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.

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.

TP4W is amazing and I am so very thankful I found them 9 years ago!! Amazing partnership between midwives and doctors, sweet nurses and front end staff, and relaxing environment. I literally recommend them to all my friends! I look forward to my appointments and feel like I’m going to catch up with old friends.

I’ve always had wonderful experiences at TP4W. Everyone is friendly, knowledgeable, and thorough in their care. April delivered my son and I can’t say enough wonderful things about her. She is patient and compassionate. I had the best labor and delivery experience thanks to her. I do and will continue to recommend them to my friends and family!

TP4W is amazing and I am so very thankful I found them 9 years ago!! Amazing partnership between midwives and doctors, sweet nurses and front end staff, and relaxing environment. I literally recommend them to all my friends! I look forward to my appointments and feel like I’m going to catch up with old friends.

I have been seeing Dr. Grana for just about 4 years now and I must admit that she has been the very best OB I have ever had! She is so personable, friendly, and all around caring about her patients. I’ve never had any issues with the staff, the office is very clean, and if Dr. Grana is running behind, they let me know ahead of time. I highly recommend Dr. Grana and this office to anyone!

I was referred here by my family doctor. I had found out I was pregnant with my first child later last year and had the most difficult time scheduling an appointment at my last OB/GYN Doctor. I was on the verge of tears because I didn’t know what my next steps were and thank goodness I was referred to Triangle Physicians for Women. The service is amazing every appointment I’ve had and they are so organized and have made me feel so comfortable. I have to thank them for making this pregnancy so much smoother and less stressful than it would have been had I stayed with my previous doctor. I highly recommend this place!