What happens after the initial consultation? During the initial consultation, we review your history and symptoms, discuss your options, and work together to create a treatment plan. We often perform lab work, and many patients can begin treatment that day when appropriate. For women in perimenopause and menopause, treatment may need to change as their symptoms and hormone patterns change. We may adjust the medication dose or try a different formulation. When women first start treatment, they typically see me every six to eight weeks until we find a regimen that works well for them. Once treatment is stable, visits can often be spaced out to a few times a year, depending on individual needs. What can women expect during the adjustment period? Some women experience side effects during the first four to six months. These may include breast tenderness or changes in bleeding. Progesterone can also cause sleepiness, which may improve within the first week or two. Follow-up visits give us an opportunity to discuss how you’re feeling, review any side effects, and make adjustments. Let your provider know about new or unexpected bleeding so it can be assessed rather than assumed to be part of the adjustment. — Transcript edited for clarity and reviewed by Alan McCool, MD, FACS. Reviewed: October 17, 2026