too early for help?

No. Perimenopause symptoms often start years before your final period. Testing and a tailored plan can help well before menopause is “official.”

Is bioidentical hormone therapy right for me?

It depends on your labs, symptoms, and history. We evaluate all three, explain the options, and only recommend BHRT when it’s a good fit — then monitor closely.

Do you take insurance?

True You is a cash-based practice, so your care isn’t limited by insurance rules on testing or time. We’re transparent about costs during your consultation.

How long does perimenopause last?

It varies widely. For many women it lasts several years before the final period. Symptoms can change along the way, so your plan is reviewed and adjusted over time.

Can hormone therapy help with hot flashes and sleep?

For many women, yes. When it’s appropriate for you, bioidentical estrogen and progesterone can reduce hot flashes and night sweats and improve sleep. We monitor your response and adjust as needed.

How long can I stay on hormone therapy?

There’s no fixed cutoff. We review your symptoms, health, and goals regularly and decide together whether to continue, adjust, or taper.

What if I can’t or don’t want to take hormones?

That’s fine. We can focus on sleep, stress, nutrition, strength, thyroid, and metabolic health, and discuss non-hormonal options that fit your history.

Why am I gaining weight during menopause?

Falling estrogen changes where the body stores fat and can make insulin resistance more likely, while poor sleep raises appetite. We test those drivers and can build in medical weight loss when it helps.

Does menopause affect bone and heart health?

Lower estrogen after menopause affects bone density and cardiovascular risk. We factor that into your plan through testing, strength and nutrition guidance, and — when appropriate — hormone therapy.

Can I get help if I’m in my late 30s or early 40s?

Yes. Perimenopause symptoms can start earlier than many people expect. If your sleep, cycles, or mood have changed, it’s worth testing.

Can I do follow-up visits virtually?

Many of them. Your first visit and labs are in person at our downtown Fredericksburg office; after that, much of the ongoing care can be virtual.

Do you check my thyroid too?

Yes. A slow thyroid can mimic and worsen menopause symptoms — fatigue, weight gain, low mood, and brain fog — so a full thyroid panel is part of the work-up.

How do I get started?

Book an initial appointment. We’ll talk through your symptoms and cycles and order the hormone and thyroid testing that fits your situation.

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