Conditions
Menopause symptoms: treatment and video visits
Menopause symptoms such as hot flashes, night sweats, poor sleep and mood changes usually start in perimenopause, the years before your periods stop. Menopause itself means 12 months in a row without a period, most often between ages 45 and 55. By video, the doctor evaluates you, reviews your risks and explains your options. If appropriate, the doctor prescribes and we send your prescription to your pharmacy.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Very heavy vaginal bleeding, or bleeding with dizziness or fainting
- Chest pain, shortness of breath, or pain and swelling in one leg, especially if you use hormone therapy
- Sudden weakness on one side of the body, a drooping face or trouble speaking
- Thoughts of harming yourself: call 988 or Línea PAS 1-800-981-0023
Help lines
At a glance
Menopause
Common symptoms
- Irregular periods or periods that change
- Hot flashes: a sudden warm feeling in your face, neck and chest
- Night sweats
- Trouble sleeping and tiredness
- Vaginal dryness and pain during sex
- Mood changes, irritability or anxiety
- Leaking urine or other urinary problems
- Other names
- Perimenopause · Menopausal transition
- Treatment
- Routine changes, non-hormonal treatments or hormone therapy, only when the medical evaluation calls for it
On this page(8)
What is menopause?
Menopause is when your periods stop for good and you can no longer get pregnant. It is confirmed after 12 months without a period. According to MedlinePlus, it most often happens between ages 45 and 55.
The years before are called perimenopause, or the menopausal transition. It usually starts in your 40s, can last several years, and is when hormone changes cause the most symptoms. Periods become irregular, but until you have gone 12 months without one, you can still get pregnant. If you don’t want a pregnancy at this stage, the CDC describes how effective each method is, and the doctor helps you choose: see birth control online.
How we care for you by video
You see Dr. Diana Nieves Castro, MD, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks about your symptoms, your periods, your medicines and your history: blood pressure, blood clots, heart disease, stroke and breast cancer in you or your family.
With that, the doctor explains the options that fit you: changes to your routine, non-hormonal treatments or hormone therapy. If needed, we give you a lab order for a lab near you, for example to rule out another cause of your symptoms. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances. It is part of what your online primary care doctor does.
If you already use a menopause treatment and only need a prescription refill, that is a follow-up visit.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text.
Request your visit.
Book a visit and choose "Doctor visit" (or "Follow-up visit" for a refill). You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If needed, you get a lab order or a referral.
What the visit costs
A menopause evaluation is a US$79 doctor visit, with no membership. A refill of a medicine you already use is a US$49 follow-up visit. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. See all prices.
Common menopause symptoms
Not everyone has the same symptoms. Night sweats can have other causes too: read night sweats. The most common menopause symptoms are:
- Irregular periods or periods that change
- Hot flashes: a sudden warm feeling in your face, neck and chest
- Night sweats
- Trouble sleeping and tiredness
- Vaginal dryness and pain during sex
- Mood changes, irritability or anxiety
- Leaking urine or other urinary problems
Treating menopause symptoms
Changes to your routine. MedlinePlus recommends dressing in layers (useful in Puerto Rico’s heat), avoiding alcohol and caffeine, exercising, lowering stress and keeping good sleep habits.
Non-hormonal options. Some non-hormonal medicines help with hot flashes, lubricants help with vaginal dryness, and cognitive behavioral therapy helps with sleep; see also insomnia. According to the NEI, the hormone changes of menopause can make it harder for your body to make tears: if your eyes burn, see dry eyes.
Hormone therapy. It uses estrogen, or estrogen plus progestin if you have a uterus, to protect the lining of the uterus. According to MedlinePlus, the lowest dose that works is used, and women at high risk of stroke, heart disease, blood clots or breast cancer should not use it. That is why the doctor reviews your risks before considering it; if appropriate, she prescribes it.
If your mood symptoms are severe or you have thoughts of harming yourself, call or text 988 or Línea PAS at 1-800-981-0023.
Bleeding after menopause
Any vaginal bleeding after 12 months without a period, or bleeding between periods, needs to be checked. MedlinePlus advises contacting a provider. By video, the doctor listens and we refer you for an in-person evaluation with gynecology. If the bleeding is very heavy or you feel dizzy or faint, go to the emergency room or call 911.
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
How do I know if I’m in menopause?
Can I get hormone therapy by video?
Are there non-hormonal treatments for hot flashes?
Can I get pregnant during perimenopause?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (4)
- Menopause (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Menopause, medical encyclopedia (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Contraception and Birth Control Methods (CDC) (opens in a new tab) (accessed 2026-10-02)
- Causes of Dry Eye (National Eye Institute, NIH) (opens in a new tab) (accessed 2026-10-02)