Perimenopause & Menopause Care,Centered Around You
Hot flashes, changing periods, disrupted sleep, anxiety, brain fog, weight changes, and vaginal symptoms can feel disconnected. Often, they are part of the same hormonal transition.
At Mulberry, Dr. Andrew Nyein provides comprehensive, physician-led evaluation and individualized treatment for the full picture — through unhurried visits, evidence-based options, and a care plan that evolves with you.
Could This Be Perimenopause?
These changes often appear one at a time, which is why they are so easily dismissed. Seen together, they tell a more recognizable story.
One Transition, Evaluated as a Whole
Perimenopause is the transition leading up to menopause, when estrogen and progesterone begin to fluctuate unpredictably—often beginning in the 40s and lasting several years. Menopause itself is defined as twelve consecutive months without a period; the years that follow bring their own hormonal and health considerations.
Because hormones fluctuate rather than simply decline, symptoms may be inconsistent and confusing—even when routine laboratory results appear normal. Symptoms that seem unrelated may be connected through the hormonal, metabolic, and life changes of midlife.
Diagnosis begins with listening. A careful history of your cycles, symptoms, and their timing is often more informative than any single blood test. Evaluation at Mulberry begins with an unhurried conversation, with targeted laboratory testing and imaging used when they add meaningful clinical information.
Bleeding changes receive particular attention. As a gynecologic surgeon, Dr. Nyein can evaluate abnormal bleeding comprehensively, using transvaginal ultrasound, endometrial sampling, and in-office hysteroscopy when clinically indicated.
What Your Care May Address
Rather than treating each symptom in isolation, Dr. Nyein evaluates how they connect — across four related areas.
Symptoms & Quality of Life
Hot flashes and night sweats, disrupted sleep, mood changes, anxiety, and brain fog are evaluated together because they often influence and amplify one another. With appropriate treatment, these symptoms can often improve substantially.
Periods & Gynecologic Health
Cycles commonly become irregular during perimenopause, but very heavy, prolonged, or between-period bleeding—and any bleeding after menopause—warrants proper evaluation by a gynecologic surgeon.
Advanced Gynecology →Metabolic & Preventive Health
Midlife weight change deserves medical context, not blame. Evaluation looks beyond the scale to consider thyroid function, glucose and lipid health, body composition, nutrition, movement, sleep, and other contributing factors.
The menopause transition is also an important prevention window. Bone health, cardiovascular and metabolic risk, and appropriate screening are reviewed and coordinated through one physician.
Sexual & Genitourinary Health
Vaginal dryness, discomfort with intimacy, and urinary symptoms are very common after menopause and may persist or worsen without treatment. At Mulberry, they are addressed with the same clinical seriousness—and discretion—as every other aspect of your health.
Sexual Health & GSM →Treatment Designed Around You
There is no single protocol. After evaluation, Dr. Nyein builds an individualized plan and revisits it as your transition evolves. Depending on your symptoms, goals, and history, that plan may draw on:
- Hormone therapy — for many healthy women younger than 60 or within ten years of menopause onset, the benefits for bothersome symptoms generally outweigh the risks when no contraindications are present.
- Non-hormonal medications — well-studied options when hormones are not preferred or appropriate.
- Vaginal therapies — including low-dose vaginal estrogen for genitourinary symptoms.
- Lifestyle & preventive care — sleep restoration, protein and strength to protect muscle, and bone and cardiovascular protection.
- Coordinated care — respectful referrals when additional support adds value.
One Transition.
One Physician. One Plan.
Many women navigating this transition are sent in five directions: a sleep specialist for the waking, a psychiatrist for the anxiety, a trainer for the weight, and a gynecologist for the bleeding—with no one connecting them. At Mulberry, the connections are the point.
This is medicine designed around who you are now — and who you will continue to be.
Evidence-Based Hormonal Care
Grounded in current clinical evidence and informed by ongoing education in menopause care.
Diagnosis by Listening
Unhurried history-taking first; labs and imaging where they add clarity, not as a substitute.
Surgical-Level Bleeding Evaluation
Abnormal bleeding evaluated definitively by a gynecologic surgeon — in the same practice.
Prevention Built In
Bone, cardiovascular, and metabolic protection woven into your ongoing care.
One Physician, Every Visit
Dr. Nyein personally, from your first consultation through every follow-up.
Dr. Andrew Nyein is a member of The Menopause Society and remains engaged with evolving evidence and education in menopause and midlife women’s health.
What To Expect
During Your
Consultation
Your consultation is unhurried and comprehensive. As an osteopathic physician, Dr. Nyein considers the whole picture—not hormones alone. Your consultation may explore six interconnected dimensions of midlife health:
You Do Not Have to
Figure This Out Alone
You do not need to wait until symptoms become severe—or until you are certain they are caused by menopause. A thoughtful evaluation can help clarify what is changing, rule out other concerns, and identify the options most appropriate for you.