A woman comes in reporting low desire or pain, certain the problem is hers alone. Often it isn't — her partner is navigating his own unspoken midlife changes, and the two are compounding each other. Treating only half of a relationship leaves most of the picture unaddressed.

New Orleans summers now run four degrees hotter than they did in 1970, and that shift lands differently on a body navigating perimenopause. Hot flashes that felt manageable in February become a daily disruption by August — not because anything hormonal changed, but because the environment moved the trigger point.

Most women know menopause is coming. They've heard about hot flashes, maybe from a mother or a passing joke on television. But knowing menopause exists and being genuinely prepared for it are two different things — and for the majority of women entering perimenopause, the experience lands harder than expected and gets far less medical attention than it deserves. That gap isn't a personal failure. It's a systemic one.