Personalized telehealth care for perimenopause and menopause, including hot flashes, night sweats, sleep changes, brain fog, vaginal and urinary symptoms, libido concerns, and other hormone-related changes.
Hormone changes during perimenopause and menopause can be gradual, unpredictable, and easy to dismiss as stress, anxiety, poor sleep, or 'just aging.' I take time to review what changed, when it changed, your cycle pattern, symptoms, medical history, previous treatment, and relevant laboratory testing. Treatment may include estradiol, micronized progesterone, low-dose testosterone, vaginal estrogen, and other supportive therapies when clinically appropriate.
You don't need every box checked. If two or three of these sound familiar — or you've been told "your labs look fine" while still feeling off — it's worth a real conversation.
"Every one of these gets asked about on the intake — not skipped because a number came back inside a reference range."
New or worsening anxiety, mood swings, or irritability that feels chemical
Hot flashes, night sweats, or sleep that breaks at 2 or 3 AM
Cycle changes — shorter, heavier, skipped, or unpredictable
Brain fog, word-finding trouble, memory lapses
Joint pain, stiffness, frozen shoulder, new aches in your 40s or 50s
Low libido, vaginal dryness, or painful intimacy
Weight gain at the waistline despite no real lifestyle change
Heart palpitations after a normal cardiac workup
Hair thinning, widening part, increased shedding
Told you're 'too young' or your 'labs look fine' while you still feel off
Cycles can still be regular and FSH can still look 'normal' while symptoms are very real
Perimenopause is defined by hormonal instability, not deficiency — a single lab draw is a poor tool for measuring instability
Symptoms, history, and timing matter as much as the number on the page
Hormonal changes can contribute to mood changes, sleep disruption, headaches, cognitive complaints, palpitations, and musculoskeletal symptoms — though these symptoms can also have other causes
Many women are treated for anxiety or depression for years before perimenopause is considered
If a symptom started or got louder in your late 30s or 40s, hormones belong in the differential
Perimenopause commonly starts in the late 30s and 40s — sometimes earlier
Being told you're 'too young' is the single most common reason women lose years before getting evaluated
Age is one data point, not the answer
"Bioidentical" means the hormone is structurally identical to what your body makes — estradiol and micronized progesterone are available as FDA-approved products
Compounding isn't required for bioidentical therapy; professional guidelines generally favor FDA-approved options when they meet your needs
Dose, route (oral, transdermal, vaginal), and combination matter and should be tailored to you
The best-supported use is low sexual desire with distress (HSDD) in postmenopausal women after other contributing causes are evaluated
There is no FDA-approved testosterone product for women, so any use is off-label and dosed to female physiologic levels
Evidence does not support prescribing it for energy, mood, or general wellbeing; treatment includes baseline and follow-up monitoring
If you've been dismissed, rushed, or told to come back when your periods stop — that's not evaluation. That's a brush-off.
Keep reading
Before your first visit, these are the pieces I most often send patients. They cover the questions that come up again and again in perimenopause and menopause visits.
A woman is born with every egg she'll ever have. Estrogen and progesterone aren't produced on a schedule set by a calendar — they're produced by the follicles that mature each cycle. As the follicle pool shrinks, ovulation becomes less predictable, and so does everything downstream of it. That's the mechanism behind perimenopause: not a smooth decline, but an increasingly erratic signal.
Cycles can still look regular while ovulation becomes less reliable. Progesterone is made after ovulation, so cycles without reliable ovulation can mean lower progesterone — which some women notice as worse PMS, shorter luteal phases, lighter sleep, or anxiety that feels new.
As the follicle pool declines, FSH rises to push the ovaries harder. Estradiol doesn't fall in a straight line — it swings, sometimes higher than it ever was, then crashes. Those swings drive hot flashes, migraines, palpitations, heavy or unpredictable bleeding, brain fog, and mood changes. This is also why one blood draw so often looks 'normal.'
Twelve months without a period. Estradiol and progesterone settle at a low, stable baseline. Symptoms often change character here — fewer wild swings, more of the steady effects: vaginal dryness, sleep disruption, joint pain, skin and hair changes, and accelerating bone loss in the first years after the final period.
Women make testosterone too, in the ovaries and adrenal glands, and levels generally decline gradually with age. Surgical menopause can lower it more abruptly. It rarely gets measured, which is part of why low libido, low drive, and loss of stamina get written off.
Perimenopause can last four to ten years. The goal isn't to reverse aging — it's to treat symptoms and protect bone, brain, and cardiovascular health during a transition that isn't optional.
There are a lot of telehealth options available. Here's how I approach care differently — one experienced clinician, thoughtful evaluation, and ongoing follow-through that doesn't disappear after the first visit.
Same clinician, every visit. I know your history, your labs, and what you've already tried. Nothing gets lost in a handoff.
Before recommending treatment, I review your symptoms, medical history, lifestyle factors, and relevant laboratory data to better understand the full picture.
Message me directly. I answer. I adjust as your body responds, and I keep adjusting for as long as you're a patient.
Complete a secure intake form and upload any relevant records or laboratory results if available.
An unhurried 1:1 telehealth visit. I go through your labs, talk through what's been going on, and build a plan together.
Prescriptions sent to your pharmacy of choice, with dosing adjusted to how you actually respond — not a one-size protocol.
Direct messaging, regular check-ins, and a clinician who follows through.
One clear program built around your goals, symptoms, labs, and ongoing care.
Menopause & HRT starts with a $199 initial evaluation, then continues at $99 per month. Prescriptions are sent to the pharmacy you choose. Medication, pharmacy costs, laboratory testing, and imaging are separate and paid directly to the pharmacy, lab, or imaging center.
