Hormones, menopause, and Ovella — answered

Ovella Health is a physician-led virtual practice for women in perimenopause, menopause, and beyond. We provide personalized hormone replacement therapy (HRT), longevity, and preventive care via telehealth — one pathway, individualized to you. Learn more about becoming a patient →

Ovella Health was co-founded by Dr. Kelly Baxter, MD and Dr. Kelsey Sherman, MD. Both are board-certified family medicine physicians (DABFM) and Menopause Society Certified Practitioners (MSCP) — the credential awarded by The Menopause Society (formerly NAMS) for clinicians with demonstrated expertise in midlife hormone care.

We are currently licensed to see patients physically located in Montana, Colorado, Wyoming, and Idaho. State licensure is required for telehealth, so you must be in one of these four states at the time of your visit. We update this list as our licensure expands.

One pathway, individualized to you. Hormone optimization is our core work — HRT, symptom relief, and care that takes the time to actually personalize your plan. When you want to go deeper into longevity and prevention (comprehensive screening labs, DEXA scans, coronary calcium scoring, supplement strategy), we're here for that too — you just pay for our time. Membership covers between-visit messaging and ongoing support. See the full overview →

All visits are conducted via secure video. After you book, you'll complete a short intake and receive a video link. First visits are typically 60 minutes so we can actually individualize your care. Between visits, you can message your doctor directly through our secure platform.

HRT replaces the estrogen, progesterone, and (sometimes) testosterone that decline during perimenopause and menopause. It is the most effective available treatment for vasomotor symptoms (hot flashes and night sweats) and for prevention of osteoporosis in appropriate candidates.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

Hormones have been studied for decades, and for most healthy women the risks of HRT are small and well-characterized. The Menopause Society's 2022 position statement supports HRT for most women under age 60 or within 10 years of menopause.

Safer formulations exist for women with specific risk factors. Transdermal estrogen (patches, gels, and sprays) does not carry the venous thromboembolism (blood clot) risk associated with oral estrogen — making hormone therapy appropriate for many women who might otherwise be excluded.

The breast cancer conversation has been historically misleading. The original Women's Health Initiative findings were widely misinterpreted; subsequent re-analyses and decades of follow-up research have clarified that estrogen-only therapy (for women without a uterus) shows no increase — and in some analyses a decrease — in breast cancer risk. Combined therapy with micronized (bioidentical) progesterone appears to carry less risk than the synthetic progestin used in the original WHI. For most women, the absolute increase is small or shows no clear increase at all.

It's also worth knowing that breast cancer risk can be meaningfully reduced through lifestyle — regular exercise, limiting or abstaining from alcohol, not smoking, and maintaining a healthy body weight all matter. For patients with a high-risk family history, we offer evaluation for genetic testing and higher-risk screening protocols. Being at higher genetic risk does not automatically mean hormone therapy is off the table — we would individualize the safest regimen alongside appropriate screening.

We strive to use the safest formulation for your individual history, and we spend the time to educate every patient on the risks and benefits so you can make an informed decision that's right for you.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.
Manson JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA 2017;318(10):927-938.
Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies. BMJ 2019;364:k4810.
Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008;107(1):103-111.
World Cancer Research Fund / American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Breast Cancer (Continuous Update Project, 2018).
US Preventive Services Task Force. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer. JAMA 2019;322(7):652-665.

“Bioidentical” means the hormone is molecularly identical to what your body makes. FDA-approved bioidentical options exist — estradiol (patches, gels, sprays, oral, vaginal) and oral micronized progesterone — and are different from compounded bioidentical formulations, which are not FDA-regulated for purity or dose.

Reference: ACOG Committee Opinion No. 532: Compounded Bioidentical Menopausal Hormone Therapy. Obstet Gynecol 2012;120:411-415 (reaffirmed 2020).

We prescribe FDA-approved bioidentical hormones whenever clinically appropriate, because the safety, dosing, and quality data are stronger than for compounded products. We do not routinely prescribe pellets or compounded combinations. The Menopause Society and ACOG advise caution with compounded hormones outside of specific medical situations.

