Mojo Klinik / Conditions / Hormones / Perimenopause and Menopause
DR MARIA MACKEY
Mojo Klinik · Neutral Bay Sydney
Perimenopause and menopause.
The transition that has not been adequately explained.
Hormones do not move in a straight line.
Symptoms can begin years before any change in your cycle. A single blood test on the wrong day can look entirely normal.
SOUND FAMILIAR?
You will recognise yourself in some of these.
Most patients who walk through our door arrive carrying one or
more of these.
- You are between 35 and 55 and the words perimenopause or menopause have entered your thinking
- Your sleep has fallen apart for no reason you can identify
- Your weight is shifting in ways diet and exercise no longer fix
- The 3am waking is a regular event
- Your mood, your patience, your cognitive sharpness have all changed
- Your cycle has become unpredictable, heavier, or different in some new way
- You have been told your hormone levels are fine but you know something has shifted
- You are experiencing symptoms that no one has properly investigated
There is almost always a clinical explanation. Pulling on the thread is what we do.
WHAT PERIMENOPAUSE AND MENOPAUSE ACTUALLY ARE
Perimenopause is a 4 to 10 year biological transition. Not a single event.
It typically begins in the late thirties or early forties, often years before any change in cycle length. By the time the cycles become unpredictable, the hormonal shifts have usually been underway for some time. Menopause functional medicine starts with mapping where
you actually are.
Menopause itself is the point at which 12 months have passed without a period. The hormonal floor reached. Postmenopause is the long-term phase that follows.
"Why is the most predictable transition in women’s health still the most underdiagnosed? Symptoms can begin in the late thirties. Most women are told they are too young, or that their hormones look fine on a single blood test drawn on the wrong day. There is always more to look at."
A STAGING MAP
Understanding your stage.
Where you sit on the timeline changes the plan.
01
LATE REPRODUCTIVE
Cycles still regular but starting to feel different.
Often the most missed stage.
02
PERIMENOPAUSE
Cycle variability without other
clear cause.
The decade most patients never get framed.
03
MENOPAUSE
12 months without a period.
A point in time, not a state.
04
POSTMENOPAUSE
The years after.
Long-term hormonal recalibration matters here.
A complete picture takes years. Identifying your stage is the starting point.
OUR THREE – PHASE APPROACH
Map the hormones. Build the plan. Review against where you actually move.
A 42-year-old in early perimenopause needs a different plan from a 55-year-old in postmenopause, even with similar symptoms. Knowing where you sit on the timeline changes the picture.
Phase 1
Investigate
Weeks 1 to 3
Detailed history. Comprehensive hormone panel. Full thyroid panel. Adrenal and metabolic markers. Review of any previous testing.
Phase 2
Plan
Weeks 3 to 8
A plan built from what your testing actually shows. Lifestyle and nutritional support, targeted supplementation, hormone therapy where clinically appropriate.
Phase 3
Review
Months 3 to 6
Sleep, mood, and energy often respond first within 4 to 8 weeks. Hot flushes and weight changes typically take 3 to 6 months. We pace and review against the biology.
UNDERSTANDING YOUR STAGE
Where you sit on the timeline changes the picture.
A 42-year-old in early perimenopause needs a different plan from a 55-year-old in postmenopause, even with similar symptoms.
Late reproductive
- Late 30s to early 40s
- Cycle still regular but starting to feel different
- Sleep, mood, energy may shift first
- Often dismissed as stress or ageing; the most missed stage
Perimenopause
- Typically 40 to 51
- Cycle becomes unpredictable
- Symptoms intensify The 4 to 10 year transition window
- Hormonal variability is the signature
Menopause
- Average age: 51 to 52 in Australia
- A point in time, note a state
- 12 months without a period
- Hormonal floor reached
Postmenopause
- Long-term phase: the years after
- Hormonal baseline now low and stable
- Bone, cardiovascular, cognitive priorities matter most
- Long term hormonal recalibration matters here
A comprehensive hormonal assessment goes beyond a single oestradiol blood test on the wrong day of your cycle. Testing is matched to your specific picture, and may include oestradiol, progesterone, FSH, LH, SHBG, free and total testosterone, DHEAS, DUTCH testing, full thyroid panel, 4-point urinary hormone testing, fasting glucose/insulin/HbA1c, and bone or inflammatory markers where indicated.
IS MOJO KLINIK RIGHT FOR YOU?
Is this approach right for you?
IT'S A FIT IF
- You are between 35 and 55 with hormonal symptoms that have not been properly investigated
- You have been told your hormones are fine on a single blood test
- You want a doctor who will run a comprehensive panel, not just FSH
- You want to discuss MHT and bioidentical hormones with someone who knows the current AMS guidance
- You prefer not to use hormone therapy and want a non-hormonal plan as well
- You want sleep, mood, weight, and cognitive symptoms taken seriously, not normalised
NOT A FIT IF
- You want a fast script with no investigation
- You want a generic protocol with no testing behind it
- You want us to replace your endocrinologist, gynaecologist, or oncology team
HOW TO START
Two ways to start with us.
You have two booking options with Dr Maria Mackey. The right one depends on whether you want a focused hormone consultation or a deeper big-picture investigation.
OPTION 1
Hormone Assessment with Dr Maria Mackey
- 45 minutes
- $390 in-person
- $410 Zoom
Medicare rebate available for in-person initial consultations
The fast-track. If your concerns are primarily hormonal and you want to move quickly to clarity and a plan. Targeted testing and a personalised plan that may include lifestyle, supplementation, or hormone therapy.
