Questions and answers

Perimenopause is usually recognized from your symptoms and changes in your cycle rather than a single blood test, because hormone levels swing from day to day during this stage. Changing periods, new sleep problems, hot flashes or mood changes in your forties are common signs. Dr. Balat will look at the whole pattern, and may order tests to rule out other causes such as thyroid problems.

Menopause is confirmed once you have gone twelve months in a row without a period. It is most often reached in the early fifties. Everything before that point is perimenopause, and every year after it is postmenopause.

Some changes come with age, but many of the symptoms women are told to live with, such as night sweats, broken sleep, painful intercourse and bladder urgency, are driven by hormonal change and can be treated. It is worth an evaluation rather than an assumption.

It varies widely. Hot flashes and night sweats last several years for many women and more than a decade for some. Vaginal dryness and bladder symptoms tend to continue or worsen over time without treatment.

You do not have to see a gynecologist, but it helps. Midlife symptoms often overlap with gynecologic issues such as abnormal bleeding, fibroids, endometriosis and pelvic floor changes. A gynecologist can evaluate and treat them together.

For healthy women under 60, or within ten years of menopause, who have bothersome symptoms, current guidance from The Menopause Society is that the benefits generally outweigh the risks. It is not right for everyone. Your personal and family history, your age and your timing all shape the decision, which Dr. Balat reviews with you individually.

Hormone therapy is usually not recommended for women with a history of breast or uterine cancer, blood clots, stroke, active liver disease or unexplained vaginal bleeding. There are effective non-hormonal options for women in these groups.

Hormone therapy comes in several forms and doses, from systemic treatment for whole-body symptoms to low-dose vaginal therapy for local dryness and bladder symptoms. The right form depends on your symptoms, your history and your preferences, and is decided at your consultation.

There is no fixed stopping point. The decision is revisited regularly, weighing how well it is working against any change in your health. Some women use it for a few years, others longer.

Often, yes, though not always to diagnose menopause itself. Tests such as thyroid function, blood count, lipids and glucose help rule out other causes and establish a baseline for your long-term health.

The MonaLisa Touch is an in-office fractional CO2 laser treatment for vaginal dryness, irritation and painful intercourse related to menopause. It is hormone-free, takes only a few minutes, and is usually given as a series of sessions followed by yearly maintenance. Dr. Balat was among the first physicians in Houston to offer it.

The MonaLisa Touch is often considered for women who cannot use or prefer not to use vaginal estrogen, including many breast cancer survivors. The decision is made with your full history in view, and in some cases in coordination with your oncologist.

The O-Shot is a procedure that uses platelet-rich plasma from your own blood, placed in specific areas of the vaginal wall and near the clitoris. Women consider it for changes in arousal, sensation, dryness and mild stress urinary incontinence. Research is still early, and results vary.

A numbing cream is applied before the injections, and most women describe little discomfort. The visit usually takes about half an hour, and most women return to normal activities the same day.

They work differently and address overlapping but different concerns. The MonaLisa Touch focuses on the tissue changes of vaginal atrophy, while the O-Shot is often chosen for arousal, sensation and mild leakage. Some women benefit from both, or from vaginal hormone therapy instead. Dr. Balat will compare the options for your situation.

Not entirely. Cycles may become more regular with age, but the metabolic side of PCOS, including insulin resistance and higher cholesterol, often continues. Ongoing screening of blood sugar, cholesterol and blood pressure is part of good care.

Symptoms usually ease as estrogen falls, but not for every woman. A history of endometriosis also affects how hormone therapy is planned, so it is important that the same team understands both.

No. Many women control their symptoms well with hormonal and pain treatments. When surgery is needed, Dr. Balat performs minimally invasive procedures at the Binz Surgery Center.

You can book online through the Plaza OB/GYN scheduling page, request an online consultation, or call (713) 522-3333. You can also leave your details on this site and the office will call you back.

Plaza OB/GYN is at 1801 Binz Street, Suite 500, Houston, TX 77004, in Houston's Museum District near the Texas Medical Center. Office hours are monday to Friday, 8:30 AM to 5:00 PM.

Yes. If you would like to talk before coming into the office, you can request an online consultation through the Plaza OB/GYN website.

Menopause care at Plaza OB/GYN is led by Isam Balat, MD, working alongside nurse practitioner Angela Montgomery, MSN, NP.