​​If you are 30-65 years old and noticing changes that may be related to shifts in your hormones, and you want to learn more about how to reduce symptoms and future health risks that happen with these hormonal shifts, then I would love to meet you. 

Go to Our Services page to schedule your first visit or a brief discovery call if you still are unsure after exploring the website

It is important to recognize that our understanding of the human body, health, and medicine is constantly evolving.  Medicine's foundation and strength is built upon our collective ability to challenge our assumptions,  scrutinize new evidence, and continually improve our care. 

We don't have all the answers, we never will. We do our best with what we have at any given time.  

While we continue to grapple with uncertainties, our role as healers is to lean in, listen, and really hear our patients concerns. 

Our role as scientists, is to bring a critical eye to our observations, data, and conclusions we make.  

At the heart of the historical concern with MHT is it's potential to increase the risk of invasive breast cancer.  I consider this risk very seriously when I advise patients on MHT.

Trends in breast cancer over the past century have fluctuated up and down, but overall, there has been an increase in incidence over the past 50 years.  

The reasons for the fluctuations and overall rise are unclear. 

Twenty years ago, popular media reported on The Women's Health Initiative findings of the potential increased risk of invasive breast cancer while on a combination of equine estrogens and synthetic medroxyprogesterone.   However, the science is more nuanced.   Notably, those women who took estrogen alone without any progesterone had a lower risk of breast cancer!

In Medicine, we first aim to do no harm, and we hold each other accountable.   

The faulty interpretations of this very specific data that was overemphasized in the media was not without harm.   The fear of breast cancer spread like wildfire and created a cloud of fear that took 20 years to start to clear.

There is now a growing number of menopause-informed providers who see the harms of not prescribing hormones over the past 20 years, including the morbidity and mortality related to heart health, bone health, dementia, and possibly even breast cancer.  Not to mention the symptoms and unnecessary suffering that lead to excessive health care costs and a diaspora of women from the workforce.

With this paradigm shift, we can more clearly see the path forward.

Today, newer hormone regimens are prescribed with the following improved practices in mind:

• Starting Menopausal Hormone Therapy before age 60 or within 10-years of menopause,

• Focus on lower doses,

• Delivery of estrogen transdermally  (patch, gel, spray) rather than oral pills and,

• Use of bioidentical hormones derived from plants, rather than conjugated equine estrogens or synthetic progesterone, and

• Improved risk benefit analysis - balancing the potential small increase risk of breast cancer in the setting of improved quality of life and potential for decrease risk of heart disease, bone disease, dementia, and all cause mortality.

The hormones I prescribe are bioidentical, plant-based, and FDA approved for safety and efficacy.

Essentially, these hormones are chemically identical to the hormones naturally produced by the human body, derived from plant sources, and have been approved for use by the Food and Drug Administration (FDA) for medical treatment. 

Estrogen can be given in several forms. Systemic forms include oral pills, and topical formulations, such as skin patches, gels, and sprays that are FDA-approved. 

Local forms are topical, used vaginally or on skin at lower concentrations than systemic doses in the form of creams, gels, tablets, or silicone rings

When Progesterone is indicated, the choice is typically in the form of a oral micronized progesterone pill or an intrauterine device (IUD system that dispenses Levonorgesterone ( progesterone) such as Mirena or Lilleta)

Testosterone treatment is more complicated. Unfortunately, currently there are no FDA-approved forms of testosterone approved for women.   The doses available for men are 10x the dose appropriate for women.    When testosterone treatment is indicated, monitoring blood tests are required and prescriptions may need to come from a compounding pharmacy. 

Compounded bioidentical hormones are made by a compounding pharmacist from a health care professional’s prescription. Compounded drugs are not regulated by the U.S. Food and Drug Administration (FDA). Compounding pharmacies must be licensed, but they do not have to show the safety, effectiveness, and quality control that the FDA requires of drug makers.

The Menopause Society recommends AGAINST testing hormone levels, in most situations, as a means of determining which hormones to prescribe and at what doses. 

This is because your hormone levels fluctuate throughout the day. Determination of your treatment plan is based on your symptoms, your health risks, and other individual factors.  We will have time to discuss this at your visit.  

While I aim to prescribe the lowest dose necessary to achieve your goals, you will ultimately determine if the dose is right for you based on how you feel.

Not at this time.

As an Independent, solo practitioner, I have chosen to have a direct financial relationship with patients so that our time is not dictated by the constraints of the current health system.

I can provide you with the necessary paperwork that you can submit to your insurance company for reimbursement purposes. Depending on your policy, you may be reimbursed for a portion of the visit charge.

Every woman in NH and VT will go through menopause and many will have disruptive symptoms and future health risks that impair their ability to show up as their best selves for the second half of their life.   If your decision to seek or receive care is limited by your ability to pay for services, please let me know and we an work together to get you the care you deserve.