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Evaluation
We help identify the factors contributing to your symptoms and build a plan that fits your life.
Skip to content So many women are going through perimenopause and menopause, and it still does not get talked about in a way that feels helpful. Maybe you are having sudden hot flashes, waking up drenched at night, struggling with sleep, noticing brain fog or memory changes, or simply feeling like your body is doing things you do not recognize. First, take a breath. Your body is not failing you. Your hormones are shifting — and that transition can affect everything from mood, sleep, energy, and libido to metabolism, bone health, and heart health. At Alpenaura Holistic Health in Bend, Oregon, our goal is to help you navigate this season with more clarity, confidence, and support. We look at perimenopause and menopause through an integrative lens. That means we are not trying to put a temporary band-aid on a hot flash — we are looking at the whole picture: your symptoms, your labs, your health history, your goals, and how to support your quality of life now while protecting your long-term health.
Perimenopause can begin years before periods stop — often in the early forties, sometimes sooner —
and symptoms frequently appear long before labs look “menopausal.” This is why so many women are
told nothing is wrong during the years they feel worst. Diagnosis is based on symptoms and pattern, not on a single hormone level.
Symptom-based evaluation rather than lab thresholds alone
• Cycle changes and irregular bleeding
• Sleep disruption and early waking
• New or worsening anxiety and irritability
• Brain fog and memory changes
• Weight and body composition changes
• Hot flashes and night sweats
• Vaginal dryness and libido changes
• Joint aches and new physical symptoms
• Education about what to expect and when
Hormone therapy is not right for everyone, but it is appropriate for far more women than the past two
decades of caution suggested. We discuss the evidence honestly, review your personal risk factors, and
make the decision together — including when the answer is a non-hormonal approach.
• Individualized risk and benefit discussion
• Bioidentical hormone therapy including estrogen, progesterone, and testosterone
• Delivery options including patches, creams, sublingual tablets, pellets, and vaginal therapies
• Localized vaginal therapy for genitourinary symptoms
• Non-hormonal options when hormone therapy is not appropriate
• Sleep, mood, and nervous-system support
• Ongoing monitoring and dose adjustment
• Care for breast cancer survivors, individualized in collaboration with oncology
The menopause transition is a meaningful window for long-term health. Bone density, cardiovascular
risk, and metabolic health all shift during this period, and decisions made now affect the decades that
follow — which is why our care extends past symptom management.
• Bone health evaluation and DEXA coordination
• Cardiovascular risk assessment
• Metabolic and insulin resistance evaluation
• Thyroid evaluation
• Nutrition and protein guidance
• Strength training and movement support for bone and muscle
• Preventive care planning
• Ongoing monitoring as needs change
From the Nurse Practitioner
We help identify the factors contributing to your symptoms and build a plan that fits your life.
We offer individualized support around nutrition, movement, sleep, stress, blood sugar balance, and lifestyle habits without shame, crash dieting, or unrealistic expectations.
Hormonal shifts, thyroid dysfunction, PCOS, insulin resistance, perimenopause, menopause, medications, poor sleep, chronic stress, and under-fueling can all affect metabolism.
While GLP-1s can be an effective tool for some patients, we also explore lifestyle foundations, hormone and thyroid optimization, supplements, and other pharmaceutical interventions depending on the patient's history, goals, risks, and clinical needs.
Every woman’s health journey is unique. Here are answers to some of the most common questions about our approach to women’s health, hormone care, treatment options, and personalized care at Alpenaura.
Perimenopause is diagnosed clinically, based on your symptoms, age, and cycle pattern rather than a single lab value. Hormone levels fluctuate substantially during this transition, so a normal-looking result on any given day does not rule it out. If your cycles are changing and you are experiencing sleep, mood, or temperature symptoms, that pattern is meaningful.
The concerns that shaped a generation of practice came largely from a study whose findings have since been substantially reinterpreted, particularly regarding the age at which therapy begins. For many healthy women within about ten years of menopause, the benefits outweigh the risks. That said, this is an individual decision based on your history, risk factors, and goals — and we will give you an honest assessment of both sides.
No. Perimenopause is often when symptoms are most disruptive, and treatment during this stage is both appropriate and effective. There is no reason to wait years for a milestone before addressing how you feel.
There are meaningful non-hormonal options for hot flashes, sleep, and mood, along with vaginal therapies for genitourinary symptoms and lifestyle strategies with real evidence behind them. Hormone therapy is one tool among several, not the only path.
Explore simple medication support or a more guided membership with monthly check-ins, provider visits, supplies, and included labs on select tiers.
Best for patients who want medication access and pharmacy coordination with visits/labs handled separately.
Best for patients who want structure, accountability, supplies, labs on select tiers, and follow-up built in.
| Pathway | Semaglutide | Tirzepatide | Best Fit |
|---|---|---|---|
| Basic GLP Support | $225-$325/mo | $275-$499/mo | Lower-touch support; visits and labs handled separately. |
| Comprehensive Reset | $325-$475/mo | $375-$625/mo | More structure: supplies, monthly MA check-ins, quarterly provider visits, labs on Standard/Advanced tiers. |
Comprehensive Standard and Advanced Reset memberships include an Expanded Metabolic Panel at initiation and a Basic Weight Loss Safety Panel at 6 months; both annually thereafter. Microdose Reset and Basic GLP Support patients may choose cash-pay labs a la carte, if they opt out of billing through insurance.
Medication is prescribed only when clinically appropriate.
Titration is based on tolerability, goals, and response.
Standard/Advanced Reset tiers include baseline and 6-month labs.
Monthly check-ins help you stay supported between visits.
| Start-Up | Commitment | Good To Know |
|---|---|---|
| $149 one-time enrollment/setup fee | 3-month initial commitment for medication-inclusive plans | Medication is not guaranteed. Eligibility, medication choice, and dose are determined after clinical review. |
Symptoms rarely have a single cause. Explore the other areas of Jade’s practice — hormone therapy, women’s health, medical weight loss, and comprehensive evaluation.
"Comprehensive women’s health care for every stage of life, from preventive care to hormone and cycle support."
"Bioidentical hormone therapy for perimenopause, menopause, and the symptoms you've been told to live with."
"An ongoing partnership in your health: comprehensive testing, personalized protocols, and a provider who knows your story."
YOUR CARE STARTS HERE
Stop guessing about your symptoms. Comprehensive testing, honest answers, and a plan built around
you — with Jade Carboy, NP
