Everything you need
to know before
your first visit.

The Next Chapter Clinic is for women in perimenopause or menopause who are looking for knowledgeable, unhurried, specialized care. If you've been dismissed, rushed, or told your symptoms are "just part of getting older", this practice was built for you.

We see women who are experiencing hot flashes, night sweats, sleep disruption, mood changes, brain fog, vaginal dryness, low libido, irregular cycles, or any combination of symptoms that feel connected to hormonal changes in midlife.

We also see women who simply want to be proactive about their menopause transition, understanding their options before symptoms become disruptive.

We are currently licensed to see patients in Michigan, Colorado, and Arizona. You must be physically located in one of these states at the time of your telehealth visit.

We are actively working to expand to additional states. If you are located elsewhere and would like to be notified when we launch in your state, please use the contact form to join our waitlist.

No referral is needed. You can book directly online without any prior authorization or referral from another provider.

That said, we do recommend staying connected with your primary care provider for routine health maintenance, annual physicals, mammograms, Pap smears, and other preventive care. We focus specifically on menopause and hormonal health, and we work alongside your existing care team rather than replacing them.

After booking, you'll receive a link to complete your intake forms through our secure patient portal. Please complete these before your visit, they include your health history, current medications, and a detailed symptom questionnaire. The more detail you provide, the more productive your first visit will be.

If you have any recent lab work, feel free to upload it to the portal or bring it up during your visit. It's helpful but not required, we can order new labs if needed.

Absolutely, in fact, some of the most important time to start menopause care is during perimenopause, which begins while you're still having periods. Perimenopause can start years before your last period, and symptoms during this transition can be just as disruptive as full menopause.

You do not need to have reached menopause (12 consecutive months without a period) to be seen here. If you're experiencing symptoms that feel hormonally driven, regardless of where you are in your cycle, you are welcome to book.

We are a cash-pay practice and do not bill insurance directly for visit fees. This means we are not in-network with any insurance plan, and we do not submit claims on your behalf.

Here's why we made this choice: the traditional insurance billing model requires short appointments, standardized care, and an enormous amount of administrative overhead. By operating outside that system, we can offer longer visits, more personalized care, and a simpler, more transparent experience.

We know this isn't the right model for everyone, and we want to be upfront about it. If in-network insurance coverage is important to you, platforms like Midi Health or your local OB/GYN practice may be better options. If you value the kind of specialized, unhurried care we offer, the out-of-pocket cost tends to be well worth it for our patients.

Yes, we provide a superbill for every visit upon request. A superbill is an itemized receipt that includes all the information your insurance company needs to process a reimbursement claim: your provider's NPI, the date of service, procedure codes (CPT codes), and diagnosis codes (ICD-10 codes).

You submit the superbill directly to your insurance company. Whether and how much they reimburse depends entirely on your individual plan, particularly whether you have out-of-network benefits. Plans with out-of-network coverage (common in PPO plans) may reimburse a portion of your visit cost. HMO plans typically do not cover out-of-network services.

We recommend calling the member services number on the back of your insurance card to ask about your out-of-network mental health or specialist benefits before your visit, so you know what to expect.

Yes, HSA and FSA cards are accepted for all visit fees and lab review fees. As a licensed healthcare provider, our services are HSA/FSA eligible by definition, you do not need any special approval or paperwork to use your card.

Simply use your HSA or FSA debit card at checkout just like a regular debit card. If your plan requires a receipt for reimbursement, we provide an itemized receipt with all required information.

We require 24 hours notice for cancellations or rescheduling. Cancellations made with less than 24 hours notice may be subject to a cancellation fee. No-shows without notice will be charged the full visit fee.

We understand that life happens, if you have an emergency, please reach out through the patient portal and we will work with you. We ask for the same courtesy in return, as appointment slots are reserved specifically for you.

Appointments are currently available on Tuesday and Wednesday mornings (9am–1pm) and Sunday mornings (10am–noon). We intentionally offer weekend availability because we know most of our patients are working during the week and struggle to get away for appointments.

Booking is done online through our scheduling system, choose the time that works best for you and you'll receive a confirmation with your patient portal link to complete your intake forms.

Initial consultations are 60–90 minutes. This is intentional. Menopause care done well requires time, time to review your full health history, understand your symptoms in context, discuss your concerns and goals, explain your options clearly, and build a care plan together. We don't rush that process.

Follow-up visits are 30 minutes. Once we know your history and have an established care plan, follow-ups are focused check-ins to monitor your response to treatment, review any new symptoms or labs, and adjust your plan as needed.

