Most women feel dismissed for years before getting answers. This tool exists so that doesn't happen here. Your check-ins become your data — and your data drives every decision we make about your treatment.
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Log Today
A 2-minute check-in. Your name and date of birth are pre-filled. Submit and come back — we save everything.
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My Trends
Your symptom trends charted over time. See what's improving, what's holding steady, and what needs attention.
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What to Expect
Where you are in treatment, what's normal, what to watch for — and the bigger picture for your heart, bones, brain, libido, and sexual health. The teaching most clinics don't have time for.
Personalized timeline
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My Medications
On estrogen, testosterone, or both? Log and track each separately — side effects monitored, benefits charted.
Estrogen + Testosterone
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EstrogenOnly
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BothEstrogen + Testosterone
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TestosteroneOnly
Your #1 priority
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For emergencies or urgent issues, go to the emergency room or urgent care. This tracker is for routine clinical check-ins — it isn't monitored in real time.
It's been a while. Your last check-in was days ago. Regular logging helps us spot trends — even when symptoms feel the same.
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My Trends
Your trends over time.
Lines moving down means symptoms are improving — Severe is at the top, None is at the bottom.
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Log your first check-in in the Today tab. Your trends will appear here after a few check-ins.
All symptoms
Overall trend over time
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Start here on your first visit.
This is where you'll learn what's normal at every stage of your treatment, what to watch for, and what to expect from your symptoms over time. Your check-ins start to make a lot more sense once you've spent a few minutes here.
What to Expect
Your treatment journey.
Every woman responds differently. These are general guides — not deadlines. Tracking helps us tell the difference between "this needs more time" and "this needs adjustment."
🌸Estrogen — your journey
What to expect right now
Response window
Where are you in your current dose?
Enter the date you started your most recent estrogen dose or dose change. We'll show you exactly what to expect right now — and which symptoms are still in their response window.
Leave blank if unchanged from your treatment start date.
We've pre-filled your treatment start date. If you've had a dose change since then, update it here and press Update.
Week 1–2
Too early to tell
Feeling nothing yet is common. This doesn't mean it isn't working.
Week 3–4
First signals
Earliest window where we may consider adjusting, depending on tracking.
Week 5–6+
Full effect window
Clearer trends emerge — improvement, stability, or a signal to adjust.
At 2 weeks, it's completely normal to feel nothing yet. Tracking helps us decide whether it's time to reassess — or just too early.
Symptom by symptom
What improves when — estrogen.
Symptoms don't all respond on the same schedule. These are typical timeframes — and once you enter your dose-change date above, we'll show you where each one stands right now.
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Hot flashes & night sweats
Often 1–3 weeks · Full benefit 6–8 weeks
Many people notice change early, but it may take longer to feel steady relief.
Right now:Enter your dose-change date above
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Sleep
Up to ~6 weeks
Sleep is often the first symptom to respond. Many patients notice improvement by week 3.
Right now:Enter your dose-change date above
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Mood & anxiety
Often 2–4 months
This tends to be a slower, steadier improvement — not an overnight change.
Right now:Enter your dose-change date above
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Brain fog & focus
Often ~3–4 months
Mental clarity often improves after sleep improves and hormone levels stabilize.
Right now:Enter your dose-change date above
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Vaginal dryness & discomfort
Often 8–12 weeks · Sometimes longer
Tissues heal over time — this one is usually gradual. Vaginal estrogen works locally and faster — see the section below.
Right now:Enter your dose-change date above
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Libido & sexual desire
Can take up to ~6 months
This is often the slowest to shift. Estrogen alone may help — many women also benefit from adding testosterone for desire.
Right now:Enter your dose-change date above
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Joint pain
Often 4–8 weeks
Estrogen has anti-inflammatory effects. Joint comfort often improves as systemic levels stabilize.
Right now:Enter your dose-change date above
Worth a conversation
Have you considered adding testosterone?
You've done everything right with estrogen. Some symptoms — desire, mental clarity, motivation, vitality — just don't fully respond to estrogen alone. That's biology, not failure.
Testosterone is a foundational female hormone (not a "libido drug"), produced naturally throughout life and declining through perimenopause. Adding physiologic doses often closes the gap that estrogen alone leaves open.
If you're still feeling flat, foggy, or low-libido six weeks or more into your current estrogen dose, it's worth discussing.
If you have a uterus, you take progesterone alongside estrogen — it protects the uterine lining. It also has its own benefits and its own settling-in profile, separate from estrogen.