HSA / FSA cards accepted
Comprehensive hormone-focused evaluation
One-time
$199
Billed once
Initial laboratory testing, if needed, is billed separately by the lab.
Book initial evaluationStep 2 · ongoing hormone management after your initial evaluation
Monthly
$99
per month · cancel anytime
·Billed separately
Transfer Your Hormone Therapy Care
Already on hormone therapy elsewhere?
Transfer patients are welcome. Bring your current prescription, recent laboratory testing if available, and a brief summary of what's been tried. I'll review what's working, what isn't, and where dosing or route might need adjustment.
Not all treatment options are appropriate for every patient. Program fees are cash-pay. HSA and FSA cards are accepted, and I can provide an itemized receipt you may submit to your insurer for possible reimbursement — reimbursement isn't guaranteed. Insurance can often be used for medications and laboratory testing. Prior authorizations and other administrative requests are not included in the membership.
Don't see your question? Reach out — you'll get a reply directly from Mallory. Messages are typically answered within 2 business days.
Ask a questionOften, yes. Hormone therapy is not limited to women who have completed menopause. If perimenopausal symptoms are affecting sleep, mood, cycles, or quality of life, treatment may be appropriate after we review your history, symptoms, and any relevant laboratory testing.
No. Waiting twelve months without a period isn't a requirement for treatment. Many women are treated during perimenopause, when cycles are still occurring but symptoms have already started.
HRT is the general term for hormone replacement therapy. BHRT refers to hormones that are structurally identical to the ones your body makes, such as estradiol and micronized progesterone — many of which are FDA-approved. The label matters less than the specific hormone, dose, and route prescribed for you.
Yes. Menopause and perimenopause care is well suited to telehealth. Visits happen by secure video, laboratory testing is ordered locally when needed, and prescriptions are sent to the pharmacy you choose in states where I'm licensed.
Common options include estradiol (patch, gel, spray, or oral), micronized progesterone, vaginal estrogen for genitourinary symptoms, and low-dose testosterone in select cases. What's appropriate depends on your symptoms, history, and whether you still have a uterus.
Not always. Hormone-related laboratory evaluation can help inform whether treatment is appropriate and what options to consider. If you have recent testing, we'll review those results first and only order what's missing.
Probably not. Perimenopause often starts in the late 30s and 40s, and cycles can still be regular while symptoms are very real. Age alone doesn't rule symptoms in or out.
For most healthy women in or near menopause, current evidence supports BHRT as a safe and effective option. I screen for contraindications and review individual risks and benefits before prescribing.
In some cases, yes. Low-dose testosterone may be considered for women experiencing symptoms such as low libido, fatigue, or reduced sense of wellbeing when clinically appropriate. Because testosterone is a controlled substance, it can only be prescribed in IN, NV, NM, and MT.
I primarily prescribe FDA-approved estradiol and micronized progesterone in transdermal, oral, or vaginal forms, along with compounded testosterone when appropriate. Pellets carry dosing and adjustability limitations I'd rather not work around.
Most patients check in every 4–8 weeks while we dial in dosing, then move to less frequent visits as things stabilize. Repeat laboratory testing is ordered when clinically appropriate.
Response times vary. Some women notice improvements within a few weeks; others see more gradual change over several months as treatment is adjusted.
Program fees are cash-pay. HSA and FSA cards are accepted, and I can provide an itemized receipt you may submit to your insurer for possible reimbursement — reimbursement isn't guaranteed. Insurance can often be used for medications and laboratory testing when applicable. Prior authorizations are not included in the membership.
Yes. HSA and FSA cards are accepted for program fees and, in most cases, for medication and laboratory testing as well. If your plan requires a receipt or letter of medical necessity, just ask.
Messaging is included for questions about your active hormone plan — dose adjustments, refill requests, how a new formulation is feeling, and follow-up on symptoms. Messaging is for brief treatment-related questions, answered within 2 business days; weekends and observed holidays do not count. Messaging is not for new medical concerns, urgent symptoms, or prescriptions outside your hormone program. Those require a scheduled visit.
Symptom guides
Why hot flashes and night sweats happen in perimenopause and menopause, which hormonal and non-hormonal treatments are used, and how online care with an FNP-C works.
Read the guideWhat perimenopause tests can and cannot show, why FSH and estradiol levels are unreliable in midlife, and which labs are genuinely useful before starting hormone therapy.
Read the guideWhy perimenopause disrupts sleep, how night sweats, progesterone changes and anxiety interact, and what treatment options are considered in an online visit.
Read the guideWhy weight and body composition shift in perimenopause, how hormones, sleep and insulin resistance interact, and how hormone care and medical weight management fit together.
Read the guideGenitourinary syndrome of menopause explained: dryness, burning, painful sex and urinary symptoms, plus vaginal estrogen and non-hormonal treatment options through telehealth.
Read the guideTransparent cash-pay pricing for online menopause and perimenopause hormone therapy: monthly plans, what is included, and what labs and medication cost separately.
Read the guideWhere care is available
Ready when you are
During your visit, we'll review your health history, goals, symptoms, and treatment options to determine an appropriate plan moving forward.
From the journal
Endocrine · 7 min
Perimenopause isn't defined by hormone loss. It's defined by hormonal instability — and that instability can disrupt every system in the body years before periods stop.
Read →
Hormone Health · 8 min
Perimenopause can begin in the late 30s and routinely shows up as anxiety, joint pain, palpitations, or insomnia long before a single period is missed. Here's what to actually look for.
Read →
Diagnostics · 7 min
TSH is the recommended first-line test, and for most people it answers the question. When symptoms and TSH don't line up, a broader look — free T4 and thyroid antibodies in particular — can add useful context.
Read →
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