Perimenopause affects
everything. Isabella
helps you see why.
Whether you're experiencing hot flashes, night sweats, sleep disruption, mood changes, or brain fog - Ziva connects your wearable data, HRT adherence, symptom tags, and lab results so you and your provider can finally understand what's driving how you feel.
For women in perimenopause and menopause - alongside their care team.
🔒 HIPAA compliant
⌚ Apple Watch & Oura
✦ Free to start
Isabella · Your perimenopause health today
HRV ⌚
58ms
↑ from 34ms last month
Hot flashes
3
this week, ↓ from 12
HRT
✓
patch changed · Mon
Hot flash frequency — last 4 weeks
12
9
5
3
Wk1
Wk2
Wk3
Wk4
Week 1 · 12 hot flashesThis week · 3 ✓
Isabella · Today's insight
"Your hot flash frequency is down to 3 this week — your best since starting HRT. Your Apple Watch shows skin temperature spikes are less frequent and shorter. Your HRV has improved to 58ms, up from 34ms last month. Your provider will want to see this trend at your next visit."
New to Ziva?
Ziva Health is an AI-powered health companion for managing chronic conditions. Isabella is Ziva's AI coach - she reads your wearable data, tracks HRT adherence, logs your symptom tags, and shows you how your hormones, sleep, and lifestyle are connected over time.
How Ziva works for perimenopause
Three steps to understanding what your body is going through.
Understanding perimenopause
It's not a steady decline.
It's years of fluctuation.
Perimenopause is the transition before menopause - typically beginning in the mid-to-late 40s, sometimes earlier, and lasting 4–10 years. Symptoms aren't caused by low estrogen: they're caused by unpredictable swings in estrogen and progesterone. A bad week doesn't mean things are getting worse. It means your hormones fluctuated. Understanding what's driving your symptoms makes them easier to manage.
🌡
Estrogen fluctuates - it doesn't just fall
Estrogen swings up and down erratically before it finally declines. These spikes and drops trigger hot flashes, mood shifts, and headaches. Your wearable skin temperature picks up these events in real time.
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Progesterone drops first
Progesterone declines earlier and more steadily than estrogen. It governs sleep quality and cycle regularity - which is why disrupted sleep and irregular periods are often the first signs, before hot flashes even begin.
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Sleep architecture changes - not just night sweats
Hormonal changes alter sleep stages even without visible sweating - reducing deep sleep and REM. You can sleep 8 hours and wake exhausted. Your wearable captures the fragmentation that explains why.
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HRV and stress resilience decline
Estrogen protects the autonomic nervous system. As it fluctuates, HRV declines - which is why stress hits harder, recovery takes longer, and brain fog is more persistent. Your wearable HRV tracks this directly.
The stages — where you might be
Early perimenopause
Cycles become irregular. Symptoms may be mild and intermittent. FSH begins to rise. Often begins in the mid-to-late 40s, sometimes earlier.
Late perimenopause
Periods become infrequent - gaps of 60+ days. Hot flashes and sleep disruption often intensify. Estrogen levels increasingly erratic. FSH typically elevated.
Menopause
12 consecutive months without a period. Average age 51 in the US. FSH above 30 mIU/mL is a typical marker. Symptoms often peak around this transition.
Post-menopause
After 12 months without a period. Symptoms typically stabilise but may continue for years. HRT and lifestyle management remain important for long-term cardiovascular and bone health.
Why symptoms vary so much week to week
Because estrogen fluctuates rather than steadily declining, two weeks in the same month can feel completely different. Tracking wearable signals and symptom tags over time reveals your personal pattern - the triggers, the rhythms, and what's actually helping.
What Isabella tracks
Four signals that explain
how you're feeling day to day.
Perimenopause is unpredictable. Symptoms vary week to week, and the connection between hormones, sleep, stress, and how you feel is rarely visible in a 10-minute appointment. Isabella tracks the signals that make the pattern clear.
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Skin temperature · hot flash detection
Your Apple Watch or Oura Ring detects temperature spikes automatically - hot flash frequency, timing, and duration, without you having to log anything. The first objective hot flash signal you can share with your provider.