Most patients follow up every 6–8 weeks after starting a new treatment, this allows us to assess how you're responding and make any early adjustments. Once your symptoms are well-managed and your treatment is stable, we typically move to quarterly (every 3 months) follow-ups.

For patients who are well-established and stable, we may extend to every 6 months. Between visits, you can always reach us through secure messaging in the patient portal for questions that don't require a full appointment.

Yes, always. This is one of the most important things that distinguishes The Next Chapter Clinic from large telehealth platforms. You will always see Megan Nelson, CNM, MSCP, every visit, every time.

Continuity of care matters enormously in menopause treatment. Your provider needs to know your full history, understand how you've responded to previous treatments, and remember what you discussed last time. You should never have to re-explain your story at every visit.

No, there is no predetermined treatment plan. Your care is built entirely around your individual health history, risk factors, symptoms, and preferences.

Hormone therapy is the most effective treatment for most menopause symptoms and is appropriate for the majority of healthy women, but it isn't right for everyone, and we never push any treatment. If you have concerns about hormones, are not a candidate for HRT, or simply prefer a non-hormonal approach, we have effective options for you as well.

You will always be an active participant in your treatment decisions. We explain your options, discuss the evidence, and make a plan together.

Prescriptions are sent electronically to the pharmacy of your choice. Any retail pharmacy, CVS, Walgreens, Rite Aid, Costco, your local independent pharmacy, can fill them.

If cost is a concern, we can recommend strategies to minimize your out-of-pocket pharmacy costs, including GoodRx and other discount programs that often make hormone therapy very affordable even without insurance coverage.

It varies by symptom and treatment type, but here's a general guide:

• Hot flashes and night sweats, most women notice improvement within 2–4 weeks of starting hormone therapy, with full effect by 8–12 weeks
• Sleep, often improves alongside hot flash relief, typically within the first month
• Mood and energy, usually 4–8 weeks
• Vaginal symptoms, local estrogen can take 8–12 weeks for full improvement, though many women notice some relief earlier
• Libido, typically takes 3–6 months to fully assess

If you're not seeing the response you hoped for, we adjust. Getting the right dose and formulation sometimes takes a visit or two, which is completely normal.

Yes, we see many patients who are already on hormone therapy but feel their current regimen isn't working well, or whose provider doesn't have time to optimize it properly.

Please bring your current medication list, any recent labs, and a summary of your current regimen to your first visit. We'll review everything and work with you to refine your treatment if needed.

Yes, hormone therapy is not appropriate for everyone. Absolute contraindications include:

• Active or recent hormone-sensitive cancers (certain breast, uterine, or ovarian cancers)
• Unexplained vaginal bleeding
• Active blood clots or a history of clotting disorders (though transdermal estrogen has a much lower clot risk than oral)
• Active liver disease
• Pregnancy

Women with certain personal or family health histories may need a more personalized risk-benefit conversation. This is exactly why a thorough intake and health history review is part of every first visit, we assess your individual situation before making any recommendations.

If HRT is not appropriate for you, there are effective non-hormonal options, you won't leave without a plan.

The old guidance that "HRT should only be used for the shortest time at the lowest dose" is being actively revised by menopause specialists. Current evidence supports long-term use for many women when the benefits outweigh the risks and treatment is periodically reviewed.

There is no arbitrary time limit. Many women benefit from hormone therapy for a decade or more. We review your treatment annually and adjust our recommendations as new evidence emerges and as your health circumstances change.

The decision about duration is yours to make in partnership with your provider, not a blanket policy applied to all women.

No, labs are not required before your first visit. If you have recent labs (within the past 6–12 months), feel free to bring them or upload them to the patient portal. They provide helpful context.

If you don't have labs, that's completely fine. We'll discuss whether labs would be useful in your situation and order them if appropriate. For many patients, menopause is a clinical diagnosis based on symptoms and history, labs are supportive but not always required to start treatment.

Lab costs depend on your insurance. Labs are ordered through Labcorp or Quest and billed directly to your insurance, completely separate from your visit fee.

• If you have insurance that covers diagnostic labs: You'll pay your plan's normal cost-sharing (copay, coinsurance, or deductible). Many standard menopause labs are covered under medical necessity with the appropriate diagnosis code.
• If you're on a high-deductible plan and haven't met your deductible: You'll pay the negotiated rate, typically much lower than the sticker price.
• If you're paying cash: A thorough menopause panel typically runs $150–$300 at self-pay rates.

We will always use appropriate diagnosis codes to support insurance coverage of your labs. We cannot guarantee what your specific plan will cover, we recommend contacting your insurer if you have questions about lab coverage.

Results are sent directly to us and will appear in your patient portal. We review every result in full, not just the flagged values, and contact you with a summary and any recommended next steps.

If your labs are reviewed outside of a scheduled visit, a $75 lab review fee applies. This covers the time to thoroughly interpret your results, write a summary, and communicate findings and recommendations to you. If lab review happens as part of a scheduled follow-up visit, it's included in your visit fee.

You need a smartphone, tablet, or computer with a camera and microphone, and a reliable internet connection. That's it. No app download is required, your visit link will be sent to you before your appointment and you simply click to join.

We recommend finding a private, quiet space for your visit where you can speak freely. A set of earbuds or headphones can help with audio clarity.

For menopause care specifically, yes. The vast majority of menopause evaluation and management is conversation-based: understanding your symptoms, reviewing your history, discussing options, and monitoring your response to treatment over time. None of that requires you to be in the same room.

Physical examination is not a routine part of menopause care the way it is for other conditions. We can see you, hear you, review your labs, prescribe and adjust medications, and provide the same quality of clinical care through a screen as we could in person.

Yes. All visits are conducted through a HIPAA-compliant telehealth platform. Your health information is encrypted and protected. We have Business Associate Agreements in place with every technology vendor that handles patient information.

Your health information is never shared with third parties without your explicit consent, in accordance with HIPAA privacy rules.

Yes, you must be physically present in a state where we are licensed (Michigan, Colorado, or Arizona) at the time of your telehealth visit. This is a legal requirement tied to our clinical licensure, not a preference.

If you are traveling outside of these states on the day of your visit, please reschedule. We're happy to accommodate rescheduling requests with adequate notice.

Yes. GLP-1 medications are part of our practice because weight changes during perimenopause and menopause are directly connected to hormonal shifts — not just lifestyle factors. For women whose menopause transition has significantly affected their metabolism and weight, GLP-1 therapy can be a meaningful part of their overall care plan.

We prescribe Zepbound (tirzepatide) and Wegovy (semaglutide) — brand name medications sent electronically to the pharmacy of your choice. We assess whether GLP-1 therapy is appropriate for you as part of your initial or follow-up consultation.

The medication cost is separate from your visit fee and depends entirely on your insurance situation. Here's a breakdown:

• Commercial insurance with savings card: Patients who enroll in the Eli Lilly savings card at zepbound.lilly.com/savings often pay as little as $25/month at a retail pharmacy
• No insurance — LillyDirect: Zepbound is available directly through Eli Lilly at lillydirect.com starting at $299/month for starter doses and $449/month for maintenance doses
• Medicare: The manufacturer savings card does not apply to Medicare. Starting July 2026, a $50/month cap under Medicare Part D applies for eligible GLP-1 medications

Yes — if your insurance requires a prior authorization for your GLP-1 medication, we will complete and submit the documentation on your behalf for a $75 prior authorization processing fee. This covers preparing the PA form, writing any required letter of medical necessity, and submitting through your insurance.

A few things to know about the PA process:

• Processing typically takes 3–14 business days depending on your insurance
• Approval is not guaranteed — coverage decisions are made entirely by your insurance company
• If your PA is denied, you have the right to appeal. We can assist with an appeal letter for an additional $75
• We cannot guarantee what your insurance will cover or how long the process will take

No — we prescribe brand name GLP-1 medications only. The FDA resolved the semaglutide and tirzepatide shortages in early 2025, which ended the legal pathway that had allowed most compounding pharmacies to produce these medications at lower cost. Mass compounded GLP-1s are no longer legally available.

We know this is disappointing for patients who were accessing compounded versions at $150–$200/month. The manufacturer savings programs and LillyDirect are now the best options for keeping costs manageable, and for most patients with commercial insurance the savings card brings the cost to a very reasonable level.

We follow a structured monitoring schedule to make sure your treatment is safe and effective:

• Before starting: Baseline labs including metabolic panel, liver function, HbA1c if relevant, and a full health history review
• First 3 months: Follow-up visits every 4–6 weeks to assess your response, manage any side effects, and titrate your dose
• Once stable: Quarterly follow-ups, with lab monitoring every 6–12 months

Because we're also managing your menopause care, your GLP-1 monitoring is integrated into your overall care plan rather than being a separate program. One provider, one complete picture.