The Art of the Consultation

• What It Is: A comprehensive intake process that prioritizes your full story over a simple symptom checklist.

• Primary Benefits:

  • Establishes a space of safety and belief where your experiences are validated.

  • Uncovers a lifelong hormonal narrative, identifying potential issues like Post-Birth Control Syndrome (PBCS).

  • Assesses your "psychosocial ecosystem"—stress, sleep, support—as a key diagnostic tool.

• How It Works (The Science): We recognize that chronic emotional stress is a primary driver of hormonal imbalance. By understanding your full hormonal history and current life stressors, we can begin to connect the dots between your life and your biology, moving us toward a true root-cause analysis.

• Important Safety Information: This comprehensive consultation is the mandatory first step to ensure we design a program that is both safe and effective for your unique situation.

Foundational & Advanced Lab Panels

• What It Is: A multi-layered laboratory analysis that assesses your complete metabolic, hormonal, and cellular health.

• Primary Benefits:

  • Provides objective data to confirm clinical findings and rule out other conditions like thyroid disease.

  • Goes beyond standard tests to assess cardiovascular risk (ApoB), inflammation (hs-CRP), and blood sugar stability (Fasting Insulin, HbA1c).

  • Allows for advanced analysis of your stress axis (DUTCH Test), gut health's impact on estrogen (Estrobolome), and real-time blood sugar (CGM).

• How It Works (The Science): We use a foundational panel to assess your baseline health, a hormone panel to measure key players like Estradiol, Progesterone, and Testosterone, and advanced functional tests to map your unique physiology, including cortisol patterns and how your gut bacteria regulate estrogen.

• Important Safety Information: All lab testing is interpreted by our clinical team in the context of your symptoms and full health history.

Genomic Personalization

• What It Is: An optional genetic analysis that allows us to tailor your interventions with unprecedented precision based on your unique genetic blueprint.

• Primary Benefits:

  • Allows for proactive strategies to mitigate long-term, genetically-influenced health risks.

  • Guides safer and more effective hormone therapy dosing and administration routes.

  • Shifts the goal from short-term symptom relief to building a foundation for a "vibrant centenarian".

• How It Works (The Science): Knowing your ApoE4 status, the most significant genetic risk factor for late-onset Alzheimer's, makes the conversation about early, neuroprotective estrogen therapy critically important. Understanding your estrogen metabolism genes (like COMT and MTHFR) helps us support your body's detoxification pathways with targeted supplements, potentially allowing for lower, safer MHT doses.

• Important Safety Information: Genetic testing provides information about predispositions, not certainties. All results are discussed in a detailed consultation to ensure proper context and understanding.

Perimenopause is the transitional period leading up to your final menstrual period, often starting in your early to mid-40s and lasting 4-8 years. It is not a disease, but a natural stage of life defined by hormonal volatility, not just decline. The defining characteristic is a change in your menstrual cycle. Progesterone is the first hormone to plummet, leading to a state of "estrogen dominance" that causes early symptoms like anxiety, insomnia, and heavy, irregular bleeding. This is followed by erratic surges and crashes of estrogen, which trigger classic symptoms like hot flashes, night sweats, migraines, and severe brain fog.

Why Your Symptoms Have Been Dismissed

You are not imagining it. The medical system frequently fails to recognize and validate the real, biologically-driven symptoms of perimenopause. This happens for several reasons: you may be told you are "too young" for it to be your hormones ; a provider may rely on a misleading "normal" blood test, which is just a snapshot in time of a wildly fluctuating system ; or each symptom is treated individually with sleeping pills, antidepressants, or referrals for expensive cardiac workups, failing to see the single underlying cause. This experience of "medical gaslighting" leaves women feeling unheard and questioning their own reality. Our philosophy begins by ending this cycle.

Estrogen Therapy

• What It Is: The primary and most effective treatment for the systemic symptoms of menopause.

• Primary Benefits:

  • Directly treats vasomotor symptoms (hot flashes and night sweats), brain fog, and mood changes.

  • Is a first-line option for the prevention of osteoporosis in symptomatic women.

  • Appears to be cardioprotective when initiated within the "window of opportunity" (under age 60 or within 10 years of menopause).

• How It Works (The Science): We use bioidentical 17-beta Estradiol, which is structurally identical to the hormone your body produces. We strongly prefer the transdermal route (patches or gels) over oral pills, as this avoids the first-pass effect in the liver and is associated with a lower risk of blood clots (VTE).

• Important Safety Information: Estrogen therapy is contraindicated in women with a history of breast cancer, estrogen-sensitive malignancies, or a history of VTE/stroke.

Progesterone Therapy

• What It Is: The essential protector hormone required for any woman with a uterus who is taking systemic estrogen.

• Primary Benefits:

  • Its sole medical purpose in MHT is to protect the uterine lining (endometrium) from hyperplasia and cancer.

  • Bioidentical micronized progesterone offers additional benefits, including a natural sedative effect that significantly improves sleep.

• How It Works (The Science): Progesterone opposes estrogen's proliferative effect on the endometrium. We prefer oral micronized progesterone, which has a superior metabolic profile and may have a lower breast cancer risk profile compared to synthetic progestins. For women who experience side effects, it can be used vaginally to deliver a high concentration to the uterus with fewer systemic effects.

• Important Safety Information: Progesterone is not needed for women who have had a hysterectomy (unless they have a history of endometriosis).

Testosterone Therapy

• What It Is: The off-label use of testosterone therapy to address symptoms that persist after estrogen and progesterone have been optimized.

• Primary Benefits:

  • The primary indication is for Hypoactive Sexual Desire Disorder (HSDD), for which it is a highly effective treatment.