😴
Sleep quality & HRV
Night sweats fragment sleep - your wearable captures wake events, sleep stages, and HRV decline automatically. Isabella shows you whether poor sleep is driving your fatigue and brain fog, and tracks whether it's improving with HRT.
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HRT adherence & timing
Every dose, patch change, or gel application logged and timestamped. HRT consistency is the single biggest driver of symptom control - Isabella tracks it and correlates missed doses with symptom flares.
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Lab results · FSH & estradiol
Enter FSH, estradiol, LH, and progesterone when you have them. Isabella overlays each result on your symptom and wearable history - so you can finally see the relationship between your hormones and how you actually feel.
Isabella · What drove your symptoms this month
Missed patch day (2 occasions)Hot flash spike days after
High-stress week (HRV 28ms avg)Night sweats ↑, sleep 52%
Consistent patch schedule (week 4)Recovery score ↑ best week
Reduced caffeine + alcoholHot flash count halved
Isabella · Monthly summary
"Your two worst weeks correlated with a missed patch and a high-stress period where your HRV dropped to 28ms. Your best week was week 4 — patch on time both days, lower caffeine intake, HRV recovered to 58ms. The pattern is clear: consistent HRT and managing stress are the two biggest levers you have right now."
Hot flash detection
The first objective hot flash signal
you can share with your provider.
Until now, the only way to track hot flashes was counting them yourself. Your Apple Watch or Oura Ring detects skin temperature spikes automatically - frequency, duration, and time of day - and cross-references them with your own tags. Your provider gets objective data, not just "I'm having a lot of hot flashes."
✓Skin temp spike detection from Apple Watch Series 8+ or Oura Ring Gen 3+ — automatic, no logging needed
✓Confirm spikes with a quick tag — builds a validated log of hot flash events with timestamps
✓Night sweat detection — temperature spikes during sleep correlated with sleep fragmentation from your wearable
✓Trigger correlation — Isabella identifies patterns between hot flashes and caffeine, alcohol, stress, and missed HRT
✓30-day hot flash summary included in your monthly report — ready to share at your next appointment
Isabella · Hot flash log — this week
M
T
W
T
3
FSa
Su
Skin temp spikes (Apple Watch) · down from 12 last week · best week this month
Night sweats
1 this week
↓ from 6 last week
Sleep efficiency
79% ⌚
↑ from 61% last week
HRV ⌚
58ms
↑ best in 6 weeks
Brain fog tags
0 this week
↓ from 4 last week
Isabella · Week review
"Your best week in two months. Hot flashes down to 3, sleep back above 79%, HRV at 58ms, and no brain fog. Patch was on time both days this week — that's the pattern. Your provider will be able to see this improvement in your next report."
Hot flash frequency vs HRT adherence — 4 weeks
Patch schedule set by provider · adherence from your HRT log
Wk 1 — HRT log: patch not logged Sat12 hot flashes
Wk 2 — HRT log: patch logged late (2 days)9 hot flashes
Wk 3 — HRT log: patch on schedule5 hot flashes
Wk 4 — HRT log: both changes on schedule3 hot flashes ✓
HRT adherence & lab correlation — 4 months
Month 1 — FSH 48 mIU/mLAdherence 62% · 14 hot flashes/wk
Month 2 — HRT startedAdherence 78% · 9 hot flashes/wk
Month 3 — FSH 32 mIU/mLAdherence 88% · 6 hot flashes/wk
Month 4 - estradiol improvingAdherence 96% · 3 hot flashes/wk ✓
Isabella · Lab insight
"Your FSH has come down from 48 to 32 mIU/mL over 3 months, and your hot flash frequency has followed — from 14 to 3 per week. Your estradiol is improving. The most consistent predictor of your symptom score is your HRT adherence the week before. Month 4 at 96% adherence is your best yet."
HRT management
HRT only works when
it's taken consistently.