Reference: ACOG Committee Opinion No. 532: Compounded Bioidentical Menopausal Hormone Therapy. Obstet Gynecol 2012;120:411-415 (reaffirmed 2020).

Most healthy women with bothersome perimenopause or menopause symptoms are candidates for HRT. Specific contraindications include a personal history of breast cancer, recent or active venous thromboembolism, untreated coronary artery disease, and certain liver disease. We discuss your individual risk-benefit balance at your first visit.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

Common side effects in the first few months can include breast tenderness, bloating, mood changes, or breakthrough bleeding — most resolve as your body adjusts, and we adjust dose or delivery method when they don't. Less common but more significant risks (venous thromboembolism, stroke) vary by formulation, route of delivery, and individual factors. Transdermal estrogen carries a lower clot risk than oral.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

There is no fixed time limit. The Menopause Society’s current position is that the duration of HRT should be individualized based on a woman's symptoms, risks, and goals — there is no arbitrary “stop at age X” rule. Many women continue HRT for many years with ongoing benefit.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

Perimenopause is the transition leading up to menopause, when ovarian function and hormone production begin to fluctuate. It usually starts in a woman’s 40s but can begin in the late 30s, and can last from a few years to over a decade before periods stop entirely. Menopause is defined as 12 consecutive months without a period.

Common symptoms include hot flashes, night sweats, sleep disturbance, brain fog, mood changes (anxiety and irritability), low libido, vaginal dryness, weight changes (especially abdominal), joint pain, and irregular or heavy periods (in perimenopause). Severity varies widely from person to person.

Reference: ACOG Practice Bulletin No. 141: Management of Menopausal Symptoms. Obstet Gynecol 2014;123:202-216 (reaffirmed 2023).

Cognitive symptoms — word-finding difficulty, slower processing, foggy thinking — are commonly reported in perimenopause and often improve with HRT, especially when started early in the menopausal transition.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

HRT does not directly cause weight loss, but it can support metabolic health by improving sleep, shifting body composition away from visceral (abdominal) fat, and preserving lean muscle when combined with strength training. Weight changes in menopause are driven primarily by hormonal shifts in body composition rather than caloric intake alone.

Reference: The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767-794.

GSM includes vaginal dryness, painful sex, urinary urgency, and recurrent UTIs caused by declining estrogen in genitourinary tissues. Systemic HRT (pill, patch, gel) treats GSM for many women, but symptoms often persist on systemic therapy alone — in which case adding low-dose vaginal estrogen is safe and effective. Vaginal estrogen is minimally absorbed systemically: there can be some early absorption (especially with significant vaginal atrophy and skin thinning), but blood levels typically become undetectable with continued use. Using systemic HRT and low-dose vaginal estrogen together is appropriate and safe for many women.

Reference: The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause 2020;27(9):976-992.

Our standard prices for visits and memberships are published on our website for transparency. We are a direct-pay practice, so you'll know the cost before you schedule. A personalized written Good Faith Estimate is available on request — just email admin@ovellahealth.com.

Ovella Health does not bill insurance directly. We can provide a superbill (an itemized receipt) that you can submit to your insurance for possible out-of-network reimbursement, depending on your plan. Most HSA and FSA accounts will cover our services.

We order labs and imaging through your local lab or imaging center (or your preferred network). You pay those facilities directly — and we encourage you to request a Good Faith Estimate from them in advance, especially if you're paying out of pocket. We do not have visibility into outside facility pricing. That said, we do have access to discounted cash-pay lab testing through Quest locations — typically $50–$300 for individualized or comprehensive lab panels. Just ask.

The best place to start is a free 15-minute discovery call. We'll discuss what brought you to Ovella and help you pick the plan that fits your goals.

We are not able to bill Medicare, and patients cannot submit superbills to Medicare for reimbursement. If you are on Medicare, you’ll need to book with Dr. Kelly Baxter, MD — due to Medicare requirements she is the only Ovella physician who can see Medicare patients. Questions? Reach us at admin@ovellahealth.com.