Question 1

What is perimenopause vs. menopause and when do these typically occur?

Accepted Answer

Menopause is a point in time 12 months after a women's final menstrual period. The years leading up to that point is perimenopause -  when women may have changes in their monthly cycles, hot flashes, bone pain, insomnia, increased anxiety and other symptoms.  The perimenopause can begin up to 10 years prior to menopause - which typically occurs between the ages of 45-55.

Question 2

Do I need lab tests to diagnose menopause?

Accepted Answer

No. Menopause is defined as your final menstrual period with no menstrual bleeding for 12 months. 
Natural Menopause occurs between the ages of 45-55; Surgical Menopause can happen at any age when the ovaries are removed.
If you are younger than 40 years old, and have not had a period in > 3 months then labs are indicated to determine the cause.  
There are many other reasons labs may be indicated such as anemia due to heavy bleeding, changes in mood, weight, sleep and joint pain.
If you have an IUD or have had a hysterectomy, blood work is often helpful to determine whether you are in menopause

Question 3

Does Seattle Menopause Medicine prescribe bio-identical and other hormone treatment?

Accepted Answer

YES. Bio-identical hormone therapy refers to body identical estradiol, progesterone, and testosterone. All of our physicians  are knowledgeable in the various hormone therapy options, including creams, gels, oral hormones, patches, vaginal rings, and other options as applicable to you. They can prescribe estrogen, progesterone, and testosterone therapy to the pharmacy.  We do partner with compounding pharmacy if needed. They do not recommend pellet implantation of any kind.

Question 4

Are hormones the only treatment for hot flashes?

Accepted Answer

No. There are several non-hormonal prescription medications available for hot flash/night sweat.  Your doctor can discuss the use of gabapentin, SSRI, SNRI, fezolinetant, elinzanetant, and oxybutynin.
There are many supplements on the market such as magnesium, black cohosh, pollen extract (Relizen), ammonium succinate (Amberen), and more.  There is limited scientific data to support this use of supplements, however, we are happy to discuss this with you.
There are other options such as cognitive behavioral therapy and clinical hypnosis to reduce the destress from hot flashes.  Some have found acupuncture helpful.

Question 5

What labs do you typically perform?

Accepted Answer

Depending on your personal history labs may be indicated: 
Thyroid labs – to check for underlying thyroid issues. 
Cholesterol labs – depending on your personal and family history. We also like to include apolipoprotein B and lipoprotein a.
Complete metabolic profile and complete blood count – if not done in the last year to check on kidney, liver, and blood status.  
Hormone levels may be tested if someone is on testosterone, not responding to hormone therapy as predicted, or under the age of 45.

Question 6

What is a hot flash?

Accepted Answer

3 out of 4 women experience hot flashes, which often start in perimenopause and continue several years after the final menstrual period (menopause). 
Hot flashes are a sudden feeling of heat in the upper part of your body, face and neck  which can cause redness and heavy sweating.  When the wave passes, you may experience intense cold chills.   Women experience vasomotor symptoms differently - some have hot flashes, night sweats, or even just a sense of being warmer than usual. Some people can feel colder as well.

Question 7

What other systems are affected by menopause?

Accepted Answer

- Cardiovascular Health - blood pressure, risk of stroke, heart attacks
- Bone Health - osteoporosis or thinning of the bones
- Sexual Health 
- Libido (desire)
- Vulva and vaginal dryness
- Urinary incontinence  both urge and stress
- Weight gain, body composition changes
- Sleep - waking up in the middle of the night, as well as difficulty falling asleep
- Emotional health - increase or new onset anxiety, depression
- Muscularskeletal pain, muscle pain, joint pain
- and more

Question 8

Can Seattle Menopause Medicine act as my primary care clinic?

Accepted Answer

NO Our doctors will not be acting as your primary care physicians. They are happy to partner with your physician. They will provide you with a list of recommended screening tests depending on your current health status.  You can take this list to your next primary care appointment, or if your insurance allows, they can assist you with referrals.

Question 9

Do you take insurance?

Accepted Answer

NO. We are out of network with all insurance providers, including Medicare or Medicaid. Upon request, we can provide a superbill for you to submit to your insurance. Depending on your plan you may be able to get reimbursed some of the cost. Please look at the back of your insurance card and call the members or customer service line to ask if you have out of network benefits.  You should also ask your insurance if they cover telehealth visits out of network.Codes we use CPT code(visit or procedure code):99205 New patient visit 99215 Established patient visit ICD 10 code (diagnosis code commonly used)Z79.890 - hormone replacement therapyN95.1 - menopausal and female climacteric stateWe do not make any guarantees of any insurance reimbursement. Our cost is $450 for up to 60 minute new patient appointment, $250 for up to 30 minute follow up, and $300 for yearly check ins.  Medicare and Medicaid rules:Dr. Busch is opted out with Medicare and the only physician who can see patients who have Medicare at our clinics.  Patients will need to sign an "opt-out" contract and there is NO  reimbursement. Patients are solely responsible for their visits cost - per the Federal government opt out physician guidelines. Dr. Busch CANNOT see state funded Medicaid, AppleHealth patients.Dr Dvorak cannot see patients who have Medicare or Medicaid as any part of their insurance.

Question 10

Do you take Medicare or Medicaid?

Accepted Answer

Dr. Busch is able to see patients who have Medicare, they will need to sign an  "Private Contract". This means those with Medicare will sign a private contract with Dr Busch agreeing to pay directly for services and cannot seek reimbursement from Medicare. This includes Medicare part B, managed cared plans, and supplement (gap) insurance. Patients confirm that they will not submit any invoice to Medicare as Dr. Busch is opted out of Medicare and there is not a Medicare contracted physician. We are not able to see patients who have Medicaid. This includes all Managed Medicare and AppleCare product, etc. You will be asked to sign our financial policy verifying that you do not have Medicare or Medicaid.  (IF you have Medicare you will sign an opt out contract with Dr. Busch only).  Dr. Dvorak cannot see Medicare or Medicaid patients.

Question 11

How do I make an appointment?

Accepted Answer

Click here to schedule a new patient appointment, a credit card is required and there is a $150 deposit which will be applied to your appointment. If you cancel prior to 48 hours your deposit will be refunded.  It is your responsibility to note the day, time, and location of your appointment. Thank you!

Question 12

Do you offer telehealth?

Accepted Answer

YES. We provide care onsite or via telehealth through your Charm Health Portal 
 
  Occasionally, your doctor will request you come into the office for a visit if your concerns need to be seen and examined.  If you are looking for telehealth and there are no appointments listed in the schedule please contact the clinic.

Question 13

Can I use my FSA or HSA?

Accepted Answer

YES. You can submit your HSA or FSA card to have on file. We can provide a detailed receipt called a "superbill" for you to keep for your records.  Receipts can also be found in your Charm Patient Portal.  Please check with your tax accountant for more details.

Question 14

How can I contact you after hours?

Accepted Answer

While we do not provide any on-call or after hour services, your doctor is available via the patient portal for non-urgent questions. If you are having an emergency - like heavy bleeding, chest pain, shortness of breath or other critical issue please go to your nearest urgent care center or emergency room.  
E-visits, messaging with your physician, may result in a follow up visit charge of $100.

Question 15

Do you recommend any online resources for information?

Accepted Answer

The OASH (Office of the Assistant Secretary of Health) Office of Women's Health webpage about menopause.
The Menopause Society, formerly known as North America Menopause Society, is an amazing resource for evidence based information.  Their website is https://www.menopause.org/for-women

SEATTLE MENOPAUSE MEDICINE

FAQS