Menopausal Management

What is menopause?

Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility. Menopause occurs, on average, at age 51. The years between puberty (when periods start) and menopause are called premenopause.

What is perimenopause?

Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning “around menopause”). It can last 6 years or more, and ends 1 year after the final menstrual period.


MonaLisa Touch
Triangle Physicians for Women now offers MonaLisa Touch to treat vaginal health after menopause.  This in-office treatment delivers gentle laser energy to the vaginal wall that stimulates a healing response, generating new collagen in the tissue.  A typical course of treatment is three procedures over 18 weeks.


  • In-office procedure
  • No anesthesia, virtually painless
  • No downtime
  • Minimal side effects
  • Each treatment is less than 5 minutes
  • Thousands of women have been treated worldwide since 2012

In both European and US clinical trials, women reported symptom relief after the very first treatment and even greater improvement after treatments 2 and 3.

What is hormone therapy?

Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond. Hormone therapies are the prescription drugs used most often when treating menopause symptoms.

  • Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women. Many kinds of estrogen therapy are available in the United States and Canada to treat menopause-related symptoms. A variety of estrogen types, delivery systems, and dosage strengths give each woman a better chance to find which option is best for her.
  • Progestogen, another hormone, has sometimes been used alone during perimenopause to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels during this transition. There are various progestogen options, and they allow tailoring to a woman’s unique needs.
  • Combined estrogen-progestogen therapy (EPT) with various dosing schedules (often called “regimens”) can also be used for menopause-related symptoms. These regimens include taking estrogen and progestogen separately or through convenient combination EPT products. Each woman should feel comfortable exploring different options with her clinician to determine which is best for her.

What are bioidentical hormones?

Sometimes custom-compounded hormones are referred to as “bioidentical hormones” or “natural hormones.” These terms mean different things to different people. To scientists and healthcare providers, bioidentical hormones are those that are chemically identical to the hormones produced by women (primarily in the ovaries) during their reproductive years. A woman’s body can make various estrogens (such as 17beta-estradiol, estrone, and estriol) as well as progesterone, testosterone, and other hormones. Thus, bioidentical hormone therapy can mean a medication that provides one or more of these hormones as the active ingredient.
If you are experiencing any of these menopause or perimenopause symptoms, call our office at 919-678-6900 for a complete evaluation.

Dr. Pearce was attentive, listened well, and provided a comfortable experience for me. My recent vaginal exams have been very uncomfortable and she provided a very comfortable exam this time.

Dr. Pearce was AMAZING! She answered all my questions and didn’t make me feel rushed. Best experience I’ve had at Triangle yet! She really put my worried first-time mom mind at ease.

I think Dr. Grana and her assistant (Mandy) are the best. I have been going to TP4W for years – at least 20, and I have never been disappointed with the level of care I have received. I can be a challenge as my level for pain tolerance is low and they put up with me! I can’t help but highly recommend the practice to anyone looking for exemplary women’s healthcare.

Love love love Dr. Grana and her crew. Love going to Holly Springs office. The girls are the best from Lisa at the front desk to all the girls in the back. Your music and atmosphere is great. Thanks for making these appointments fun!! Yes believe it or not, fun!!!

Dr V and the office staff were all very professional, understanding, caring and very efficient. I would be happy to recommend this practice to friends, family and associates. – Barbara M. Lucas

My visit was great! & my past visit have all been great.Kristy helped me even with me being a bit stressed & in a hurry because I had to be seen & my job is super strict. Her urgency to get me seen was phenomenal. I even got to see Heather, she’s awesome & amazing. She helped deliver my baby girl a year ago. My whole family loves her and Dr Sheshadri. We actually can’t wait to get pregnant again hahaha. Everyone treats you with respect and always makes sure your okay & answers whatever questions you have before you leave. Even leaving a message for the nurses,they get back to you so quickly.  This practice really makes you feel taken care of.  We appreciate you all!  – Erika Hooks

My experience with the TP4W staff has been top of the line.  They helped me through three pregnancies and coached me through every step of the way.  Eternally thankful I chose TP4W.  – Britney

TP4W have such amazing doctors, midwives and nurses.  I cannot say enough about Dr. Grana and the rest of the staff for all the help, advice, guidance and medical care they provided me with all of my kids.  She made me feel safe and calm through both c-sections.  My routine care and pregnancy care have always been top notch and I would recommend them to anyone looking for an OBGYN.  – Brooke

We were honored to receive a hand written note..

Dr. Grana, Angie, Jessica, Heather, April, Sarah and the rest of the staff –

Thank you all so much for taking such good care of me through both of my pregnancies and births, especially my latest one on 10/29! most of yall know how nervous I was from having gone through a lot (to say the least) with my first in 2016. You all made me feel so comfortable and at ease before, during and after. And going through a touch year with my dad, you guys always asked how he was doing at every appointment, which was so thoughtful and beyond your job description. I know that you all see many women go through what i did each and every day and deliver many babies and perform many c-sections. But I hope you know how special Ruby’s delivery was to me. You all have amazing jobs! I cannot thank you all enough. Merry Christmas!

Love, Lucy

I have been going to TP4W since 2010/11 and could not be happier.

The staff, nurses, midwives, and doctors are all amazing. I have 2 sons, both delivered via cesarean by Dr. V. Every visit and every provider did everything in their power to give me the birth experience I wanted, and also ensure that myself and my babies were safe and healthy. Dr. V even did everything in his power to help me avoid my first c-section and VBAC with the second, but that turned out to be out of his hands and he was the absolute best surgeon. With my two pregnancies, I experienced a few scares and some unusual circumstances that would be too long and too private to write in a review, but every single hurdle was handled with grace, honesty, and professionalism. I am so thankful for the recommendation from a friend to come to this office. I can’t imagine ever going to another practice.