OPTION 2
Mojo New Patient Appointment with Dr Maria Mackey
- 1 Hour
- $490 in-person
- $510 Zoom
Medicare rebate available for in-person initial consultations
The deep dive. If you want a full big-picture investigation, including hormones alongside gut, thyroid, adrenal, fatigue, and other interconnected systems.
For full pricing, see Consultation Fees. Telehealth available Australia-wide for followups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.
FAQ
Frequently Asked Questions.
How much does a perimenopause or menopause consultation cost at Mojo Klinik?
The Hormone Assessment with Dr Maria Mackey is the fast-track: 45 minutes, $390 in-person or $410 by Zoom, with a Medicare rebate available for inperson initial consultations. The deeper option is the Mojo New Patient Appointment: 1 hour, $490 in-person or $510 by Zoom. Functional pathology (DUTCH testing, full thyroid panel, urinary hormone testing) is billed separately by the lab.
"The 45-minute Hormone Assessment is enough for most women whose primary concern is the perimenopausal transition. The Mojo New Patient Appointment is the right call when there are also gut, fatigue, or thyroid issues that need to be looked at alongside the hormones."
80% of women experience significant vasomotor and hormonal symptoms during the
menopausal transition, with severity varying significantly based on individual factors.
Australasian Menopause Society, 2024.
Can I have perimenopause symptoms with a normal hormone test?
Yes, very commonly. Hormones in perimenopause fluctuate dramatically. A single blood test drawn on the wrong day can look entirely normal in a woman with significant symptoms. We assess the full picture, not a single test, including thyroid, adrenal, and metabolic markers.
"Perimenopause is the most underdiagnosed and undertreated transition in women’s health. Symptoms can begin in the late thirties. Most women are told they are too young, or that their hormones look fine on a single blood test drawn on the wrong day."
A 2025 SHAW / Mira Health survey found that 21% of Australian women report being dismissed
by a healthcare provider when raising hormonal concerns.
When does perimenopause start?
For most women, perimenopause begins in the late 30s to mid-40s. The transition typically lasts 4 to 10 years before periods stop entirely. Symptoms can begin years before any change in cycle length.
"The first hormonal shifts often appear five to seven years before periods actually stop. Many women are surprised to learn their symptoms at 42 are already perimenopause. They are not too young. They are right on time."
A 2023 SWAN cohort follow-up published in the Journal of Clinical Endocrinology and Metabolism confirmed that perimenopausal hormonal changes are detectable on average 7 to 8 years before the final menstrual period.
How long until I feel better?
Most patients notice initial improvement within 4 to 8 weeks of starting a
structured plan. Sleep, mood, and energy often respond first. Hot flushes
and weight changes typically take longer, often 3 to 6 months, depending on
the individual picture and the chosen approach.
"I tell patients the first month is foundation. Real change usually shows up between weeks 6 and 12. The work that lasts is done in the first three to six months."
A 2023 patient outcome study in Climacteric found that structured perimenopause programmes produced significant symptom score reduction at 8 weeks that was sustained at 6-month follow-up.
What is the difference between MHT and bioidentical hormones?
MHT (menopausal hormone therapy) is the broader medical category. Bodyidentical hormone therapy refers to forms of MHT structurally identical to the hormones your body produces. We discuss both options in the context of current Australasian Menopause Society guidance, your individual situation, and your medical history. The specific regimen, where any is recommended, is discussed in detail at consultation.
"The bioidentical-versus-MHT framing is often presented as a debate. In current practice the two overlap considerably. The body-identical regimen now recommended in current AMS guidance is first-line for most women without contraindications. We discuss the options and tailor the choice to your specific picture."
The 2023 Australasian Menopause Society (AMS) guidelines set out the current preferred MHT regimen for most women without contraindications. For the AMS’s own patient information on bioidentical and body-identical hormone therapy, see menopause.org.au/hp/informationsheets/bioidentical-hormones-for-menopausal-symptoms. We discuss the AMS position in detail at consultation.
What if I do not want hormone therapy?
Hormone therapy is one option among several. We can build a nonhormonal plan for women who prefer it or for whom MHT is not appropriate. This may include lifestyle, nutritional, supplemental, sleep, stress, and metabolic strategies, with hormonal pathology used to inform the plan rather than as a prescription gateway.
"A meaningful proportion of my patients do not want hormone therapy, or are not suited to it. We have a full toolkit either way. Lifestyle, nutrition, targeted supplementation, and stress work, properly applied and individualised, can do significant clinical work on their own."
A 2024 systematic review in Maturitas documented clinically meaningful symptom
reduction in approximately 55 to 70% of perimenopausal women using structured nonhormonal approaches.
Is integrative care suitable for women or men with a history of serious illness?
This requires individual clinical assessment. We assess carefully when a patient has a personal or family history of serious illness. The treating specialist team continues to manage the underlying condition. Some interventions may be unsuitable, others may need modification. The full picture is reviewed at consultation.
"For women or men with a personal orfamily history of breast cancer, cardiovascular disease, or significant clotting risk, the conversation about hormone therapy is genuinely individualised. We work with your specialist team. We do not prescribe in isolation."
The 2024 update of the AMS position statement on MHT in women with elevated risk profiles
details the contraindications and the situations where careful, individualised approaches
remain appropriate.
AN INVITATION
Ready to be properly investigated?
One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.
WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089
HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement