• In short, yes they are technically different. HRT refers to literally replacing a woman's hormones after they are abruptly lost. An example is surgical removal of the ovaries, the organs that produce the critical hormones of estrogen, progesterone, and testosterone (yes, women make testosterone too). Hormone therapy, or menopausal hormone therapy (MHT), refers to replacing hormones that are either very fluctuant during perimenopause or depleted after menopause. McKenzee can treat both of these and more.

• A few big events have taken place that have resulted in menopause "having a moment", and we are here for it! We've had ample research for many decades showing that for the majority of women, hormone therapy is safe, effective, and comes with many health preventative benefits. It is important to understand the results and implications of the Women's Health Initiative. This is to date the largest randomized controlled trial regarding women's health and hormone therapy. In 2002 the authors of this study released preliminary results of the study and prematurely stopped the study due to concerns regarding the safety of MHT. Unfortunately, we now know that the study results were significantly misinterpreted and how this was communicated to the public was very flawed as well. This is not to say it was a "bad study", it was and still is an important and useful study. The difference is now we have rebuked those unfounded claims and MHT is once again recognized as a safe and critical therapy for women's health. Additionally, the FDA recently removed the Black Box Warning on FDA approved hormone products  in the U.S., representing a positive step forward. It should be noted that it is not common for a black box warning to be removed and takes significant effort and data to do so.

• Menopause is an event that will occur in every single woman's life. There is not a similar event that occurs for men, although some men will experience a decrease in their hormones as well. Menopause refers to the time when a woman's body stops producing critical hormones like estrogen, progesterone, and testosterone. Perimenopause refers to the time period, usually 7-10 years leading up to menopause, when women began experiencing some of the symptoms related to this change. This may include hot flashes, night sweats, changes in mood and energy level, fatigue, brain fog, sleep disturbance, weight changes, joint and muscle aches and pains, vaginal dryness, decreased libido, increased urinary tract infections and more. There are various definitions of menopause, but most experts agree this is when a woman has not had a period for 12 months or longer. For women who have had their uterus removed (hysterectomy), this is more nuanced. In perimenopause, women may experience significant fluctuations in their menstrual periods.

• These chapters in a woman's life typically cause major symptoms and disruptions to quality of life. There are hormone receptors all over our body such as the brain, bones and muscles. genitourinary system, and cardiovascular system. Thus, women may experience brain fog, mood changes, sleep disruption, hot flashes and night sweats, weight changes, vaginal dryness or painful sex, decreased libido, urinary tract infections and more. These symptoms are not just bothersome, they are not something for women to simply ignore or power through. This change places women at significantly increased risk for heart attacks and strokes, dementia, osteoporosis and broken bones, frailty and falls, urinary tract infections, sepsis and death. We can not afford to ignore this any longer. For the majority of women, MHT is incredibly safe and effective in relieving their symptoms while also adding preventative benefits against cardiovascular disease, dementia, osteoporosis and fractures, urinary tract infections, and even serious infections like sepsis

• McKenzee has built her career around being approachable, prioritizing listening to the patient or client and hearing their concerns, and providing evidence based and individualized care. We will sit down with you in person or virtually, we want to hear your story and know this takes much more than 15 minutes and a one size fits all approach. We want you to feel completely comfortable discussing your concerns and to know that you are in charge of your health and wellness journey, we are thrilled and honored to be a part of it! We believe that while hormone therapy is safe and effective for the majority of women, some will prefer to avoid this or are not candidates; where we come in is to ensure each woman at a minimum has the best information and options available to her regardless of which path she chooses to take.

• It is important to “do your research” when choosing a clinician to manage your hormonal concerns and prescribe hormone therapy. McKenzee usually opts for FDA approved hormone therapy as it is extensively researched and thoroughly vetted to be sure what you are putting in your body is safe and effective. Compounded medications do have a place in the women’s health and hormones, this is an individual discussion. We use In Health Pharmacy in Fargo as they have an excellent team and provide an ethical, consistent product. McKenzee has met with their team and toured their pharmacy.

• McKenzee does not provide or promote pellets as a way to take hormone therapy. These are not well studied, expensive, invasive (cut the skin open to place the pellet), often a one-size-fits-all approach, result in very high levels of hormones, and tend to be highest risk for side effects.

There are several ways to deliver healthcare in the U.S. and around the world. Traditionally in the U.S., most of us are familiar with an insurance based model. An emerging model that does improve access to quality, individualized care and tends to be more cost effective over time is a direct care or cash based model.

Next Chapter Hormone & Wellness is a small, solo private practice that operates a “cash based” model for several reasons.

• We prioritize pricing transparency. This means when you receive care at our clinic, you know exactly what you will pay. There will be no guessing what the service costs or what will be covered.

• We believe are prices are highly competitive with other similar practices throughout MN and ND. When compared to more urban areas or large online telehealth companies, our prices are often half the cost.

• Insurance companies all too often have the end say in your care, when it should be your clinician and you who have the final say.

• Due to the cost of running a clinic that takes and processes insurance, it has become nearly impossible in modern day to run an insurance based practice similar to Next Chapter Hormone & Wellness.

• As insurance coverage often lacks a decade or more behind modern science and medicine, often these critical women’s health services are not even covered under insurance.

• We accept HSA and FSA cards, no problem!

• We can provide a “super bill” for you if you are interested. This is a detailed service list that you can submit to your insurance company, sometimes they will provide some coverage with this approach.

• Typically we prescribe FDA approved hormone therapy not only because it has the best safety and efficacy data behind it, but also due to this- your insurance company is more likely to cover/contribute to the cost of your prescriptions and tends to be more cost effective than compounded medications.

Currently in our early opening phase, we can not see Medicare patients at Next Chapter Hormone & Wellness. Due to Medicare regulations, an individual who is covered by Medicare in any capacity (primary, secondary, etc.) may only pay cash for services if the clinician is “opted out” of Medicare. At present time, this is not an option for McKenzee.

However, please know it is very important to me to be able to see all women who are interested in this service. I will be working diligently to include Medicare patients in the near future. Even when this occurs, it will remain a cash based practice and Medicare patients will not have insurance coverage of their visit.