Perimenopause

Reproductive Hormone Overview

This module provides a clinical overview of how hormone monitoring with Mira can support individualized care during the perimenopausal transition. It outlines when Mira testing is most clinically beneficial and explores factors that may influence hormone patterns, including hormone therapy, contraceptive use, and procedures such as hysterectomy or uterine ablation.

Content is grounded in provider case observations, published research, and ongoing third-party studies. While Mira can offer valuable insights for many patients using HRT or navigating perimenopause, its use may not be appropriate in all cases. This module clarifies where Mira is most effective and where alternative assessments may be more suitable.

Designed as a reference for clinical application, this module supports providers in making informed, patient-centered decisions throughout the perimenopausal transition.

Overview

In this video, Christina Saldanha provides a brief introduction to ovarian hormones, explaining both those produced by the ovaries and those produced by the brain that act on the ovaries. She covers key hormones such as estrogen, progesterone, testosterone, AMH, FSH, and LH, offering valuable insights into their roles in reproductive health.

Overview

In this video, Christina explains the biphasic menstrual cycle, covering the follicular and luteal phases, including the process of ovulation. She discusses follicular development, the release of the egg during ovulation, the production of progesterone by the corpus luteum post-ovulation, and what constitutes a normal cycle length and amount of bleeding.

Overview

In this video, Christina Saldanha covers period changes during early and late perimenopause, including potential risks such as polyps, fibroids, worsening endometriosis, anemia, and cancer. She also explains what constitutes irregular bleeding and when further investigation is warranted to ensure proper care for women in perimenopause.

‍

Overview

In this video, Christina Saldanha provides an in-depth explanation of hot flashes, including what they are, when they are typically worse, and how they present. She explores the relationship between hot flashes and estrogen levels, their origins in the brain, and the impact they have on sleep and mood. Christina also covers the prevalence of hot flashes, who is most affected, and how long they generally last. Additionally, she discusses other potential causes of hot flashes that should be ruled out and reviews the most effective treatment options for managing this symptom.

‍

Overview

In this video, Christina Saldanha discusses how depression can worsen during perimenopause, exploring the link between vasomotor symptoms (VMS) and depression. She also addresses how perimenopause may exacerbate PTSD symptoms and offers insights into managing these mental health challenges during this transitional phase. This video provides valuable information for providers to better understand and support patients experiencing emotional changes during perimenopause.

‍

Overview

In this video, Christina Saldanha explains menopause and perimenopause, including their definitions, typical onset age, and how long perimenopause can last. She discusses the different types of menopause and how menopause should be viewed as a transition along a spectrum. Christina also explores the health implications associated with each stage and provides specific details on the different types of menopause, offering valuable insights for providers in managing patient care during these transitions.

‍

Overview

In this video, Christina Saldanha discusses the importance of understanding perimenopause and menopause, emphasizing the individualized nature of the experience for each woman. She highlights the lack of awareness among both patients and providers, and the significant impact these transitions can have on women's lives. Christina also addresses the fact that many women will spend over half of their lives in menopause, and the estimated financial loss due to missed work and healthcare costs related to menopause symptoms. This video provides valuable insights for providers on the need for better awareness and support.

‍

Overview

This video by Christina Saldanha  delves into the hormonal changes women experience from menarche to menopause, with a specific focus on perimenopause, often referred to as the "zone of chaos." During this phase, estrogen levels fluctuate significantly, and the brain-ovary feedback loop becomes less effective. As the ovaries become less responsive to hormonal signals, the brain compensates by increasing follicle-stimulating hormone (FSH) production to boost estrogen. This leads to unpredictable highs and lows in estrogen levels, causing a variety of symptoms. In addition, changes in the estrogen-progesterone balance further complicate these hormonal fluctuations, presenting additional challenges for women during perimenopause.

Description:

‍This module provides an in-depth exploration of estradiol and FSH interactions during the perimenopausal transition. Providers will learn why single-day hormone measurements may be insufficient, and how physiological feedback loops, cycle variability, and estrogen therapy can complicate interpretation. Through real-world case data, participants will gain skills in recognizing ovulatory and anovulatory patterns and understanding hormone trends within the broader clinical context—supporting more accurate assessments of ovarian function during this transitional phase.

