What is perimenopause and when does it start?
Perimenopause is the transition period before menopause. It is a time of hormonal chaos, when the ovaries produce estrogen and progesterone at fluctuating rates as the overall levels slowly decline. It's often described as "puberty in reverse." It can begin as early as the mid-to-late 30s, typically starts in the 40s and usually lasts 4–10 years before menopause itself. Some of the most common symptoms are period irregularity, hot flushes, sleep disturbance, anxiety, depression, brain fog and joint pain. However, there are around 70 symptoms total, which can be vague and range from mild to severe.
What is the difference between perimenopause, menopause and postmenopause?
Perimenopause is the transitional stage with fluctuating hormones and irregular cycles. Menopause is marked retroactively, after 12 consecutive months without a period, typically around age 51. Postmenopause refers to the years that follow menopause when estrogen and progesterone levels remain low and stable.
Why is treating symptoms associated with perimenopause, menopause and postmenopause important?
Treating symptoms is about more than short-term relief. It supports long-term health, vitality and quality of life. Managing symptoms well can help women stay engaged in the workforce or present in their relationships and daily life. Practically, this can look like better sleep so women can function well during the day, decreased joint pain so women can keep exercising and improved mood for a better overall quality of life. Treating this transition thoughtfully is an investment in one's long-term health and longevity, not just symptom relief.
What is an MSCP provider?
MSCP stands for Menopause Society Certified Practitioner, a credential from The Menopause Society (formerly NAMS) that recognizes clinicians who have demonstrated specialized competency in evidence-based menopause care.
What is shared decision making?
Shared decision making is a collaborative approach where you and your provider work together to choose a care plan, combining medical evidence and your provider's expertise with your personal values, preferences and goals. Rather than being handed a recommendation, you're given the time and information to understand your options and make an informed choice together.
What are Septima's hours and is Heather a solo provider?
Heather is a solo provider, so every visit is with her personally. She aims to be available for appointments most business days, either in person or via telehealth, with the exception of vacation time and holidays. Knowing many of her prospective patients have busy schedules, she plans to offer some early-start and late-ending clinic days. Check when Heather is available for appointments.
What's included with my visit?
Every visit at Septima is designed to support you well beyond the appointment itself. You'll receive 20 free follow-up messages with Heather so you have a way to ask clarifying questions or share updates as you navigate your care. You'll also get one month of free access to Septima's educational library, including instructional strength-training videos created by Alison Marra and a full library of information about the menopause transition. Care doesn't end when the appointment does. Septima is built for patients to feel genuinely supported throughout their journey.
Why is strength training instruction included?
One in two women over the age of 50 will suffer an osteoporosis-related fracture in their lifetime. The majority of hip fractures occur in women. Hip and spine fractures can be genuinely debilitating, affecting mobility and independence. Learning how to strength train safely and appropriately is one of the most effective, evidence-based ways to help protect bone health during and after the menopause transition. Heather is passionate about making sure patients receive proper education on strength training technique and Septima also maintains a referral list of personal trainers and exercise programs for patients who want additional hands-on support.
How many visits does it usually take to feel like my symptoms are managed?
Every patient's journey is different. Most patients find their needs are fully met with an initial intake visit plus 2–4 follow-up visits spaced roughly 4–8 weeks apart. This gives enough time to see how your body responds to a treatment plan. Adjustments will be made along the way and your 20 free follow-up messages are available in between visits for anything that comes up.
Do you see patients outside of Washington state?
Septima is only able to see patients who are physical residents of Washington state, in keeping with state licensure requirements. The practice is located in Seattle, but telehealth visits are available to patients located anywhere within Washington state, not just the Seattle area. Learn more about telehealth across Washington.
Does Septima accept insurance?
Septima is a direct-pay practice. Operating outside of insurance allows Heather to give every patient the appropriate time and care their visit deserves. Patients pay directly for visits rather than billing insurance. Visits are HSA/FSA eligible and a detailed superbill is provided at patient request for those who wish to seek reimbursement from their insurer.
Can Physician Associates (PAs) prescribe medication?
Yes. Physician Associates are licensed to diagnose, treat and prescribe medication, working in collaboration with a physician. Heather is able to prescribe the full range of treatment options discussed at Septima including menopause hormone therapy (MHT), non-hormonal medications for symptom relief and treatment for related concerns such as vaginitis and urinary tract infections along with anything else that comes up in your care.
Septima Social
You're supported every step of the way. Septima hosts recurring gatherings blending community and education, held four times per year. Enjoy mingling over food, followed by a talk from an expert speaker — a chance to learn something real, ask questions and connect with other women in the same season of life.
Our first gathering is coming in Fall 2026. Details to follow.
Follow along on Instagram @septimahealth for updates as each session is confirmed.