What progesterone often helps: sleep onset and depth (especially when taken at night), nervous-system calm, anxiety, and mood stability.
What's normal in the first 4–6 weeks: some grogginess in the morning if dosed too early, mild breast tenderness, occasional bloating. These usually settle. If they don't, we adjust.
If you feel sedated or "hung over" the morning after, message us — timing or formulation can be tuned.
Vaginal dryness, UTIs & tissue health
Vaginal estrogen is its own conversation.
Vaginal dryness, painful sex, urinary urgency, and recurrent UTIs are all part of genitourinary syndrome of menopause (GSM) — and they often need direct, local treatment in addition to systemic estrogen.
Vaginal estrogen is separate from systemic. It's applied locally as a cream, tablet, or ring. Absorption into the bloodstream is minimal-to-none, which means:
You can use it even if you're already on transdermal estrogen
It's generally considered safe for women with breast cancer history (with their oncologist's input)
It works locally and gradually — most women notice improvement over 4–8 weeks of consistent use
Recurrent UTIs are often a tell that GSM is undertreated. Vaginal estrogen has been shown to dramatically reduce UTI recurrence in postmenopausal women.
If any of this applies to you and isn't on your plan, message us.
Sexual health, libido & desire
Why this section exists
Hormones help. They don't do it alone.
Sexual changes in midlife — comfort, desire, arousal, orgasm — are medical issues, not personal failures. Hormones are one piece. Sleep, stress, mental load, partnership, context, and how desire actually works at this stage all matter too.
This applies whether you're partnered, single, or somewhere in between.
Three legs of the stool
Sexual desire is biopsychosocial.
In sexual medicine, desire is described as biopsychosocial — shaped by three connected factors. When one leg is shorter, desire feels unsteady. Hormone therapy supports the biology leg. The other two often need attention too.
Stress, mental load, mood, body image, past experiences.
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Context
Connection, communication, time, privacy, the realities of midlife.
Does this sound familiar?
What you might be noticing.
These changes are common in midlife — and treatable, even if you've been dismissed before.
Comfort changes
Dryness, irritation, or burning
Pain or discomfort with intimacy
Urinary irritation or recurrent UTIs
Feeling "off" or easily inflamed
Desire & response changes
Lower interest in sex
Slower or harder arousal
Orgasms weaker or harder to reach
Sex no longer feeling like it used to
You don't have to bring it up perfectly. We ask about sexual health routinely — because it matters medically.
Important — don't push through pain
Painful sex isn't something to power through.
Pain creates pelvic floor guarding. Guarding creates more pain. Pain suppresses arousal — which creates more pain. Patients who push through often make the underlying problem worse without knowing.
If sex hurts: address it early. Vaginal estrogen, lubrication, pelvic floor physical therapy, slower lead-in — there are usually several effective steps before pain becomes the default.
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Why desire feels different now
The shift from spontaneous to responsive desire
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Most women are taught about spontaneous desire — the kind that arrives uninvited and drives action. That's the dominant pattern in your 20s and into your 30s.
By midlife, most women shift toward responsive desire — desire that builds after engagement begins, not before.
This isn't a failure or a loss. It's a normal shift. But if you're still waiting for spontaneous desire to show up first, you'll wait a long time — and feel "broken" while you wait.
Once you understand the shift, the strategies further down start making sense.
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What hormones can and can't do
Realistic expectations
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What hormones can do:
Estrogen restores blood flow, tissue sensitivity, and arousal response. If your body can't respond physically, desire has nowhere to go.
Testosterone supports interest, mental "spark," and feeling engaged.
Optimized hormones improve sleep, mood, and energy — which create the capacity for desire to exist.
What hormones can't do:
Create instant or spontaneous desire on demand
Override stress, exhaustion, "touched out," or disconnection
Replace the lead-in your brain now needs
Make you 25 again — this is a different phase, not a broken one
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What to actually do
Practical strategies that work with your physiology
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1. Schedule intimacy. Not unromantic — realistic. Pick a day or time when you're not exhausted. Removes the "should we or shouldn't we" mental load. Gives your brain time to anticipate.
2. Decide you're open before you feel it. Instead of waiting for desire, ask: "Am I open to this?" That shift alone matters.
3. Create a lead-in. Flirting earlier in the day, non-sexual touch, a shower, changing clothes, resetting your environment. You're transitioning your brain — not flipping a switch.