Description:

This module examines the decline in progesterone levels across the menopausal transition and the hormonal patterns that accompany this shift, including reduced luteal progesterone secretion and increased anovulatory cycles. Through analysis of real-world hormone data, providers will learn to recognize patterns associated with low progesterone and unopposed estrogen, helping to support clinical interpretation and patient education during perimenopause.

Description:

‍This clinical training module provides healthcare professionals with a practical, informed framework for using Mira to support hormone tracking in perimenopausal patients. Through a step-by-step decision flowchart, participants will learn how to assess when Mira is appropriate, how to interpret hormone trends in the context of symptoms, and how to determine next steps based on the patient's ovulatory status, hormone coordination, and treatment goals.The module guides practitioners through common perimenopausal hormone patterns—including progesterone decline, estrogen dominance, and cycle irregularity—and demonstrates how to incorporate hormone data to enhance care planning, patient education, and therapeutic decision-making. Emphasis is placed on collaborative care, real-world case applications, and aligning hormone testing with clinical relevance.

Description:

In this video, Christina Saldanha explains how testing hormone levels is an important step in understanding and managing peri/menopause symptoms. Hormones such as estrogen, progesterone, testosterone, and thyroid hormones play a crucial role in regulating various bodily functions, including menstrual cycles, mood, energy levels, and metabolism. Hormone testing can help identify imbalances that may be contributing to symptoms such as hot flashes, night sweats, mood swings, and fatigue.

There are several ways to test hormone levels, including blood tests, saliva tests, and urine tests. Blood tests are the most common method and can provide a snapshot of hormone levels at a specific moment in time. Saliva tests measure the levels of hormones that are free and active in the body, while urine tests can provide a more comprehensive picture of hormone metabolites.

Key Lesson Concepts:

• Hormones such as estrogen, progesterone, testosterone, and thyroid hormones play a crucial role in regulating bodily functions.
• Hormone testing can help identify imbalances that may be contributing to peri/menopause symptoms.
• Testing methods include blood tests, saliva tests, and urine tests, each offering unique insights into hormone levels.

Description:

In this module, Christina Saldanha guides providers through the critical distinctions between progesterone, progestogens, and progestins, clarifying their roles and implications for clinical care. Providers will gain a deeper understanding of the essential physiological functions of progesterone for individuals with a uterus — from supporting endometrial health to promoting overall hormonal balance. We will also review the clinical benefits of progesterone supplementation.

Description:

‍In this module, Christina Saldanha presents a practical framework for tailoring hormone therapy across the stages of perimenopause and menopause. Using a "crescendo-decrescendo" model of hormonal change, she outlines clinical strategies for supporting patients in early perimenopause, mid-to-late perimenopause, and postmenopause, including guidance on when to consider progesterone, estrogen, and testosterone therapies.

Description:

‍In this case-based module, Christina Saldanha presents the clinical journey of a 38-year-old woman with a history of hysterectomy and persistent cyclical symptoms, including irritability, insomnia, and mood fluctuations. Despite normal lab results, the patient reported a recurring monthly pattern, prompting the provider to use Mira’s real-time hormone tracking for further evaluation.Mira revealed that the patient was still ovulating and exhibited a typical hormonal rhythm. Her symptoms consistently occurred during the luteal phase, especially in the second half, when progesterone levels began to decline. This insight guided the provider to initiate cyclical (luteal-phase) progesterone supplementation, along with targeted nutrient support. The intervention led to significant improvements in both emotional and physical symptoms.

This module highlights the clinical utility of Mira in:

• Detecting hidden hormonal patterns post-hysterectomy

• Affirming the patient’s experience of luteal-phase symptom cycles

• Guiding individualized and timely hormone therapy interventions

Description

‍This case-based module features a 46-year-old perimenopausal woman presenting with menorrhagia, mood changes, and systemic symptoms commonly associated with the menopausal transition. Christina Saldanha guides providers through a step-by-step diagnostic and therapeutic approach, using the Mira hormone monitor to confirm abnormal hormone patterns—specifically persistently elevated estrogen—and to inform the timing of intervention. Key clinical decisions include initiating oral micronized progesterone, assessing the use of an LNG-IUD, and later incorporating estradiol therapy to optimize symptom management. This case illustrates how real-time hormone data can improve clinical decision-making, validate patient experiences, and support personalized care throughout perimenopause.