Menopause, perimenopause, PMDD & PCOS care · Washington, DC
Your labs came back “normal.” You still don’t feel like yourself.
You’re not imagining it. Erin Sengel is a board-certified nurse practitioner who focuses on hormones and midlife health. Her first visit is 90 minutes, built around labs ordered for you, and it ends with a written plan.
In person in Dupont Circle, or by telehealth for DC and Virginia residents.
- FNP-BCBoard-certified family nurse practitioner
- 15+ yearsClinical experience
- Menopause-trainedListed in the AAWHM national clinician directory
- DipACLMDiplomate, American Board of Lifestyle Medicine
- Obesity medicineCertificate of Advanced Education
Why you may still be looking for answers
“It’s just stress.” “It’s just getting older.” “Your labs look fine.”
Most clinicians get very little training in menopause and hormone health. So a lot of women in their late 30s, 40s and 50s are sent home with a normal lab report and the same symptoms they walked in with.
Hormones in perimenopause don’t decline in a straight line
Estrogen can spike and crash from month to month while progesterone falls first. A single blood test can look normal on the day it’s drawn. That’s why perimenopause is diagnosed mainly from your symptoms and history.
No symptom happens on its own
Poor sleep, weight around your middle, mood changes and brain fog are often connected. Looking at them one at a time, in a 15-minute visit, is how the pattern gets missed.
Labs are a tool, not the verdict
Erin uses labs to rule out other causes, check your thyroid and cardiometabolic health, and make sure any treatment is safe for you. Then she connects the results to how you’ve actually been feeling.
Does this sound familiar?
Check what you’ve been noticing.
Pick the one that fits best. You don’t need a diagnosis to book, and you don’t need to know which stage you’re in.
Perimenopause: the unpredictable years
Perimenopause can start in your late 30s or 40s, often years before your periods stop. Symptoms tend to come in waves: a good few weeks, then a rough stretch.
Checked a few? Bring this list to your visit.
Book your reviewMenopause and beyond: the steady low
Menopause is 12 months without a period, most often between 45 and 55. Estrogen stays low instead of swinging, so symptoms are more constant, and some changes build quietly over time.
Checked a few? Bring this list to your visit.
Book your reviewPMDD: when the week before your period changes who you are
PMDD, or premenstrual dysphoric disorder, is more than PMS. Symptoms are severe enough to affect your work, relationships or daily life, and they lift within a few days after your period starts. It affects an estimated 3 to 8 percent of women who menstruate.
Mood and mind
Body
The pattern is the clue: you feel like yourself for part of the month, then the same symptoms return before your period, every cycle.
Book your reviewIf you ever have thoughts of harming yourself, call or text 988, the Suicide and Crisis Lifeline, or go to the nearest emergency room.
PCOS (now called PMOS): more than a period problem
PCOS affects roughly 1 in 10 women, and many go years without a diagnosis, or are simply told to lose weight or go on birth control. Its new name, polyendocrine metabolic ovarian syndrome, puts metabolism front and center.
You don’t need to be overweight to have PCOS. Lean women can have insulin resistance too.
Book your reviewWeight and metabolism: when what used to work stops working
Midlife weight gain is rarely about willpower. Changing hormones, insulin resistance, poor sleep and muscle loss all push in the same direction. Erin treats it as a medical problem, with the whole picture in view.
Checked a few? Bring this list to your visit.
Book your reviewNot sure which one fits? You don’t need to know. That’s what the first visit is for.
How it works
One unhurried visit, built around your labs.
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Today
Book your In-Depth Lab and Health Review
Choose a time online, in person or by telehealth. You’ll get intake forms through our secure patient portal so your visit starts with your full story.
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Before your visit
Erin orders labs specific to you
After reading your intake, Erin orders a panel built around your symptoms, history and goals, such as hormone, thyroid and cardiometabolic markers. Get them drawn in our Dupont Circle office or at any Labcorp. The cost is included.
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About 3 weeks out
Your 90-minute review
Erin goes through every result in plain language and connects it to your symptoms, cycle history, sleep, mood, medications and family history. Nothing is rushed and nothing gets skipped.
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You leave with
A written findings document and a clear plan
Your priorities, the options for each, their benefits and risks, and next steps you choose together. What you do from there is up to you.
Priority 1
| Focus area | Metabolic stabilization |
|---|---|
| Why this matters |
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| Potential areas of support |
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Labs included. In person or telehealth.
Meet your provider
Erin Sengel, FNP-BC, MSN, DipACLM
Erin is a board-certified family nurse practitioner who focuses on perimenopause, menopause and midlife health, with more than 15 years of clinical experience.
She has advanced training in women’s hormone therapy through the Academy for Advanced Women’s Health Medicine and is listed in its national directory of menopause-trained clinicians. As a lifestyle medicine diplomate and former fitness coach, she pairs medication, when it’s right for you, with practical support for sleep, strength, nutrition and stress.
What her patients say most often: they finally feel heard.
- Board-certified Family Nurse Practitioner
- AAWHM menopause clinician directory
- Diplomate, American Board of Lifestyle Medicine
- Advanced education in obesity medicine
- Speaker, Women’s Health Summit
- Community workshops on perimenopause and pelvic floor health
Choosing a menopause provider
What good hormone care should look like.
