Ree R. Smith, FNP

260 West 5th Street, Cookeville, Tennessee 38501, United States

(931) 229-0552

New Location opening January 1, 2020 260 W 5th Street, Cookeville, TN

How do I know if I am in menopause?

 Menopause is medically defined by experiencing one year without a period with no other known cause. Hormonal changes can begin 10 years before menopause during the perimenopausal years. Some women may experience challenging hormonal fluctuations in there 20’s! If you are uncertain if your symptoms could be due to a hormonal imbalance, please feel free to contact us with any questions. We are happy to help! A self assessment is available here

What are the stages of menopause?

 The menpause transition can begin occurring in the 40's and is often described as perimenopause. Your menstrual cycle may become irregular, experience more difficulty sleeping. Most commonly, anxiety and/or depression occur and many women do  not relate their symptoms  to  hormonal fluctuations. Cick here to be redirected to Women's Health Research Institute at Northwestern University and discover more about the stages of menopause. 

What are bioidentical hormones?

 There can be a lot of confusion around the term 'bioidentical'. Bioidentical is a used to define hormones that are molecularly identical to those produced in the body. Bioidentical hormones are available through pharmaceutical companies (Envista, Estrace, Vivelle, etc. are examples) as well as compounding pharmacies. Click here for a complete listing of FDA approved bioidentical hormones. 

What is Video chat?

 A Video chat offers you the opportunity to get your questions regarding hormonal imbalances answered for free! You can connect with us through our telemedicine platform. Just go to the scheduling page and pick a convenient time. No special equipment is needed. You can connect with us through computer or smartphone. Please use the contact form if you wish to communicate via email. And of course, you can call and speak to by telephone at (931) 229-0552.

Telemedicine for menopause? Does it work?

 Telemedicine is very well suited for menopause medicine. Each woman may experience varying symptoms. Taking the time for a discussion is incredibly important and not often possible in a routine office visit. Telemedicine offers the time to carefully examine individual difficulties and customize solutions. 

What type of treatment options are available?

 We offer several options including bioidentical topical hormones as some studies have demonstrated a more positive safety profile as opposed to oral and injected compounds. We offer pharmaceutical topical bioidentical formulations including Estrace Vaginal cream, Alora, Climara, Esclim, Estraderm, FemPatch, Menostar, Vivelle, generic transdermal patch, Estrogel, Elestrin, Divigel topical gel, Evamist topical spray, Estring vaginal ring, Femring Vaginal ring, Vagifem vaginal tablet, Estrasorb topical lotion and Prometrium pill. We can also provide customized formulations which can be compounded. 

Are there any treatments that don't include hormones?

 Many avenues to alleviate symptoms along the meopause journey exist. You may prefer nonhormonal pharmaceutical medications, lifestyle changes, dietary adjustments, nutritional supplements, botanicals, aromatherapy, mind-body techniques, yoga, acupuncture, and/or a functional medicine approach. We can provide guidance for women who choose not to use hormones to optimize health.

How do I know if I need HT?

 A good question. Hormone Therapy (HT) is not a one-size fits all solution. Proper treatment HT requires a comprehensive medical evaluation based on a review of symptomology. Our Nurse Practioner Menopause Specialist can discuss your individual risk factors and expected benefits and togeter you can decide if HT is a good fit. 

Will my insurance cover it?

 Your health insurance may cover some expenses. We do not bill health insurance directly and we are not a preferred provider for any insurance. However, we can provide all the paperwork necessary to file with your insurance carrier. 

What labs do I need?

Every women should have the basics including complete blood count, comprehensive metabolic profile, and cholesterol screening regularly (usually once a year but can be more frequent depending on health conditions and medications). Other testing should be customized for each woman and may include thyroid testing (including TSH, Free T3, Free T4, and reverse T3), estradiol, progesterone, testosterone, DHEA, SHBG (sex hormone binding globulin), Vitamin D, Vitamin B12, Folate, and others. Lab testing is generally not required to diagnose menopause. Clinical presentation and symptoms usually provide needed information for diagnosis.

 Your health insurance may cover some blood testing. We can provide an order for any needed lab work. 

We do not endorse salivary testing as this method has not demonstrated accuracy.

We do not profit from testing.

What products do you sell?

 We do not sell any products. It has long been considered unethical for a medical provider to sell any products as the profit motive could impact treatment decisions.. We recommend what we feel is the best option for each unique woman. Beware of any provider or company that is trying to sell you "a one size fits all" product for hormone replacement or recommends extensive and frequent testing to customize dose.  Each woman is unique and has individual needs. The solution will be variable. 

Are there any hidden costs?

 No. We are very transparent regarding cost. There are no hidden fees or recurring subscription fees. All visits are $65 for 30 minutes or $120 per hour. Labs (if necessary) are billed separately directly from the lab. If questionnaires are completed before the initial consultation, time may be used more efficiently.