Hormone Replacement Therapy in Seattle, Including Bioidentical Hormones

Hormone replacement therapy at Kosmos Medical Group is prescribed and managed by Dr. Carolan Constantine, a board-certified physician with a women's health focus, inside a concierge primary care membership in Madison Park, Seattle. It starts with a full evaluation and the right testing, uses estrogen, progesterone or testosterone only when they fit your history and goals, and is adjusted over time by a physician who also manages your heart, metabolic and bone health. Membership is $575 per month for Premium Care.

Hormone therapy, done carefully

Hormone replacement therapy is one of the most effective treatments for the symptoms of perimenopause and menopause, and one of the most oversimplified. Some clinics hand the same pellets or doses to everyone who walks in. Kosmos does the opposite. Your physician reviews your symptoms, your personal and family history and your goals, then decides with you whether hormone therapy makes sense, which form fits you best, and how to adjust it as your body changes.

Hormone care at Kosmos is led by Dr. Carolan Constantine, who is board certified in internal medicine and emergency medicine and focuses her practice on women’s health and the menopause transition.

Who hormone therapy helps

Hormone therapy is the most effective treatment available for hot flashes and night sweats, and it also treats the sleep disruption, mood changes, joint aches, vaginal dryness and bone loss that follow falling estrogen. The best candidates are women who:

• Are in perimenopause or within about ten years of their final period
• Are under 60 when they start
• Have moderate to severe symptoms, or early bone loss on a DEXA scan
• Have no history of breast cancer, blood clots, stroke or estrogen-sensitive conditions

For women outside that window, or with those histories, the calculus changes, and there are effective non-hormone options. Hormone therapy helps many women when it is matched to the right candidate and monitored properly, and that is how we prescribe it.

What we test before prescribing

We do not prescribe from a single lab value, and we do not require one to confirm menopause in a woman with typical symptoms at a typical age. What we do measure is the context the decision depends on:

• A full symptom and cycle history, including sleep, mood, cognition and sexual health
• Personal and family history of breast cancer, clotting, stroke and heart disease
• Blood pressure, lipids and metabolic markers, because midlife is when these shift
• Thyroid function, which mimics menopausal symptoms and is often missed
• Bone density by DEXA scan for women at risk, or as part of Optimal Care twice a year
• Hormone levels where they change the decision, particularly in perimenopause, in younger women, and when considering testosterone

Forms of therapy we use

Option	Used for	Notes
Estradiol patch or gel	Hot flashes, night sweats, sleep, mood, bone protection	Transdermal estrogen bypasses the liver and carries a lower clot risk than oral forms; usually our first choice
Oral estradiol	The same symptoms	Reasonable for some women; avoided where clot or migraine risk is a concern
Micronized progesterone	Uterine protection for women taking estrogen who still have a uterus; also helps sleep	Taken at night
Low-dose vaginal estrogen	Vaginal dryness, painful sex, recurrent urinary infections	Minimal systemic absorption; safe for most women, including many who cannot take systemic hormones
Testosterone	Low libido in postmenopausal women, after other causes are addressed	Off-label in women in the US; used at physiologic doses with monitoring
Non-hormone options	Hot flashes and mood when hormones are not appropriate or not wanted	Includes newer non-hormonal medications for hot flashes and targeted treatment for sleep and mood

How treatment starts and continues

First visit. A 90-minute conversation about symptoms, history and goals, and the testing above. You leave with a plan, whether or not it includes hormones.

Weeks six to eight. A check-in on symptoms and side effects. Doses are adjusted here more often than not.

Month three. A review of how you feel, blood pressure, and any labs that need repeating. From here, most women settle into a stable regimen with a review at each annual assessment.

Every year. Your physician revisits whether therapy still makes sense, at what dose, and how it fits with your heart, metabolic and bone health.

Why members choose Kosmos for hormone care

Kosmos is a primary care practice, so the physician managing your hormones knows your whole health picture. Hormone therapy is managed alongside your cardiovascular, metabolic and bone health, your physician is directly reachable when something changes, and because each physician cares for 100 families, there is time for the conversation to be as long as it needs to be.

Members navigating perimenopause or menopause more broadly can read about our menopause and perimenopause care, or what it means to have a female concierge doctor in Seattle. For the two membership tiers and what each includes, see membership and pricing.

The safety guidance on this page reflects The Menopause Society’s 2022 Hormone Therapy Position Statement and current FDA labeling. It is general information, not a treatment recommendation; decisions about hormone therapy are made with your physician.