Perimenopause starts in the forties for most women and runs two to eight years before periods stop for good. Menopause itself is a date you can only name in hindsight: twelve months in a row without a period, at an average age of 52. The years on either side bring hot flashes, night sweats, broken sleep, mood swings, irregular and sometimes heavy periods, vaginal dryness and painful sex. Underneath, bone is thinning and cholesterol is rising. On the surface, skin loses about a third of its collagen in five years, hair thins on the scalp and sprouts on the chin, and the face slackens faster than it did in the previous decade.
Med spas and hormone clinics now treat a large share of this. Some of what they offer is medicine with strong evidence behind it. Some of it is not. This page separates the two.
Hormone therapy: what it does and who it is for
Estrogen, with progesterone if you still have a uterus, is the most effective treatment for hot flashes and night sweats and for the dryness and urinary changes of menopause, and it prevents bone loss and fractures. That is the position of the Menopause Society, and in February 2026 the FDA removed its boxed-warning statements about heart disease, breast cancer and dementia from these products, citing trials in which women who started within ten years of menopause had lower mortality and fewer fractures.
The timing rule is the one to remember. For most healthy women who start before 60 or within ten years of their last period, benefit outweighs risk. Starting later is a different conversation, because the absolute risks of heart disease, stroke and clots are higher. A patch or gel at a lower dose may carry less clot and stroke risk than a tablet. Vaginal estrogen, which treats dryness locally, can be used at any age.
Only about two million of the 41 million American women aged 45 to 64 had a hormone therapy prescription in 2020. That gap is why so many are now looking for a clinic.
FDA-approved or compounded
This is the question that sorts clinics. There are FDA-approved estrogen and progesterone products that are chemically identical to your own hormones, in patches, gels, tablets and rings, each with a label, a known dose and trial data. A ‘bioidentical’ cream or a pellet from a compounding pharmacy is a different thing. Compounded drugs are not FDA-approved and their safety, effectiveness and quality are not verified before sale. The National Academies reviewed the evidence at the FDA’s request and found no rigorous proof that compounded hormone therapy is safe or effective, with limited oversight of what is in it. The Menopause Society’s concerns are concrete: underdosing, overdosing, impurities, no sterility assurance and no label listing the risks. The FDA’s rule is that compounding is for a patient who cannot use an approved drug.
A clinic that starts with approved products and reserves compounding for a real reason is practicing medicine. A clinic whose only offer is pellets dosed to a lab number is selling a program.
If hormones are not for you
Certain antidepressants, a blood pressure medicine and an antiseizure medicine are prescribed for hot flashes. Cognitive behavioral therapy helps sleep. Layers, less alcohol and caffeine, regular exercise and stress management take the edge off. None of these matches hormone therapy for flashes, but they are real options for women who cannot take estrogen or do not want to.
The skin and hair side
Collagen drops about 30% in the first five years after menopause and about 2% a year after that, which is why the change feels sudden. Skin turns dry, thin and slack; jowls, larger pores and under-eye pouches follow. Hair thins at the part and arrives under the chin and above the lip. Hormone therapy is prescribed for symptoms, not for skin. The aesthetic side is handled on its own: daily sunscreen and a retinoid as the base, laser hair removal for facial hair (six sessions or more, and not permanent on a woman’s face because of hormones), minoxidil or hair restoration for thinning treated early, and skin tightening for mild to moderate laxity. A dermatologist should look at any new dark spot before anything is done to it, because skin cancers also become more common at this age.
When the answer is a doctor, not a spa
Any bleeding after menopause is not normal and needs a provider promptly. Bone density and cholesterol need a primary care clinician who will order the tests. Premature or early menopause carries higher risks of bone loss and heart disease and is managed differently, with hormone therapy usually continued to at least the average age of menopause. A clinic that treats symptoms without asking about your periods, your family history or your last bleed is not the one to use.
How to choose a provider
Ask who prescribes: a physician, nurse practitioner or physician assistant with menopause experience. Ask whether FDA-approved patches, gels and tablets are the first offer, and why they would ever compound instead. Ask how they decide dose and how often they reassess, since the Menopause Society expects periodic reevaluation of benefit and risk. Ask what happens if you want to stop. And be cautious of any clinic that sells hormones for weight loss, energy or anti-aging rather than for the symptoms they are approved to treat.
Browse the clinics below. Bring the date of your last period, your symptoms in order of what bothers you most, and your family history of breast cancer, clots and heart disease.