4. Reduce friction. Vaginal estrogen, lubricant, address pain early, choose times when you have energy — not at the end of an exhausting day.
5. Focus on starting, not finishing. You don't need to feel desire to begin. Most women notice desire shows up after things start.
6. Lower the pressure. Not every experience needs to be perfect, intense, or exactly like it used to be. Lower pressure → better response.
Worth flagging
Some medications quietly suppress desire.
A handful of common medications can dampen desire, arousal, or both — and most patients have never been told this:
SSRIs and SNRIs (most antidepressants)
Hormonal birth control — especially low-androgen pills
Some beta blockers
Spironolactone
Sedating antihistamines
Not a reason to stop anything on your own — but worth flagging at your next visit. Sometimes a small change here makes a meaningful difference.
When sex therapy can help
The other two legs of the stool.
Sex therapy isn't couples counseling for "broken" relationships. It's specialized care for desire, arousal, communication, and intimacy concerns — the psychology and context legs that hormones can't reach directly.
We collaborate with Laurie Bonura at Connections Psychotherapy & Wellness. She specializes in sex therapy and works with individuals and couples.
Not sure whether this would be a fit? Message us — we're happy to talk through it before you reach out.
If desire, arousal, or comfort have changed and you want a clinical conversation, message us through the patient portal. This is part of your medical care — not a side issue.
The long-term picture
Beyond symptom relief.
Some benefits aren't "feel it today" benefits — they're "protect over time" benefits. Starting estradiol before age 60 or within 10 years of menopause is when the evidence for protection is strongest. The numbers below are absolute risk reductions per 1,000 women over 5 years — the most honest way to read the data.
You're on transdermal estradiol with body-identical progesterone — the formulation with the strongest safety and efficacy profile in the literature.
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All-cause mortality
Lower risk of dying from any cause when started early
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"All-cause mortality" simply means death from any cause. Studies consistently show lower all-cause mortality in women who start hormone therapy within 10 years of menopause.
Women aged 50–59
2.5
fewer deaths per 1,000 women who initiate body-identical estradiol with progesterone within 10 years of menopause.
Women aged 60–69
6.5
fewer deaths per 1,000 women on body-identical estrogen plus progesterone — even when started more than 10 years after menopause.
Body-identical estradiol with body-identical progesterone has a stronger cardiovascular safety profile than older oral/synthetic combinations, which translates to mortality benefits seen across age groups.
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Heart health
Fewer heart attacks and cardiac deaths when started within the timing window
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The "timing hypothesis" is now well-established: hormone therapy initiated before age 60 or within 10 years of menopause is associated with substantial cardiovascular protection. Initiated later, the protection is less pronounced (and risk profile differs).
Women aged 50–59
4
fewer cases of coronary heart disease (cardiovascular death or heart attack) per 1,000 women starting HRT within 10 years of menopause.
Women aged 60–69
9
fewer deaths per 1,000 women on body-identical estradiol — even when initiated more than 10 years after menopause.
For context, statins have not been shown to prevent coronary heart disease or reduce all-cause mortality when used for primary prevention in women.
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Bone health
Fewer fractures, stronger bones — measurable on DEXA
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Estrogen plays a direct role in bone density. Hormone therapy is one of the most effective treatments for preventing postmenopausal osteoporosis — and the benefits build quietly over time, whether you feel them or not.
Women aged 50–59
7
fewer fractures per 1,000 women aged 50–59 who use HRT.
Women aged 60–69
5
fewer fractures per 1,000 women aged 60–69 on HRT.
Transdermal estradiol increases bone density at the spine and hip, and the protective effect generally continues throughout treatment.
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Brain health & dementia
Lower Alzheimer's risk when timing is right
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Dementia is the leading cause of death in women in many high-income countries. Earlier and longer estrogen exposure is associated with lower Alzheimer's risk in multiple large studies.
Women starting HRT within 10 years of menopause
14.5
fewer cases of dementia per 1,000 women who start estrogen-only HRT within 10 years of menopause.
10
fewer cases per 1,000 women who start combined HRT (estrogen plus progestogen) within 10 years of menopause.
In the only study to date examining body-identical hormones specifically, formulations containing 17β-estradiol with progesterone were associated with greater reductions in neurodegenerative disease risk than older formulations. Evidence also suggests dementia risk is lower in women who use HRT for more than 10 years.
