Hot flashes, sleepless nights, brain fog, mood changes: let's face it, menopause can touch every part of life, and you can barely scratch the surface in your typical ten minute visit. Dr. Trang Eng is a board-certified internist, offering evidence-based perimenopause and menopause care for women in Arcadia, Pasadena, and across the San Gabriel Valley, with time to get it right.
Menopause gets surprisingly little time in most medical training, and many women leave appointments without answers. At Pastera, perimenopause and menopause care is a core focus of the practice, not an afterthought.
Dr. Eng follows current, evidence-based guidance on hormone and non-hormonal treatment, bone and heart health, and sexual health, and tailors care to each person's history, risks, and goals. As an internist, Dr. Eng also looks at how menopause connects to the rest of your health.
Menopause isn't a single moment. It's a transition that often unfolds over several years, and care looks different at each stage.
The transition before your final period, often beginning in your 40s and sometimes lasting several years. Hormone levels fluctuate, cycles become irregular, and symptoms like hot flashes, sleep changes, and mood shifts can start, even while you still have periods.
Menopause is confirmed after 12 months in a row without a period, not caused by something else. In the United States, the average age is about 51. Menopause can also happen earlier, or suddenly after surgery or some cancer treatments.
The years that follow. Hot flashes often ease with time but can persist for years. Long-term priorities come into focus: bone strength, heart and metabolic health, and vaginal and urinary health.
Many symptoms are easy to dismiss or blame on stress. Tap any you're experiencing to build a list you can bring to your first visit. Your selections stay on your device and are never sent anywhere.
Don't wait on these: any vaginal bleeding after menopause, very heavy bleeding, chest pain, or thoughts of harming yourself should be checked promptly. Call your doctor, or 911 in an emergency. These symptoms aren't "just menopause."
Menopause care at Pastera goes beyond hot flashes. Dr. Eng looks at the whole picture, from how you're sleeping to your heart and bone health for decades ahead.
A detailed look at your symptoms, cycle history, medical and family history, medications, and goals. For most women over 45, perimenopause and menopause are diagnosed from symptoms and history, so hormone blood tests often aren't needed. Labs are used when they help, such as checking thyroid function or ruling out other causes.
When it's a good fit, hormone therapy is the most effective treatment for hot flashes and night sweats, and it helps protect bone. Dr. Eng will walk you through your personal benefits and risks, the options, and the dose, then adjust as you go.
If hormones aren't right for you, or you'd rather not take them, there are effective options: newer prescription medications that target the brain's temperature-control center, certain low-dose antidepressants, and other medications, plus cognitive behavioral therapy (CBT).
Dryness, irritation, pain with sex, urgency, and recurrent UTIs are part of the genitourinary syndrome of menopause. Unlike hot flashes, these symptoms usually don't improve on their own, but they respond well to treatment, including low-dose vaginal estrogen, moisturizers, and pelvic floor therapy.
Low desire and discomfort are common and treatable. We'll talk openly, without rushing, about physical, hormonal, and relationship factors, and about options that may help.
The menopause transition is a time of higher risk for depression, anxiety, and sleep disruption. We screen carefully, treat what's driving the symptoms, and coordinate with therapists when that helps. Brain fog is common, and for most women it improves.
Bone loss speeds up in the years around menopause. We assess your fracture risk, arrange bone density (DEXA) screening when it's recommended, and build a plan for strength training, calcium, vitamin D, and medication if needed.
Cholesterol, blood pressure, and blood sugar often rise after menopause, and heart disease is the leading cause of death in women. As an internist, Dr. Eng monitors these closely, with wholesale-priced labs.
Shifting hormones change where the body stores fat and how it builds muscle. We'll create a realistic plan for nutrition, strength, and metabolic health, and discuss medical weight-management options when appropriate.
Heavy or unpredictable bleeding in perimenopause deserves evaluation. Pregnancy is still possible until menopause is confirmed, so we'll also talk through contraception that fits this stage of life.
Menopause before 45, premature ovarian insufficiency before 40, and menopause after surgery or cancer treatment need special attention, including how long to continue treatment to protect long-term health.
A history of breast cancer, blood clots, migraines, or heart disease changes the options, but you still deserve relief. Dr. Eng tailors treatment to your history and coordinates with your oncologist, gynecologist, or cardiologist.
Much of what people believe about hormone therapy comes from headlines in the early 2000s. Research and expert guidance have come a long way since then. You deserve a clear, personal conversation instead of fear or hype.
