Perimenopause and menopause care, led by your doctor
Hot flashes, broken sleep, mood swings and periods that change without warning often start years before your last period, and none of it is in your head. Perimenopause can begin as early as your mid-30s, and you do not have to wait for menopause to get help. Your Trio doctor listens first, builds a plan around your symptoms and your health, and adjusts it as you go. Visits are at home or by secure video.
Questions? Call (737) 363-3226, answered 24 hours a day.
● Board-certified Emergency Medicine physicians
● The same doctor every visit
● Your cost confirmed before you start
● No membership fee. HSA and FSA accepted
What women tell us they want back
Relief from hot flashes and night sweats
Hormone therapy is the most effective treatment for hot flashes and night sweats, and as they ease, many women sleep more deeply.
Steadier cycles and moods
In perimenopause, treatment can help even out irregular periods and the mood changes that come with shifting hormones.
Comfort and confidence
Low-dose vaginal estrogen treats dryness, discomfort and urinary symptoms, so intimacy and everyday life feel easier.
Stronger bones for the long run
Hormone therapy helps prevent the bone loss that comes with menopause and lowers the risk of fracture.
Results vary from person to person. Your doctor will tell you what to expect for you.
From your first visit to a plan that fits you
Consult
Your doctor listens first: your symptoms, your cycle history, how sleep and mood are holding up, and your personal and family history, including breast cancer, blood clots, migraine and liver disease.
Exam and labs
A review of your blood pressure and your screening history. Perimenopause and menopause are usually recognized from your age, your cycles and your symptoms. In perimenopause hormone levels swing so much that a single test is not reliable, so labs are ordered as needed.
The decision
Your doctor tells you whether hormone therapy is a good fit, which form, and why. Sometimes the right first step is a non-hormonal option, and you will hear that too.
Starting and adjusting
You start with a form and dose chosen for your symptoms. Your doctor checks how you feel and adjusts, one change at a time.
Follow-up
Regular check-ins to see how your symptoms are doing and to review your plan as your needs change. The same physician throughout.
What treatment can include
Estrogen
The most effective treatment for hot flashes and night sweats. It comes as a patch, a gel or other topical form, or a pill. Low-dose vaginal estrogen treats dryness, discomfort and urinary symptoms and works mostly where it is applied.
In perimenopause
Hormone therapy can start while you still have periods, so you do not have to wait for menopause to feel better. You can still get pregnant in perimenopause, so tell your doctor about your plans.
Testosterone for women
For women after menopause with low sexual desire that causes distress, a low dose of testosterone can help. No testosterone product is FDA-approved for women in the US, so it is prescribed off-label, at doses meant for women, with blood levels checked before and during treatment.
Progesterone
If you still have your uterus, estrogen is paired with a progestogen to protect the lining of the uterus. Progesterone can also help sleep for some women.
Non-hormonal options
If hormones are not right for you, there are prescription and lifestyle options for hot flashes, sleep and mood. Your doctor will walk through them with you.
Compounded hormones
Many FDA-approved hormone products are already bioidentical, meaning identical to the hormones your body made, such as estradiol patches and micronized progesterone. Some plans use a compounded hormone, prepared by a licensed pharmacy for you. When yours does, we tell you it is compounded, that compounded medications are not FDA-approved, and why it fits you.
The conversation about hormone therapy has changed
For more than twenty years, menopause hormone therapy carried a boxed warning about heart disease, breast cancer and dementia, based on a landmark study of mostly older women. In November 2025 the FDA announced it was removing those statements from the boxed warning, after a review of the evidence and an expert panel. The FDA’s guidance is that systemic hormone therapy is best started within ten years of the start of menopause or before age 60, a window that includes women in perimenopause. The right answer still depends on your age, your timing and your history, which is why a doctor makes the decision with you. Full safety information is below.1
A good fit, and when we talk first
A good fit
- Women in perimenopause or menopause whose hot flashes, night sweats, sleep, mood, cycles or vaginal symptoms affect daily life
- Women in perimenopause, within about ten years of their last period, or under 60
- Women who want a doctor to match the form and dose to them instead of guessing
- Women who tried to push through and want a real plan
What your doctor reviews with you
- Your history with breast or other hormone-sensitive cancers
- Any unexplained bleeding
- Past blood clots, stroke or heart events
- Your liver health, and whether you are pregnant
Monitored from start to finish
Your doctor starts with a low dose, checks in often and adjusts as your body responds.
