THE MENOPAUSE CLINIC
(And Perimenopause)
After five years of deep research and training in hormone therapy, menopause, and perimenopause, we’ve sifted through the noise, studied the data, and built a clear path forward.
If you’ve felt overwhelmed by conflicting information, you’re not alone—and we’re here to help.
We made a promise to our patients: to offer a truly comprehensive hormone care plan, including personalized hormone therapy,
We are in an epidemic of hormonal dysregulation over the past 50 years –
from severe PMS/PMDD to PCOS & endometriosis to infertility to adrenal dysfunction to
severe and earlier menopause and perimenopause transition.
We need to treat this conscientiously.
For those who are motivated to optimize all of the angles of your life so that hormone therapy can really shine
Your Healthiest Years Are Ahead
THIS PLAN IS DESIGNED
FOR WOMEN WHO:
Refuse to settle for a one-size-fits-all prescription
Want to care for their health from every angle
Are ready to hand over their symptoms and receive a complete, personalized roadmap forward—with ongoing support and expert monitoring
Risk assessment and treatment
is individualized
Hormone therapy is not “one size fits all”
COMPREHENSIVE EVALUATION
LIFESTYLE – NUTRIENTS – CARDIOVASCULAR RISKS – ADRENAL HEALTH – THYROID FUNCTION – HPO AXIS – HORMONE PRODUCTION & METABOLISM – INFLAMMATORY MARKERS – OSTEOPOROSIS PREVENTION
After decades of practicing medicine, we know the standard “one size fits all” approach does not work.
Current practices argue that it is sufficient to treat symptoms and ignore levels. We disagree.
Patients come to us from different practices with extremely high levels of unmonitored hormones, while others have levels which remain below the menopausal range despite treatment. Neither are asymptomatic, and neither are benefitting from the assumption that absorption and hormone metabolism will be the same in all. We test, adjust, and offer continued monitoring.
Hormonal Replacement Therapy is not the single answer alone. Your hormones work in symphony with the rest of you – in order to do this properly – we can’t leave your HPA axis, HPO axis, and thyroid stuck in dysfunctional patterns.
We look at your hormone production & metabolism, adrenal health markers, inflammation, and detoxing capacity to understand where to meet you in hormone replacement. When hormones can be optimized to match your needs, you will find benefit from a dose designed to your own body.
Ongoing cardiovascular, endometrial, breast, and bone surveillance is necessary.
How do you metabolize your estrogen? This is a critical question to address for both hormone replacement therapy as well as to reducing modifiable risk factors for breast cancer and endometriosis. Mammogram screening is an important tool, but we choose to take a proactive approach with our patients – evaluate their estrogen metabolism pathways, and then work to optimize these paths. These efforts can reduce the risk of developing breast cancer in the future.
One of the reasons we gain weight in perimenopause –
As ovarian estrogen drops, FSH stimulates
FAT tissue growth
since fat tissue produces compensatory estrogen
YET, hrt in this critical period of weight gain
is often DELAYED
YES, hormones are fluctuating at this time, but
that just means
we need to learn to test properly
Guidelines still don’t recommend testing for perimenopause or menopause since it’s complicated and difficult to decipher.
Yes, it IS complicated,
but that just means the medical community needs to
TRY HARDER FOR WOMEN –
We absolutely DO test with complete evaluations
Testing has been proven reliable when done properly*
*We will be providing details on this with research study references.
MORE IMPORTANTLY,
THE “NO NEED TO TEST” ATTITUDE CAUSES HARM
BELOW ARE A FEW CASES WE HAVE SEEN
CASE 1
55 yo female in menopause x 6 years with hot flashes – her baseline estradiol without hormone therapy is in the luteal range of a premenstrual woman. (yes, this can happen if aromatization to estrogen in fat tissue is high)
She already has unopposed estrogen which increases her risk for uterine cancer. Blindly placing her on additional estrogen therapy would be poor practice and may worsen symptoms as her night sweats are not due to estrogen deficiency.
