Your Starting Plan

A reference you can return to anytime — nothing here needs memorizing. Your exact doses are in your welcome message, and we'll adjust them together based on how you feel.

Your medications

Use both every day, even before you feel a difference. Please don't stop or change either one on your own — message me first and we'll adjust the plan together.

Estradiol gel

The estrogen portion of your treatment

Absorbed through your skin, it helps stabilize the estrogen fluctuations that can drive sleep disruption, fatigue, memory and concentration changes, and low libido.

  1. Apply one full packet to your upper inner thigh once daily.
  2. Morning or evening — pick the time you're most likely to remember.
  3. Alternate between your right and left thighs.
  4. Let it dry before dressing — usually under five minutes.
  5. Wash your hands after applying.
  6. Avoid skin contact with another person or pet at the application site for at least one hour.
If you miss a dose

Resume your normal dose the next day. Do not double the dose.

Common early side effects

Breast tenderness, mild bloating, light spotting, or breakthrough bleeding. These often improve as your body adjusts. If they're bothersome or haven't settled after a few weeks, message me.

Read more: patient guide · application instructions

Norethindrone acetate

The progestin portion of your treatment

It protects your uterine lining while you use estrogen and may help control bleeding. It's the same medication that was in your birth-control pill — the progestin portion.

  1. Take your prescribed dose by mouth once daily — for most starting plans, one-half of a 5 mg tablet.
  2. Take it at approximately the same time each day, with or without food.
  3. Continue it every day while using estradiol unless I give you different instructions.
If you miss a dose

Resume your normal dose the next day. Do not double the dose.

Changes in your bleeding

Your bleeding pattern may change after stopping your birth-control pill and beginning this plan. You may remain without periods, or you may have spotting or bleeding while your body adjusts. Message me if bleeding is heavier than light spotting, or if it returns after you've gone a significant time without it.

Read more: norethindrone patient guide

What to expect

It's completely normal to feel little or no change during the first two to three weeks. That doesn't mean the medication isn't working — it can take up to six weeks to feel the full effect of any estradiol dose.

  • Weeks 1–2

    Your body is adjusting. You may not notice a difference yet.

  • Weeks 3–6

    Early changes may become noticeable — particularly in sleep, mood, or temperature regulation.

  • Months 3–6

    This is when many women experience their fullest overall improvement.

Your starting dose is only a starting point. We adjust based primarily on your symptoms and side effects — not on one hormone level — and our goal is at least 80% improvement in the symptoms that matter most to you.

Read more: your first month · finding your dose

Your follow-up

Your symptom tracker is your routine follow-up — there's no separate appointment you need to wait for, although you can book a visit at any time. We'll text you in approximately four weeks as a reminder to log how you're feeling.

At about three weeks, we'll review together: sleep and nighttime waking, energy, libido, memory and concentration, bleeding, and any side effects like breast tenderness or bloating. Depending on your response, we may continue the same doses, increase estradiol if there's no meaningful improvement and no limiting side effects, or allow more time at the current dose if you're beginning to improve.

Later, if sleep remains a concern, we can discuss whether micronized progesterone may help. If low libido, fatigue, or cognitive symptoms remain after we optimize your estrogen treatment, we can then discuss whether testosterone evaluation is appropriate.

When to message me

Message me through the portal anytime — I review messages Monday–Friday, 9:00 AM–5:00 PM. Please reach out if:

  • Side effects are bothersome or haven't settled after a few weeks;
  • Bleeding is heavier than light spotting;
  • Bleeding returns after you've gone a significant time without it;
  • Your mood changes in a way that concerns you;
  • You're considering stopping either medication; or
  • Something just doesn't feel right.

If you'd rather talk it through, schedule a visit through the Member Hub. For billing or scheduling, email info@menopauselouisiana.com.

We'll take this one step at a time and adjust the plan based on how you feel. I'm really glad you're here.

Crystal Burke, FNP-C, MSCP
The Menopause Clinic
Monday–Friday | 9:00 AM–5:00 PM