Missed patch days, late gel applications, and forgotten doses cause hormone level dips that show up as hot flash spikes days later. Isabella tracks every HRT event with a timestamp, identifies patterns, and shows you - and your provider - exactly how adherence is affecting your symptom burden.
✓Patch change reminders, oral dose alarms, and gel application logs — all timestamped
✓Missed dose correlation — Isabella flags when a hot flash spike follows a missed or late HRT event
✓Monthly adherence percentage — visible to you and your provider in the monthly report
✓Provider can update your HRT schedule, dose, or form remotely from the portal - reflected in Isabella immediately
For your care team
Your provider sees the same data.
Objective. Before every visit.
When your provider is on Ziva, they see your skin temperature trends, HRV, hot flash frequency, HRT adherence, and lab history - all in one view, before every appointment. No more describing symptoms from memory.
Refer Ziva to my provider / care team
Your provider isn't on Ziva yet? Send them a link - they'll see your wearable data, hot flash trends, and HRT adherence before every appointment, and can update your care plan directly from the portal.
Send to my provider →Already seeing your provider?
Bring your 30-day report to your next appointment - hot flash frequency, HRV trend, HRT adherence log, and lab correlation, ready to print or share.
Get my report →What your provider sees
✓
Hot flash frequency from skin temperature — objective weekly counts, not self-reported estimates
✓
HRV and sleep fragmentation trend — correlated with hot flash burden and night sweats
✓
HRT adherence log — every dose, patch change, or gel application with timestamp
✓
FSH, estradiol, and LH trend over months — overlaid on symptom and wearable history
✓
Isabella's clinical summary — key observations and suggested discussion points before every visit
RTM billing eligible
Perimenopause qualifies for Remote Therapeutic Monitoring (RTM) billing - no second chronic condition required. Ziva's daily routines and wearable sync generate the data transmissions needed for billing codes 98977 (16+ days) or 98985 (2–15 days, new 2026 code). Share the provider page for details.
Questions
Common questions
No - Ziva works without a wearable. HRT adherence tracking, symptom tags, lab correlation, and Isabella's coaching are all available from the app alone. A wearable adds skin temperature hot flash detection, HRV, and sleep data - which makes the picture richer, but isn't required to start. Apple Watch Series 8 or later and Oura Ring Gen 3 or later are needed for skin temperature data specifically. Other wearables (Garmin, Fitbit, earlier Apple Watch) provide HRV and sleep data but not skin temperature.
Apple Watch (Series 8+) and Oura Ring (Gen 3+) measure skin temperature continuously throughout the day and night. Hot flashes cause a rapid temperature spike - typically 0.5–2°C above your baseline - that resolves within a few minutes. Ziva identifies these spikes, timestamps them, and logs frequency and duration automatically. You can confirm each spike with a quick tap ("hot flash") to validate it. Over time, Isabella identifies your personal baseline and patterns - time of day, correlation with triggers, and response to HRT.
Ziva's HRT tracking is a routine and adherence log - not a clinical tool. You select your therapy type (oral tablet, patch, gel, etc.) and your schedule, and Isabella sends reminders and records whether you've logged each dose or patch change. That's it. The value comes from what Ziva does with that data: it calculates your adherence percentage and correlates missed or late doses with your wearable signals and symptom tags - so you and your provider can see how consistency is actually affecting your hot flash frequency and how you feel.
FSH, estradiol (E2), LH, progesterone, and AMH (anti-Müllerian hormone). You can also add thyroid labs (TSH, Free T4) - thyroid dysfunction is very common in perimenopausal women and the symptoms overlap significantly. Enter results when you have them and Isabella overlays each one on your symptom burden, hot flash frequency, and wearable data from the same period - so the relationship between your hormones and how you feel becomes visible over months.
Yes. Many women in their late 30s and 40s experience symptoms - irregular periods, hot flashes, sleep changes, mood shifts - without a formal diagnosis. Ziva can help you track and document these symptoms over time, correlate them with your lab results, and build a picture that you can bring to your provider for a clinical assessment. Isabella is not a diagnostic tool, but the data it compiles often helps providers make a clearer assessment than symptoms alone.