For many healthy women who are under 60, or within 10 years of their last period, current guidance from The Menopause Society finds that the benefits of hormone therapy for bothersome hot flashes and night sweats, and for preventing bone loss, generally outweigh the risks. It isn't right for everyone. A history of certain cancers, blood clots, stroke, heart disease, or liver disease may point to other options. The right answer depends on your age, timing, health history, and preferences.
Several FDA-approved hormone products, such as estradiol and micronized progesterone, are bioidentical: chemically identical to the hormones your body makes. Custom-compounded hormone mixtures, often marketed as more natural, aren't regulated the same way for dose consistency or safety. For most patients, The Menopause Society recommends FDA-approved options, and we'll explain why.
There's no single cutoff. Many women use hormone therapy for years. We'll reassess your benefits and risks together at least once a year, and adjust the dose or stop gradually when the time is right for you.
Getting menopause treatment right usually takes a real conversation and a few adjustments. That's hard to do in a ten minute insurance visit every 2-3 months, and it's exactly what a membership practice is built for.
Time to cover every symptom, including the ones that are awkward to bring up.
Message Dr. Eng as you start or change treatment, instead of waiting months for a follow-up.
Many common menopause medications and labs are available at wholesale prices.
Your menopause doctor is also your primary care doctor: one physician who sees the full picture.
A clear, collaborative process, with no pressure toward any one treatment. Like every Pastera membership, it begins with a three-month commitment, which gives us time to find what works for you.
Bring your symptom list (the checklist above helps), your cycle history, and your current medications and supplements.
We'll go over your symptoms, your personal and family history, and your risk factors for heart disease, blood clots, breast cancer, and osteoporosis.
Labs or a bone density referral when they'll change your care, at wholesale prices.
Hormonal, non-hormonal, and lifestyle options, with honest pros and cons, so you can decide together with Dr. Eng.
Over your first three months, we check in, track how you're responding, and adjust until you feel like yourself again.
Pastera Direct Primary Care in Arcadia offers menopause care with Trang Eng, MD, a board-certified internist. Patients come from Arcadia, Pasadena, Monrovia, Sierra Madre, Temple City, San Gabriel, San Marino, and across the San Gabriel Valley, and virtual visits are available for patients in California.
Usually not. Hormone levels swing widely during perimenopause, so a single blood test often can't confirm it. For women over 45, the diagnosis is typically based on symptoms and cycle changes. Tests are helpful in some situations, such as symptoms at a younger age or to rule out thyroid problems.
Whenever symptoms affect your sleep, work, relationships, or quality of life, which is often earlier than women expect, sometimes in their early 40s. Any bleeding after menopause, or unusually heavy bleeding, should be checked promptly.
Yes. Perimenopause is often when symptoms are most unpredictable, and treatment options such as low-dose hormones, certain birth control methods, and non-hormonal medications can help.
Yes. Systemic hormone therapy is generally avoided after breast cancer, but effective non-hormonal treatments are available for hot flashes, sleep, and mood, and vaginal symptoms can often be treated too. Dr. Eng coordinates closely with your oncology team.
Many menopause visits and follow-ups can be done by secure video for patients located in California. Some care, such as a pelvic exam, requires an in-person visit in Arcadia.
Far fewer than a typical doctor. A traditional primary care physician is often responsible for 2,000 to 3,000 patients just to cover administrative overhead, resulting in 10-minute visits and weeks-long booking delays.
Pastera intentionally caps membership at roughly 10% of that.
A smaller practice is what makes unhurried visits, prompt access, and direct messaging with Dr. Eng possible. It also means Dr. Eng knows your history without scrolling through a chart. When the practice reaches capacity, new patients join a waitlist.
Menopause care is included in your Pastera membership, with no separate visit fees: $125/month for adults 18–64 and $150/month for 65+, plus a one-time $100 enrollment fee. The first 25 founding members pay $99/month. Labs and medications are available at wholesale prices. Like every Pastera membership, it begins with a three-month initial commitment. See membership details.
Most menopause treatments, hormonal and non-hormonal, take several weeks to show their full effect, and finding the right option, dose, or combination often takes a few adjustments. All Pastera memberships begin with a three-month commitment because we're built for long-term relationships, not one-off visits. For menopause care, that time lets us evaluate, fine-tune, and follow up properly, so you get real results rather than a single visit and a prescription.
Prescriptions can be filled at your usual pharmacy using your insurance, or through our wholesale pricing, whichever costs less. Many generic menopause medications are inexpensive at wholesale prices.
In person in Arcadia · virtual visits throughout California
Medically reviewed by Trang Eng, MD · Updated September 2026. This page is for general education and isn't a substitute for personal medical advice.
Unhurried, evidence-based menopause care from a board-certified internist.