HOW WE KEEP YOUR TREATMENT SAFE, SIMPLE, AND ON  SCHEDULE 

This guide explains how we handle your prescription fills and refills so you always know what to expect — when to schedule your next visit, what supply you'll receive, and how to keep your medication arriving on time. Our goal is straightforward: safe, evidence-based care delivered with as little friction as possible. 

The big picture 

When you're new to a medication, you'll receive a 90-day (3-month) supply with no refills, and we'll schedule a follow-up before your treatment runs out, so we can make sure it's working and you feel well on it. 

Once you're stable, you can be renewed for up to a 6-month supply (90 days with 1  refill) during a video visit.  The supply we send depends on the type of visit you choose — see below. 

Weight loss medication: while you're working up to your maintenance dose, you'll be seen every month. Once you're on your maintenance dose, visits move to every 3 months. 

A yearly video visit is required for continued prescribing — no exceptions. If you prefer to do most of your follow-ups by message, that's great — but we still need to see you on video once a year for every medication we prescribe. 

Video visits vs. message visits 

How long a supply you receive at each refill depends on the type of visit you have  with us: 

• Video visits: you can be renewed for up to a 6-month supply (90 days + 1 refill)  when you're stable. 
• Message visits: you can be renewed for a 90-day supply. 
• Testosterone is the exception — see the testosterone section below. 

What "stable" means 

You're considered stable on your treatment when: 

• You've completed your first follow-up visit (usually 8–12 weeks after starting or  changing your dose) and tell us you're feeling great.

• Your symptoms are controlled 

• You're not having side effects that need a medication change

Small dose adjustments to optimize how you feel will be prescribed 90 days + 1 refill. You can always book a follow-up earlier than 6 months if you are not feeling well.  

How refills work 

Our policy is simple - if you are due for a refill, you are due for a visit. 

There are no exceptions — refilling a medication requires medical decision-making, and your menopause specialist needs the chance to make sure your treatment plan is still the right one for you.  We aim to give you enough medication at each visit to last until your next scheduled visit.  If you request a refill through your patient portal or through your pharmacy, it won't be processed; instead, you'll be directed to book a follow-up visit, and we will handle the script there. 

Menopause hormone therapy (estrogen &  progesterone/progestin) 

• New start: 90-day supply with no refills, then a follow-up at 8–12 weeks. 
• Stable, video visit: 6-month supply (90 days + 1 refill). 
• Stable, message visit: 90-day supply. 
• Compounded hormone therapy, for those who have an allergy or are unable to use FDA-approved MHT,  follows the same rules as commercial products. 

After 12 months on therapy, an annual video visit is required before your next renewal/refill. 

MINOR DOSE ADJUSTMENTS 

If your menopause specialist makes a small change to your hormone therapy dose to optimize how you feel or changes your delivery method (i.e., twice-weekly patch to once weekly, patch to gel, gel to spray, etc), you can still be written for a 90-day supply with 1 refill (a 6-month supply). Big changes — or a change in the type of medication — usually mean we prescribe a 3-month supply and have you schedule a follow-up. 

Local vaginal estrogen and DHEA (prasterone) 

Vaginal estrogen creams, tablets, rings, and prasterone (DHEA) are local-only therapies and have a simpler refill schedule: 

• New start and renewals: 90-day supply with 3 refills — a full 1-year supply. 

An annual video visit is required for continued prescribing. 

If you have a history of breast or other estrogen-sensitive cancer, your menopause specialist will document a shared-decision conversation in your chart before refills continue. 

Testosterone therapy 

Testosterone is a Schedule III controlled medication, so a few extra rules apply: 

• A video visit is required to prescribe or renew testosterone. 
• Where your state allows it, new and stable patients can receive up to a 180-day supply with no refills. That is a 6-month supply and the maximum allowed by the DEA. 
• Some states limit testosterone to a 30-day supply with no refills. If you live in one of those states, we'll send the largest supply your state allows and let you know when to expect your next fill.
• We can't send early refills on testosterone, even for travel. 
• We check your state's prescription monitoring database as required by law. 

The continued use of testosterone requires periodic lab testing, and we need to review the results at the visit to send refills. If you want to begin or continue testosterone and need an order for lab testing, you can simply book a message visit to make the request. Keep in mind that a total testosterone run by LC/MS takes about 12 days for the results to become available.

Non-hormonal menopause and women's health treatments 

This includes antidepressants, oxybutynin, KNDY therapies for hot flashes (such as Veozah and Lynkuet), clonidine, sleep aids, thyroid, cholesterol, hair loss treatment, and other non-hormonal women's health medications — basically every non-hormonal therapy we prescribe, except weight loss medications and anti-aging skin creams. 

• New start: 90-day supply with no refills. 
• Follow-up timing depends on the medication — 4 weeks for KNDY therapies, 4–8  weeks for antidepressants, 8–12 weeks for everything else. 
• Stable, video visit: 6-month supply (90 days + 1 refill). 
• Stable, message visit: 90-day supply. 
• Anti-aging skin creams: tretinoin. We’ll prescribe refills - enough to last you a year. 
• An annual video visit is required to keep refills by message visit. 

If your medication requires routine monitoring (for example, fezolinetant requires liver function tests at baseline and at 3, 6, and 9 months), refills will be tied to those lab results. 

Weight loss medications 

This includes GLP-1 and GLP-1/GIP medications (such as semaglutide, liraglutide, tirzepatide, and orforglipron), Contrave (naltrexone-bupropion), and orlistat. Weight management treatment is typically lifelong — your maintenance dose may continue indefinitely to keep the weight off and the metabolic benefits in place. 

TITRATION PHASE 

While you're working up to your maintenance dose: you'll have a monthly visit and receive a 30-day supply with no refills. At each visit we'll check your weight, food noise, how you're tolerating the medication, and decide together about your next dose. 

MAINTENANCE PHASE 

Once you're on your maintenance dose: you'll move to a visit every 3 months and receive a 90-day supply at each visit. This cadence follows the guidance of every major medical society. An annual video visit is required to keep refills by message visit. 

If you pause your weight loss medication for more than 60 days and then want to restart, we'll bring you back into the monthly visit schedule until you reach your maintenance dose again.

Why we do it this way 

Every guideline in this document is built around two pillars of providing excellent midlife care: 

1. Keeping your treatment safe, effective, and optimized over time, meeting your changing women’s health needs.

2. Making sure you have a menopause specialist who actually knows you. Building healthcare relationships is key to improving your long-term health. 

Annual video visits, scheduled follow-ups, and a structured refill workflow are how we honor both. We want this part of your care to feel simple — so the medication shows up,  your visits stay on the calendar, and you can focus on feeling like yourself again, so you can age well and love life.  

Questions? 

Message us through your patient portal anytime. We're here to help!