CASE 2
59 yo female in menopause, history of hysterectomy on estradiol therapy. Her serum and urine 4 spot testing of estradiol show she is in the menopausal range.
We know from clinical studies the goal range required to achieve bone protection and other clinical outcomes. How many years has she lost taking a subtherapeutic dose? This scenario is common
CASE 3
49 yo female in menopause – her baseline levels are in menopausal range, but evaluating her estrogen metabolites – her 4-OH-E1 is high – in the luteal range of a premenopausal female.
High 4-OH-E1 increases the risk of breast cancer. Improving her detoxing pathways are important prior to starting HRT
CASE 4
43 yo female, irregular cycles, very high stress due to young children and caring for elderly parents, and demanding job with long hours – she is started on HRT without looking further at thyroid function, adrenal function, vitamin levels, lifestyle factors, or nutrition.
While HRT could still be the right option, this should never be assumed without properly addressing other possible culprits that once corrected, could normalize her own hormones.
COMPREHENSIVE HORMONAL BALANCING PROGRAM
VISIT 1:
INITIAL VIRTUAL 2 HOUR VISIT $400
Eligible to use HSA & FSA funds, superbills provided for non-Medicare reimbursement
Comprehensive history, comprehensive labs including evaluation of thyroid and adrenal function, hormonal levels via serum, hormonal metabolizing patterns via DUTCH
*INSURANCE: We do not accept insurance. We can provide a superbill post visit for non-medicare reimbursement.
This is a 2 visit package and cannot be broken up.
VISIT 2:
FOLLOW UP 1.5 HOUR IN CLINIC VISIT $300
Eligible to use HSA & FSA funds; superbills provided for non-Medicare reimbursement
Discuss lab results, physical exam, and provide personalized recommendations in a written plan
THE INITIAL CONSULTATION PACKAGE
INCLUDES:
- HPA axis: assess adrenal health/cortisol mapping & balance; DHEAS assessment
- Complete thyroid testing
- Assess factors to reduce breast cancer risk via estrogen metabolism patterns
- Complete sex hormonal testing via serum and DUTCH (androgens, estrogens, and progesterone; additional hormones tested based on history assessment)
- Nutritional & vitamin recommendations
- Assessment of bone health via DXA (DXA testing and cost is via at an outside imaging center – insurance can be applied)
- Advanced cardiovascular lab testing
- Optimizing bone health recommendations
- General gut healing protocols (does not include GI Map or SIBO testing)
- Lifestyle recommendations to optimize menopause transition
- Herbal recommendations
- Evaluation for option of Bioidentical Hormonal Therapy* (We do not start hormone therapy in the 2 visit package but will provide recommendations. We do prescribe hormone therapy in the membership follow up option)
OPTIONAL STEP 2:
THE MENOPAUSE
MEMBERSHIP
Enrollment for membership is considered AFTER Step 1 visit package above
- 4 virtual/clinic visits yearly 60 minutes each with your provider: Dr. Haque or Rachel Shelton, FNP
- Quarterly or Biannual monitoring of hormones via labs +/- DUTCH testing*
- Quarterly or Biannual monitoring of comprehensive lab panel with detailed interpretation and discussion of results*
- Personalized BHRT prescriptions when clinically appropriate
- estradiol, progesterone, DHEA, and testosterone
- compounded prescriptions for individualized dosing as needed
- Note: We do not offer pellet therapy or testosterone injections due to long-term adverse concerns that have been raised.
- 15% off supplements and wellness products
- No commitment. You can cancel any time
This service does not include other primary care or all gynecologist services – you will need to still have both a primary care doctor and a gynecologist.
Cost: $120/month; This qualifies for HSA & FSA funds, and can count towards healthcare “accumulators” such as deductibles and out of pocket maximums**.
We do not accept insurance
*Lab costs are not included in membership price and are billed directly from performing labs. Insurance can be applied for serum testing
**Costs cannot be used towards Medicare accumulators. Reimbursement cannot be requested from Medicare.
DPC MEMBERS: ASK FOR DPC DISCOUNT
Additional Resources for Patients: