Menopause and Perimenopause Care in Seattle
Menopause and perimenopause care at Kosmos Medical Group is led by Dr. Carolan Constantine, a board-certified physician with a women's health focus, inside a concierge primary care membership in Madison Park, Seattle. Perimenopause typically begins in the mid-40s and can last four to eight years; the average age of menopause in the US is 51. Kosmos treats the whole transition as part of your ongoing primary care: an unhurried first visit, real measurement, hormone therapy when it fits your history and goals, and attention to the heart, metabolic and bone health that shift in the same years. Membership is $575 per month for Premium Care.
A different kind of menopause care
Most menopause care is built around short, single-issue visits, and many women come to us after being rushed or dismissed, or after being told their labs are normal while they are not sleeping, not thinking clearly and gaining weight they cannot explain. Kosmos works differently. As a member, you have a physician who knows your history, answers directly, and has time to actually listen. Perimenopause can last the better part of a decade, so the relationship matters as much as any prescription.
Care led by a female physician
Dr. Carolan Constantine leads women’s health at Kosmos. She is board certified in internal medicine and emergency medicine, with a focus on women’s health and perimenopause.
Symptoms we treat
The symptoms we see most often include:
- Hot flashes and night sweats
- Sleep that fragments, often years before the first hot flash
- Mood changes, anxiety and a shorter fuse that feel out of character
- Brain fog, word-finding trouble and difficulty concentrating
- Weight gain around the middle despite no change in habits
- Joint and muscle aches
- Irregular, heavier or unpredictable periods in perimenopause
- Vaginal dryness, painful sex, low libido and recurrent urinary infections
- New or rising blood pressure and cholesterol
What the first visit covers
The first visit runs about 90 minutes and is built to answer one question honestly: what is actually going on, and what is the right plan for you? That means:
- A full symptom and cycle history, including sleep, mood, cognition and sexual health
- Personal and family history of breast cancer, clotting, stroke and heart disease, because these shape which treatments are safe
- Blood pressure, lipids and metabolic markers, which shift in these years
- Thyroid function, which mimics menopausal symptoms and is frequently the missed diagnosis
- Bone density by DEXA scan when indicated, and twice yearly as part of Optimal Care
- Hormone levels where they change the decision, particularly in perimenopause, in women under 45, and when considering testosterone
You leave with a plan, whether or not it includes hormones.
Your options
| Approach | Best for | How Kosmos uses it |
|---|---|---|
| Hormone therapy | Moderate to severe symptoms in women under 60 or within ten years of menopause, with no contraindications | Estradiol patch or gel as first choice, progesterone for uterine protection, adjusted over time; details on our hormone replacement therapy page |
| Low-dose vaginal estrogen | Dryness, painful sex, recurrent urinary infections | Safe for most women, including many who cannot take systemic hormones |
| Non-hormone medications | Hot flashes, sleep and mood when hormones are not appropriate or not wanted | Includes newer non-hormonal options for hot flashes and targeted treatment for sleep and mood |
| Lifestyle and metabolic care | Weight, sleep, energy, long-term heart and bone health | Strength training, protein intake, sleep, and continuous glucose monitoring where useful |
| Specialist coordination | Complex bleeding, fibroids, surgical questions, endocrine conditions | OB-GYN, endocrinology or other specialists, with your physician staying involved |
Whole-person, not just hormones
Menopause does not happen in isolation. Estrogen protects the heart and the bones, so the years around menopause are when cardiovascular risk rises and bone density begins to fall. The same years often bring changes in weight, cholesterol and blood pressure. Because Kosmos is your primary care home, your physician manages all of it together, and for Optimal Care members the advanced cardiovascular screening, DEXA and metabolic health testing happen on a schedule rather than when something goes wrong.
Who this is for
- Women in their late 30s and 40s noticing the early signs of perimenopause
- Women in menopause weighing hormone therapy and wanting an honest, individualized conversation
- Women who feel rushed or dismissed and want a physician with time and continuity
- Women who want menopause care connected to their broader health, not treated in isolation
Kosmos physicians each care for 100 families, which is what makes a 90-minute first visit and a direct line to your physician possible. Read about what it means to have a female concierge doctor in Seattle, or see membership and pricing.
The age ranges and safety guidance on this page reflect The Menopause Society’s 2022 Hormone Therapy Position Statement and its current clinical guidance. This is general information, not a treatment recommendation; decisions are made with your physician.
Your physicians
Three physicians. 100 families each.
What members say
The relationship is the difference.
5.0 stars on Google
“I have been part of multiple practices in town and have had a hard time getting through to my physician, especially when I do not feel well. That changed the moment I joined Kosmos.”
“We feel incredibly fortunate to have found Dr. Dodd at Kosmos as my husband’s concierge physician. The level of care, attention, and responsiveness he provides is truly exceptional.”
“I highly recommend Kosmos and Dr. Bhaskar. The experience is a refreshing departure from the traditional clinic model. With a fraction of the patient load you would find at a typical practice, the level of care, attention, and accessibility is exceptional.”
FAQ
Common questions.
- Yes. Women's health is a core focus at Kosmos, led by Dr. Carolan Constantine, board certified in internal and emergency medicine, with a focus on women's health. We care for women through perimenopause, the menopause transition and the years after, as part of an ongoing membership relationship rather than a one-off visit.
- Perimenopause is the transition, usually starting in the mid-40s, when estrogen and progesterone begin to fluctuate and cycles become irregular. It typically lasts four to eight years and is when most symptoms begin. Menopause is a single point: twelve months after the final period, at an average age of 51 in the US. Everything after that is postmenopause. Symptoms often peak in late perimenopause and the first years after menopause, but bone and cardiovascular effects continue, which is why the care should too.
- Yes, when it is clinically appropriate and after a real conversation about the benefits, the trade-offs and your goals. We do not prescribe from a single lab value. We look at your symptoms, your history and the full picture, start conservatively, and adjust over time. When a non-hormone or lifestyle approach is the better fit, we will tell you. Our hormone replacement therapy page explains the options in detail.
- Most menopause clinics and apps treat menopause and nothing else, often per visit or over video. Kosmos is a membership primary care practice, so your physician manages menopause alongside your metabolic, heart and bone health, knows your history, and is directly reachable. You get continuity and a whole-person plan, in person, not a single-issue visit with a stranger.
- Yes. Women's health at Kosmos is led by Dr. Carolan Constantine. Members also have a team of three physicians involved in their care.
- Kosmos is a membership practice. Premium Care is $575 per month or $6,900 per year. Optimal Care, which adds advanced preventive testing and diagnostics including DEXA bone density twice a year and advanced cardiovascular screening, is $1,250 per month. We do not bill insurance for membership services. Most members keep insurance for specialists, imaging, outside labs and hospital care, and your physician coordinates those referrals.
- Yes. Kosmos provides care through membership, which is what makes the time, access and continuity possible. The best first step is a no-pressure call to see whether it is the right fit.
Speak with our physicians.
An unhurried conversation about your health and whether Kosmos is the right fit. No obligation, no pressure.