Hormonal Therapy Services

Many people think about hot flashes, night sweats, genitourinary symptoms (dryness and irritation), weight gain, and brain fog. These are some of the most common, but there are others. Here is a list that goes through many more.

The demographics of our country are changing. 

In the past 25 years, the menopausal population of the United States has more than doubled. By 2030, almost 50% of women (and people assigned female at birth) will be menopausal. 

The significant changes people experience during menopause have often been ignored and underaddressed. There is also recognition of the misinterpretation of previous research studies, that led to the underutilization of MHT for decades.  

Like many things in life and healthcare, we must consider individual factors.  But, we now know that for many people, especially if you are within ten years of entering menopause and you are experiencing significant symptoms, MHT can represent both a safe and effective treatment option.

In the late 1990s, a large study called the Women’s Health Initiative (WHI) was conducted to assess the safety of hormone replacement therapy in women. The study was stopped early when preliminary data seemed to suggest that hormone replacement therapy was associated with significant risks. It is worth noting that at the time of these initial findings, many scientists and physicians disagreed with these findings. 

However, millions of women were taken off of the HRT that they had been taking at the time of the study, and a whole generation of women often received minimal treatment to address their symptoms. A whole generation of healthcare practitioners, including women’s health specialists, learned very little about the use of menopausal hormone therapy. 

While in medical school and training as a family physician, I received little to no training in the use of hormone therapy in menopause. I have had to pursue extensive postgraduate education. While working as an Integrative Physician in San Francisco, I gained clinical experience with hormonal lab testing and supported many people through the menopausal transition with the use of menopausal hormone therapy.

The term bio-identical refers to the chemical structure. Bio-identical hormones have the same chemical structures as those made in the human body. Examples of bio-identical hormones include estradiol and progesterone. Examples of non-bioidentical hormones include conjugated equine estrogens (CEE) and synthetic progestins like medroxyprogesterone acetate (MPA).

Bio-identical vs. non-bioidentical hormones affect the body differently and have different risk profiles. The majority of patients studied in the WHI study took non-bioidentical hormones. The dosages of hormones used were quite high and in forms that did not have the same chemical structure as those made by the human body. These non-bioidentical hormones used at high dosages are associated with negative side effects.  For example, high doses or oral (taken by mouth) non-bioidentical estrogens are associated with an increased risk of blood clots.  In addition, synthetic forms of progesterone (known as progestins) appear to be associated with higher risks for breast cancer, as well as cardiovascular disease. It is also essential that if you have a uterus and are taking estrogen (of any form), this be paired with progesterone.

The menopausal journey is unique to each individual. Some (lucky few) may experience no symptoms, others will have mild and relatively brief symptoms, and others may be more significantly impacted. Similarly, the duration of symptoms varies. On average menopausal hot flashes will last for 3-7 years, but some people may experience symptoms for 10 years or more. 

If you still have a menstrual cycle, your body makes some estrogen, although the levels may fluctuate quite a bit. Estrogen supplementation in this setting is often not needed and may often cause unwanted symptoms and side effects. Looking at other potential causes and contributors to hot flashes—adrenal dysfunction, blood sugar abnormalities, and other hormonal imbalances—can often help to improve/resolve symptoms.

Symptoms can often be improved with lifestyle changes, nutritional or herbal supplementation, and potentially supporting other hormonal levels that may be low (e.g., progesterone, DHEA, etc.)

I take a whole-person approach to working together. I consider your goals and circumstances and seek to partner with you and tailor your care accordingly.  Menopausal hormone care is having a moment. It can be challenging to navigate. On one extreme, there are online menopause health start-ups that have you fill out a questionnaire and will send you hormone creams with little interaction with a provider or individualized follow-up.  On the other extreme are practitioners charging thousands of dollars for a 3-month package guaranteed to 'balance your hormones.'  What happens after 3 months?

I offer a middle path, individualized care, by a real-live seasoned practitioner (me) who will follow and support you over the long term. While insurance does not cover my services, I aim to make my pricing transparent - you pay for your time with me, and there are no programs or packages to sign up for. 

I also offer other supportive treatments, acupuncture, and craniosacral therapy, that can be useful adjuncts during this transition.

The cost for your initial one-hour visit is $285. Lab work (not included in the cost of the visit) is ordered at the initial visit. It will be reviewed at your second visit, and treatment recommendations will be provided. A routine follow-up visit is scheduled in three months and then at least every six months to assess labs and make adjustments to therapy as needed.

Depending on the treatment plan and response, additional visits may be needed. Virtual or in-person care options are available for follow-up care.

Dr. Winbush is not enrolled in any insurance plans. She will provide a SuperBill with each visit if you wish to seek insurance reimbursement. HSA and FSA cards are also accepted.

Other costs: Insurance billing is an option for some lab testing. I also contract with LabCorp to offer affordable cash-pay pricing for labs for those without insurance or with high-deductible plans. Many integrative practices charge substantial markups on their functional medicine labs. I offer these tests to you at the lowest available price.

Please note: Dr. Winbush cannot currently accept Medicare patients, but anticipates being able to do so in early 2025. You can add your name to my Medicare waiting list here.

Schedule a free call, and let’s chat.  You can do so here (links to my scheduling page).