One change at a time, with a check-in after each change.
Your screening, including mammograms and cervical screening, kept up to date.
Questions between visits? Call any time, day or night.
A doctor, not a hormone storefront
Hormone therapy is easy to buy through apps and med spas. Using it correctly is a medical job: knowing your history before the first dose, choosing the right form, catching the symptom that matters and adjusting as you change. Every Trio physician is board certified in Emergency Medicine, and your care is directed by your doctor, not delegated.
Your cost, confirmed up front
You pay for your visits with your doctor, and any prescription is filled separately by a pharmacy or lab. We confirm your expected cost before you start. There is no membership fee, and we do not bill insurance. HSA and FSA cards are accepted, and we provide a receipt you can submit to your insurer.
Dr. Czarnik on perimenopause
Trio founder Ann Czarnik, M.D., FACEP, went through perimenopause herself after nearly two decades in emergency medicine. She talks about what she learned, and what she wants women to know, on The Ezer Effect podcast: watch on YouTube or listen on Spotify.
Serving Austin and Dallas-Fort Worth
Austin
Ann Czarnik, M.D., FACEP, and Nora Demchur, M.D. In your home or by video across Austin, Downtown Austin, East Austin, Rosedale, Tarrytown, Northwest Hills, Balcones Park, Zilker, Bouldin Creek, Travis Heights, West Lake Hills and Rollingwood.
Dallas-Fort Worth
Kelsey English, M.D., with Trio founder Ann Czarnik, M.D., FACEP. In your home or by video across Dallas, Downtown Dallas, Deep Ellum, Uptown Dallas, Highland Park, University Park, Preston Hollow, Fort Worth, Downtown Fort Worth, Cultural District, Southlake, Westlake and Mansfield.
Perimenopause and menopause questions, answered
For many healthy women who start within ten years of menopause or before 60, the benefits for symptoms can outweigh the risks. It is not right for everyone, which is why your doctor reviews your history first. In November 2025 the FDA moved to remove the heart disease, breast cancer and dementia statements from the boxed warning, while the risks remain described in the full label.
Your doctor will ask about your age, your cycles and your symptoms. Both are usually recognized from that history rather than one hormone test. In perimenopause hormone levels swing so much that a single test is not reliable, so we order labs as needed.
Yes. Symptoms often start years before your last period, and treatment does not have to wait. Hormone therapy can start while you still have periods, and your doctor matches the plan to your cycles, your symptoms and your plans. You can still get pregnant in perimenopause, so tell your doctor if that matters to you.
If you still have your uterus, yes. Estrogen alone can thicken the lining of the uterus, so it is paired with a progestogen. Low-dose vaginal estrogen is handled differently, and your doctor will explain.
Bioidentical means identical in structure to the hormones your body made, and several FDA-approved products already are. We use both FDA-approved and compounded hormones. A compounded product is not FDA-approved. If one is part of your plan, we tell you why and use a licensed US pharmacy.
That is a decision you and your doctor revisit regularly. Many women use it for a few years, and some longer. We review your plan at follow-up visits and adjust.
Common early side effects include breast tenderness, bloating, headache and spotting, which often settle as your body adjusts. Hormone therapy has benefits and risks that depend on the person: the FDA’s full prescribing information still describes risks including blood clots, stroke and breast cancer, and estrogen taken without a progestogen carries a boxed warning for cancer of the uterine lining. It is not used for women with a history of breast or other estrogen-sensitive cancer, unexplained vaginal bleeding, a past blood clot, stroke or heart attack, active liver disease, or pregnancy. Your doctor reviews all of this with you before you start and at every follow-up.
No. Trio has no waiting room. Your doctor sees you at home or by secure video, and you can call (737) 363-3226 any time.
This page is general information, not medical advice for your situation. A Trio physician decides whether hormone therapy is right for you after a consult. Compounded medications are prepared by licensed pharmacies and are not FDA-approved.
Sources
- U.S. Food and Drug Administration. HHS advances women’s health, removes misleading FDA warnings on hormone replacement therapy, November 10, 2025. fda.gov
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2022;29(7):767-794. doi.org
- Cleveland Clinic. Perimenopause: Age, Stages, Signs, Symptoms and Treatment. clevelandclinic.org
- Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab, 2019;104(10):4660-4666. doi.org