  • May also improve energy levels, mood, cognitive function, and lean muscle mass.

• How It Works (The Science): Testosterone levels decline steadily with age, and the low-estrogen state of menopause can unmask the effects of this decline. We use low-dose transdermal creams or gels to restore testosterone to the high-normal physiologic range of a young woman, which has been shown in clinical trials to significantly increase satisfying sexual events.

• Important Safety Information: All testosterone use in women is off-label and requires a thorough informed consent discussion. We prioritize safe, physiologic dosing and explicitly recommend against the use of high-dose hormone pellets, which can cause dangerously high levels and irreversible side effects.

Genitourinary Syndrome of Menopause (GSM)

• What It Is: A chronic, progressive condition caused by estrogen loss in the pelvic tissues, leading to vaginal dryness, painful sex (dyspareunia), and recurrent UTIs. It affects over 60% of women and worsens over time if left untreated.

• Primary Benefits of Treatment:

  • Restores vaginal tissue health, elasticity, and lubrication.

  • Eliminates pain during intercourse.

  • Reduces urinary urgency, frequency, and the risk of UTIs.

• How It Works (The Science): The gold standard treatment is Local Vaginal Estrogen (creams, tablets, inserts). This delivers estrogen directly to the target tissues with minimal systemic absorption. Because of its extreme safety profile, it does not require progesterone opposition, even in women with a uterus, and is considered safe for most breast cancer survivors in a shared decision with their oncologist.

• Important Safety Information: Local vaginal estrogen is a local treatment for local symptoms; it will not treat hot flashes or protect bones.

Advanced Regenerative & Arousal Therapies

• What It Is: A suite of cutting-edge, non-invasive therapies designed to rejuvenate tissue, enhance sensation, and boost arousal.

• Primary Benefits:

  • Addresses sexual dysfunction beyond just tissue dryness.

  • Enhances nerve sensitivity, orgasm intensity, and desire.

  • Offers non-hormonal options to restore function and confidence.

• How It Works (The Science):

  • The O-Shot®: Uses Platelet-Rich Plasma (PRP) from your own blood to stimulate tissue regeneration and enhance nerve sensitivity.

  • PT-141 (The "Pink Shot"): A centrally-acting peptide that increases sexual arousal and desire in the brain's pathways.

  • Emsella® Chair: Uses HIFEM technology to strengthen the pelvic floor muscles, which is critical for orgasm intensity and urinary control.

  • Transvaginal Laser Therapy: Uses gentle laser energy to remodel tissue and stimulate collagen production, complementing local estrogen therapy for GSM.

• Important Safety Information: All of these are safe, in-office procedures with minimal to no downtime. A consultation will determine the best combination of therapies for your specific goals.

Foundational Supplements & Nutrition

• What It Is: A targeted nutritional protocol to support hormonal health, muscle mass, and cellular energy.

• Our Protocol Includes:

  • Core Nutrients: Vitamin D3+K2, Magnesium, and Omega-3 Fatty Acids.

  • Sarcopenia Prevention: A focus on high protein intake (1.2-1.6 g/kg) and Creatine Monohydrate (3-5g daily) to preserve muscle and support brain energy.

  • Targeted Support: B-Vitamins for post-HBC repletion and compounds like DIM and Sulforaphane to support healthy estrogen metabolism.

• Important Safety Information: All supplement recommendations are personalized based on your lab work and health history.

Targeted Peptide Therapies

• What It Is: The use of specific signaling molecules to provide precision support for common menopausal concerns.

• Key Peptides for Women:

  • BPC-157: To accelerate healing and address menopausal joint pain (arthralgia).

  • GHK-Cu: To signal for collagen production, improving the health of skin, hair, and joints.

  • CJC-1295 / Ipamorelin: A Growth Hormone secretagogue to improve lean muscle mass, decrease body fat, and enhance sleep and recovery.

• Important Safety Information: Peptide therapies are prescribed after a thorough medical evaluation.

NAD+ Restoration (IV, SubQ, Oral)

• What It Is: A cornerstone therapy to restore levels of NAD+, a critical coenzyme for cellular energy and repair that can decline by 50% between ages 40 and 60.

• Relevance to Menopause: The decline in NAD+ exacerbates menopausal symptoms. Restoring it can significantly improve fatigue and "brain fog" by fueling mitochondrial ATP production, support metabolic health by activating sirtuin "longevity genes," and enhance cellular resilience.

• How It Works (The Science): We offer multiple strategies based on your needs. IV NAD+ provides the most potent, rapid restoration for those with significant fatigue. Subcutaneous NAD+ offers a convenient method for long-term maintenance. Oral Precursors (NR, NMN) provide foundational daily support for your body's own production pathways.

• Important Safety Information: IV NAD+ must be administered as a slow infusion to avoid temporary side effects like chest pressure or flushing.

Biohacking for Menopausal Vitality

• What It Is: The use of specific technologies to enhance energy, reduce inflammation, and improve cognition during the menopause transition.

• Our Four Pillars:

  • Photobiomodulation (PBM): Uses red and near-infrared light to boost mitochondrial energy, reduce inflammation, and support skin health.

  • Exercise with Oxygen Therapy (EWOT): Super-saturates tissues with oxygen to improve mental clarity and cellular energy.

  • Pulsed Electromagnetic Field (PEMF) Therapy: "Recharges" cells to reduce pain, improve sleep, and support bone density.

  • NanoVi Therapy: Helps combat oxidative stress and improve cellular repair, enhancing overall resilience.

• Important Safety Information: These are all non-invasive, evidence-based modalities with excellent safety profiles.