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Diabetes & metabolic health
Fewer new diabetes diagnoses; better glycemic control
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Globally, 15% of women aged 50–59 and 20% of women aged 60–69 have diabetes. Hormone therapy reduces both the risk of developing diabetes and improves glycemic control in women who already have it.
Women aged 50–59
4.5
fewer cases per 1,000 women aged 50–59 who take HRT.
Women aged 60–69
6
fewer cases per 1,000 women aged 60–69 on HRT.
Longer use appears to amplify the effect — one observational study found a 69% reduction in new-onset diabetes in women aged 52–62 who used HRT for 2.5 to 5 years. HRT also improves insulin sensitivity and reduces HbA1c in women with established diabetes.
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Genitourinary & sexual health
Tissue restoration, fewer UTIs, better function
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Estrogen restores vaginal tissue elasticity, lubrication, and pH — and protects bladder function over time. Vaginal estrogen used alongside systemic therapy dramatically reduces recurrent UTIs in postmenopausal women.
For sexual function specifically, estrogen addresses comfort and tissue health. Desire and arousal often involve testosterone — many women benefit from both working together.
Also emerging: mounting evidence suggests HRT may protect against Parkinson's disease, osteoarthritis, lung cancer, and colorectal cancer. The benefits above are those with the strongest evidence base today.
Understanding the risks
Honest numbers, in context.
The risk numbers most patients worry about come from older studies of oral estrogen with synthetic progestogens — formulations we don't use here. The data for transdermal estradiol with body-identical progesterone (what you're on) tells a different story.
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Breast cancer
Different formulations, very different numbers
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Background rate: about 23 cases of breast cancer per 1,000 women aged 50–59 over 5 years (women not on any HRT).
no evidence of increased risk in women aged 50–59 or 60–69 using transdermal estrogen with or without body-identical progesterone.
Why the difference: oral estrogen passes through the liver, where it triggers clotting-factor production. Transdermal bypasses the liver entirely. This is one of the clearest reasons we prescribe the way we do.
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Stroke
No signal under 60 with HRT, transdermal favored at any age
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Background rate: 4 strokes per 1,000 women aged 50–59 per year (9 per 1,000 for ages 60–69).
Women under 60 starting HRT within 10 years of menopause
0
no additional cases across all HRT types studied. Stroke risk in this age group is largely tied to clotting risk — and transdermal carries no clotting signal.
Women 60–69 on transdermal estradiol +/− progesterone
0
no additional cases per 1,000 women.
The stroke risk seen in some studies of older women on oral hormone therapy doesn't apply to transdermal. Body-identical progesterone is the safest progestogen here too.
What helps your hormones work best
Hormones don't work in a vacuum.
The patients who get the most out of treatment are the ones doing these alongside it. None of these are bypasses for the rest of the work — and none of the rest of the work is a bypass for hormones.
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Sleep
7–9 hours, consistent schedule. This is when your brain consolidates hormone benefits.
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Protein
Aim for ~1g per pound of goal weight. Hormones build on the raw materials you give them.
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Strength training
2–3× per week. Resistance training amplifies bone, body comp, and mood benefits.
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Stress & nervous system
Chronic stress steals from your sex hormones. Breathwork, walks, time outdoors.
⚡Testosterone — your journey
What to expect right now
Response window
Where are you in your testosterone treatment?
Testosterone works slowly in women. Most benefits unfold between 3 and 6 months. Tell us when you started — we'll show you what to expect right now.
Leave blank if unchanged from your treatment start date.
Patience pays. The biggest changes typically come between 3 and 6 months. The 8-week labs aren't a verdict — they're a calibration check.
Symptom by symptom
What improves when — testosterone.
Testosterone is patient. Most changes are gradual — first mental, then physical. Here's where you may be.
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Mental clarity & focus
Subtle by ~8 weeks · Full 3–6 months
Often the first thing women notice — quieter mind, sharper focus, less of the "fog" feeling.
Right now:Enter your testosterone start date above
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Libido & desire
3–12 months
Desire typically returns gradually. Arousal and orgasm response often improve alongside it.
Right now:Enter your testosterone start date above
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Mood & motivation
2–4 months
A subtle lift first — more drive, more presence, less of that "flat" feeling.
Right now:Enter your testosterone start date above
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Energy & stamina
3–4 months
Workouts feel easier. Recovery improves. Afternoon crashes often soften.
Right now:Enter your testosterone start date above
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Strength & body composition
6–12 months
Lean mass improves with consistent strength training. Body composition shifts are slow and worthwhile.
Right now:Enter your testosterone start date above
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Bone density
12+ months
Testosterone supports bone alongside estrogen — a long-game benefit measured on DEXA, not in the mirror.
Right now:Enter your testosterone start date above
Why testosterone matters
Not a "libido drug" — a foundational hormone.
Testosterone is produced by the ovaries and adrenal glands throughout life and declines through perimenopause. The receptors are everywhere — brain, bone, muscle, cardiovascular system, vulvar tissue — which is why its effects are systemic, not just sexual.
The strongest evidence base: sexual desire, arousal, orgasm, and overall sexual satisfaction in postmenopausal women. The 2019 Global Consensus Position Statement formally endorses testosterone for hypoactive sexual desire disorder in postmenopausal women.
Other well-supported benefits: verbal memory and executive function, mood and motivation, lean mass and bone density, energy and exercise capacity. Many women describe testosterone as the hormone that "brought me back."
Patience pays. Most women feel the biggest changes between 3 and 6 months. The 8-week lab check confirms therapeutic levels — it's calibration, not verdict.
Side effects to know about
What's normal vs. what to flag.
Common & usually mild:
Mild acne — often early, often resolves
Slight increase in fine facial or body hair
Oilier skin
Subtle change in sweat or body odor
Feeling more energized or restless
Message us if you notice:
Significant or worsening acne
Marked increase in dark, coarse hair
Voice changes (rare with proper dosing)
Clitoral changes that feel uncomfortable
New irritability, sleep disruption, or mood changes
Most side effects are dose-related and adjustable. Tracking is how we tell the difference between "settling in" and "needs adjustment."
Evidence & references›
The benefit and risk numbers above are drawn from peer-reviewed research and major systematic reviews. Selected references:
Boardman HM et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015;(3):CD002229.
Mikkola TS et al. Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause. 2015;22(9):976-83.
Hodis HN, Mack WJ. Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease. Cancer J. 2022;28(3):208-223.
Mueck AO. Postmenopausal hormone replacement therapy and cardiovascular disease: the value of transdermal estradiol and micronized progesterone. Climacteric. 2012;15 Suppl 1:11-7.
Salpeter SR et al. Effect of hormone-replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes Obes Metab. 2006;8(5):538-54.
Mauvais-Jarvis F et al. Menopausal Hormone Therapy and Type 2 Diabetes Prevention. Endocr Rev. 2017;38(3):173-188.
Manson JE et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the WHI. JAMA. 2013;310(13):1353-68.
Zhu L et al. Effect of hormone therapy on the risk of bone fractures: meta-analysis. Menopause. 2016;23(4):461-70.
Nerattini M et al. Systematic review and meta-analysis of menopause hormone therapy on Alzheimer's and dementia risk. Front Aging Neurosci. 2023;15:1260427.
Kim YJ et al. Association between menopausal hormone therapy and risk of neurodegenerative diseases. Alzheimers Dement. 2021;7(1):e12174.
Fournier A et al. Unequal risks for breast cancer associated with different hormone replacement therapies (E3N cohort). Breast Cancer Res Treat. 2008;107(1):103-11.
Abenhaim HA et al. Menopausal Hormone Therapy Formulation and Breast Cancer Risk. Obstet Gynecol. 2022;139(6):1103-1110.
Canonico M et al. Hormone replacement therapy and risk of venous thromboembolism: meta-analysis. BMJ. 2008;336(7655):1227-31.
Scarabin PY. Progestogens and venous thromboembolism in menopausal women: oral vs. transdermal estrogen meta-analysis. Climacteric. 2018;21(4):341-345.
Davis SR et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660-4666.
Newer body-identical formulations (transdermal 17β-estradiol with micronized progesterone) have a more favorable safety profile in observational data than older oral/synthetic combinations. Long-term randomized trials specifically of body-identical hormones are still accumulating.
For emergencies or urgent issues, go to the emergency room or urgent care. For non-urgent clinical questions — dose adjustments, lingering symptoms, side effect questions — message us through the patient portal.
Built by Crystal Burke, FNP-C, MSCP and Steven Youngblood, MD — The Menopause Clinic, New Orleans.
My Medications
Log & track your treatment.
Your check-ins are logged separately for each medication so your provider can see what's working and catch anything that needs attention.
Estrogen
Symptom Check-in
How are your estrogen symptoms?
Hot flashes, sleep, mood, brain fog, energy — takes about 2 minutes. Your info is pre-filled.