Most clinicians get very little menopause training, so it’s worth asking questions before you choose anyone. Here’s the standard Erin holds herself to.
Specific training
Training in menopause, not just general women’s health, and keeping up as the evidence changes.
Time to listen
A first visit long enough to hear your whole story, and a way to reach your provider between appointments.
Every option on the table
Hormone therapy when it’s right for you, plus non-hormonal medications and lifestyle approaches when it isn’t.
Honest risks and benefits
Explained in plain language, so the decision is one you make together.
The long view
Attention to your heart, bones, metabolism, mood and sexual health, not just this month’s symptoms.
Knowing when to refer
Bringing in a physical therapist, oncologist, fertility specialist or therapist when your situation calls for it.
What Erin treats
Evidence-based options, matched to you.
Every plan is based on your history, your risks and your goals. Hormones are one option, not the only one.
Perimenopause and menopause
Menopause hormone therapy (MHT), which you may know as HRT: estrogen, progesterone, and testosterone when appropriate. Vaginal estrogen for dryness and urinary symptoms. Non-hormonal prescriptions for hot flashes and sleep.
Early or surgical menopause
Care for menopause before 45 or after removal of the ovaries, where the long-term stakes for bone and heart health are higher.
PMDD
Options may include SSRIs taken daily or only in the two weeks before your period, certain birth control pills that steady hormone swings, and lifestyle support with good evidence behind it.
PCOS / PMOS
Insulin-sensitizing medication, cycle regulation that protects the uterine lining, anti-androgen treatment for acne and unwanted hair, and nutrition and strength plans built for insulin resistance.
Medical weight management
A full range of medications, including GLP-1s when appropriate, paired with nutrition and strength training so you keep the muscle you need.
Bone and heart health
Risk assessment and a prevention plan after 40, because your midlife years shape the next forty.
Cost and insurance
Your labs are included in your first visit.
In-Depth Lab and Health Review
Includes your custom lab panel, a 90-minute visit and your written findings document.
Book your reviewFirst openings are about 3 weeks out to allow time for your labs.
- Self-pay practice. We provide a superbill on request so you can submit to your insurance for possible out-of-network reimbursement. Many HSA and FSA plans can be used for medical visits; check with your plan.
- Your prescriptions, your pharmacy. Erin sends prescriptions to the pharmacy you choose, where your insurance usually covers them.
- No obligation after the review. If you’d like Erin to manage your care going forward, ongoing care is a monthly membership.
If you continue care: membership options
| Maintenance | Most chosenActive | Full-spectrum | |
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| Monthly | $150 | $200 | $250 |
| Best for | Stable plans that need ongoing oversight | Starting therapy or adjusting your plan | Several areas of focus, like hormones plus weight, thyroid or bone health |
| Visits with Erin a year | 4 | 6 | 8 |
| InBody body composition scans a year | 4 | 8 | 12 |
| Between visits | Secure messaging with Erin, symptom tracking and a two-way health journal she reviews, plus a year-round education series. Full-spectrum adds concierge-level access. | ||
Stable plans that need ongoing oversight
Starting therapy or adjusting your plan
Several areas of focus, like hormones plus weight, thyroid or bone health
Every level includes secure messaging with Erin, symptom tracking, a two-way health journal and a year-round education series.
Questions
Before you book.
Why are the first appointments about three weeks out?
That’s on purpose. After you book, Erin reviews your intake and orders your labs. The three weeks give you time to get them drawn and give Erin time to receive and analyze the results, so your 90 minutes are spent on answers, not waiting.
Do I need labs to know if I’m in perimenopause?
Usually not. Hormone levels swing day to day in perimenopause, so a single test can look normal. Erin diagnoses it mainly from your symptoms and history, and uses labs to check other causes and make treatment safe.
Is hormone therapy safe?
For most women, the benefits of hormone therapy generally outweigh the risks when it’s prescribed and monitored properly. Your personal and family history matters, and Erin will walk you through what applies to you.
What if I can’t or don’t want to take hormones?
There are effective non-hormonal prescriptions for hot flashes, sleep and mood, plus lifestyle approaches with good evidence. You’ll go over every option together.
I’m in my late 30s or early 40s. Is it too early?
No. Perimenopause symptoms often start years before periods stop. If something has changed and you don’t feel like yourself, it’s worth a conversation.
I’m not overweight. Can I still have PCOS?
Yes. Many women with PCOS are at a lean weight and still have insulin resistance and the other symptoms.
Can I do the whole thing by telehealth?
Yes, if you live in DC or Virginia. Your labs can be drawn at any Labcorp, and your 90-minute review happens by secure video.
Do you take insurance?
This is a self-pay practice. We can give you a superbill to submit for possible out-of-network reimbursement. Your prescriptions go to the pharmacy you choose, and in most cases your insurance covers them.
You don’t have to just push through it.
Book your review with Erin and leave with answers, a clear picture of your labs, and a plan made for you.
Book your In-Depth Lab and Health Review1 Dupont Circle NW, Suite 115c, Washington, DC · Telehealth for DC and Virginia