Perimenopause & Menopause Care
Anna Gunderson Integrative Medicine offers perimenopause and menopause care for women at our Victor, Idaho office and by telehealth across Idaho, Wyoming, Montana and Utah.
We look at the whole picture: your symptoms, labs, sleep, nutrition and long-term health. Then we build a plan that may include lifestyle changes, herbal and other non-hormone options, bioidentical hormone therapy, or a mix.
"Perimenopause often starts earlier than women expect, and their concerns are often dismissed because it begins before their cycles change. We help women understand perimenopause and its broad effects on the body, including energy, neurotransmitters, the gut microbiome and cardiovascular health. By recognizing each woman's needs during this time, we strive to make the roller coaster of hormone changes much smoother, both for day-to-day quality of life and for longevity and the prevention of chronic disease."
Anna Gunderson, PA-C, FMCP-M
Perimenopause & Menopause Care at a Glance
- Provider: Anna Gunderson, PA-C, FMCP-M
- Who it's for: women with symptoms of perimenopause or menopause, including women whose cycles haven't changed yet
- What's evaluated: symptoms and cycle history, hormones (blood work and DUTCH testing), thyroid, sleep, and, when needed, bone density and cardiovascular testing
- Treatment options: nutrition and lifestyle, sleep support, herbal and other non-hormone options, bioidentical hormone therapy
- Where: our Victor, Idaho office by appointment, or telehealth in Idaho, Wyoming, Montana and Utah
- Insurance: in-network with BCBS, Aetna, Cigna, Regence, Select Health and Mountain Health Co-Op, plus out-of-network and self-pay options
How do I know if I'm in perimenopause?
Perimenopause is the transition leading up to menopause, when hormone levels begin to shift. It usually starts in a woman's mid-to-late 40s, though some women notice changes in their mid-to-late 30s.
Many symptoms show up before periods change, which is one reason perimenopause is often missed. Common signs include:
- Hot flashes or night sweats
- Poor sleep
- Mood swings, anxiety, or low mood
- Brain fog and difficulty concentrating
- Fatigue or low energy
- Weight gain or difficulty losing weight
- Irregular cycles or PMS
- Low libido
- Hair thinning or skin changes
Menopause itself is reached after 12 months in a row without a period. In the U.S., the average age is 52, according to the U.S. Office on Women's Health.
What happens at your first visit?
Your first visit is a 75–90 minute telehealth appointment by Zoom. Beforehand, you'll fill out intake forms, including a symptom questionnaire.
Anna reviews your history, symptoms and goals, and orders testing as needed. That may include blood work, DUTCH hormone testing (collected at home), a thyroid evaluation, and bone density or cardiovascular testing. Together you'll talk through what's likely going on and the next steps.
What treatment options are available?
Nutrition, lifestyle and sleep
Every plan starts here. We use food as medicine, lifestyle practices that help regulate your nervous system, and healthy sleep habits. In Anna's experience, this foundation can reduce the need for prescriptions and help any medications you do take work better. Learn more about nutritional counseling and health coaching.
Herbal and other non-hormone options
Plans often include herbal treatment. We may also recommend acupuncture, physical therapy or counseling alongside your care.
Bioidentical hormone therapy
When hormones are a good fit, Anna can prescribe bioidentical estrogen, progesterone and testosterone, either as FDA-approved products or compounded preparations. Learn more about bioidentical hormone therapy.
Ongoing support
Follow-up visits are usually every 4–12 weeks, with lab work typically every 3–6 months. Emily Schneidewind, BSN, RN, our Lifestyle and Wellness Nurse, helps you build the habits, rituals and nutrition changes in your plan.
Care close to home in Teton Valley and Jackson Hole
- A local office in Victor, Idaho, with in-person visits by appointment
- Telehealth for women anywhere in Idaho, Wyoming, Montana and Utah
- In-network with major insurers, plus out-of-network and self-pay options
- Functional medicine training through the Institute for Functional Medicine, including its hormone module, combined with 14 years as a PA trained in family medicine and gynecologic care
Frequently asked questions
When does perimenopause start?
Usually in a woman's mid-to-late 40s, though some women notice changes in their mid-to-late 30s. Symptoms like poor sleep, mood changes or fatigue can begin before your cycle changes.
How long does perimenopause last?
About four years on average, but it can last up to 10 years. It ends at menopause, after 12 months in a row without a period.
How do I know if I'm in perimenopause?
There's no single test that confirms it. Anna looks at your symptoms, age and cycle history, and uses lab work to understand your hormones and rule out other causes, such as thyroid problems.
Do I need hormone therapy for menopause symptoms?
Not necessarily. Many plans start with nutrition, sleep, lifestyle and herbal options. Hormone therapy is one option when your symptoms call for it and the benefits outweigh the risks for you.
Can I be seen by telehealth if I live in Wyoming, Montana or Utah?
Yes. Anna is licensed to see patients in Idaho, Wyoming, Montana and Utah. Your first visit is by Zoom, and in-person visits are available at our Victor office by appointment.
Does insurance cover perimenopause and menopause care?
We're in-network with BCBS, Aetna, Cigna, Regence, Select Health and Mountain Health Co-Op, and we offer out-of-network and self-pay options. See our pricing page for details.
Medically reviewed by Anna Gunderson, PA-C, FMCP-M · November 4, 2026
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