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Dr. Renee M. Nelson, MD, MSCP

@myhotflashmd

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🩷Perimenopause + Menopause
💪🏻Feel better now. Build long term health
👩🏻‍💻CA Telehealth. Click link ⬇️to schedule
⬇️Free Perimenopause Guide on my website

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🎉 My Hot Flash MD is officially OPEN for scheduling! 🎉

After months of planning, preparation, and a whole lot of excitement, I am thrilled to finally open my virtual doors to patients!

After 25 years as an OB/GYN, I created My Hot Flash MD because I believe women deserve better education, better conversations, and more individualized care during perimenopause and menopause.

My Hot Flash MD is a virtual menopause practice providing personalized, evidence-based care for women throughout California.

My approach goes beyond just treating hot flashes. It’s about understanding what’s happening in your body, finding the treatment options that are right for YOU, and focusing on your long-term health and well-being.

Whether you’re struggling with symptoms, wondering if hormone therapy is right for you, or simply want to be proactive about your health as you move through midlife, I’m here to help you navigate this next chapter.

Menopause, but make it fabulous! 💗

Because this stage of life should be about so much more than just getting through it. I want to help women feel their best and set the stage for a healthy, active, fulfilling life for decades to come.

I am so excited to partner with you on this journey!

✨ Now accepting new patients throughout California!

Appointments can be scheduled through the link in my bio or at www.myhotflashmd.com.

@myhotflashmd

#menopause #perimenopause #womenshealth by @myhotflashmd

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8 days ago

You’re in your 40’s and 50’s and something feels different and you are not sure what needs attention or where to start. You may have been told by your clinician that your labs are normal or it’s just part of getting older.

I’m Dr. Renee Nelson, an OB/GYN and certified menopause practitioner preparing to open My Hot Flash MD, a telemedicine practice in California.

I’m building this practice for women navigating perimenopause and menopause who want to understand what is changing and talk through their options.

Here, I’ll teach you the basics, answer questions you might feel awkward asking and explain how midlife care connects with your long-term health.

Follow along for menopause education and updates on when scheduling opens. by @myhotflashmd

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a month ago

After 25 years as an OB/GYN, I’m beginning a new chapter.
I’ve had the privilege of caring for women through pregnancies, surgeries, menopause, and so many of life milestones. Now I’m building My Hot Flash MD, a virtual menopause practice, dedicated to providing evidence- based, personalized care for women navigating perimenopause and menopause. Over the next several weeks, I’ll be sharing both trusted menopause, education, and a behind-the-scenes look at what it’s like to leave a 25 year career and build a new practice from the ground up. I’m so glad you’re here! 💗Follow along and join the waitlist through the link in my bio. #MyHotFlashMD #Menopause #Perimenopause #WomensHealth #buildingmypractice by @myhotflashmd

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3 months ago

Can’t take hormones—or don’t want to? You still have options for hot flashes and night sweats.

These medications work on brain signaling involved in temperature regulation. Here’s how:

Veozah (fezolinetant) and Lynkuet (elinzanetant)
As estrogen declines, a group of brain cells called KNDy neurons can become overactive, triggering hot flashes. These medications block specific signals in that pathway without replacing estrogen. Veozah blocks NK3 receptors. Lynkuet blocks NK1 and NK3 receptors.

SSRIs: paroxetine, escitalopram, and citalopram
What?! Antidepressants for hot flashes?
These medications increase the availability of serotonin, a chemical messenger involved in mood AND temperature regulation. They’re thought to help stabilize the brain’s temperature-control system. You don’t have to have depression for them to help with hot flashes, but if you are having trouble with mood, these can help that too!

SNRIs: venlafaxine and desvenlafaxine
These affect both serotonin and norepinephrine, another messenger involved in temperature regulation. Like certain SSRIs, they can reduce the frequency and severity of hot flashes and help your mood.

Gabapentin
This medication changes nerve signaling and can reduce hot flashes, although its exact mechanism for this isn’t fully understood. It can be useful at night, but sleepiness and dizziness are possible side effects.

Veozah, Lynkuet, and low-dose paroxetine 7.5 mg (Brisdelle) are FDA-approved for menopausal hot flashes. The other options listed are used off-label for this purpose.

Nonhormonal doesn’t mean risk-free. Side effects, medication interactions, and any required monitoring, including liver testing for Veozah and Lynkuet matter when choosing treatment.

Hormone therapy is an important option, but if it isn’t right for you, there are other treatments worth discussing.

#menopause #perimenopause #womenshealth by @myhotflashmd

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5 hours ago

It’s World Menopause Day, and I’m glad we’re talking more openly about something that affects so much of women’s lives.
I’m a strong advocate for hormone therapy when it’s appropriate. I also want women who can’t or choose not to take hormones to know what else can help.
My goal is to help you understand your options, including their benefits and risks, so we can make decisions that fit your health history and what matters to you.
We’ve made progress. I want more women to experience that progress in their own care. by @myhotflashmd

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a day ago

In perimenopause, I haven’t changed anything. Why am I gaining weight around my middle?

I hear this often from women in perimenopause and menopause.

As estrogen declines, your body tends to store more fat around your abdomen, including visceral fat, which is the fat surrounding your organs. This can happen even without a big change on the scale. Visceral fat can worsen insulin resistance, and the two can reinforce each other. Add disrupted sleep, changes in muscle, and less time to move between work and family responsibilities. It can feel like a perfect storm.

Here’s where I’d start:
- Protein at each meal to help support muscle
- Fiber-rich foods like beans, vegetables, fruit, and whole grains. This chicken and chickpea salad gives me both protein and fiber.
- Strength training to build muscle and help your body use glucose
- Walking or other activity you enjoy alongside strength training, 3 to 4 times per week
- Fewer sugary drinks and heavily processed snacks

You don’t need to cut out all carbohydrates. Hormone therapy may help limit abdominal fat accumulation, but it isn’t a weight loss treatment. Start with something you can fit into your actual week, and then build from there.

When hormone therapy is right for you, it can work alongside nutrition, movement, and better sleep to help you feel your best during midlife.

#menopause #perimenopause #womenshealth by @myhotflashmd

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2 days ago

As an ACOG member for nearly 30 years and a menopause specialist, I’m glad to see updated guidance on treating hot flashes, sleep disruption, and mood symptoms.

Much of this is familiar to those of us who regularly provide menopause care. My hope is that these recommendations help more clinicians feel comfortable recognizing symptoms and discussing treatment.

I agree with much of the guidance, and there are areas I’d like to explore further, particularly the discussion of mood changes during perimenopause.

What I most want to see is a difference in women’s appointments, symptoms taken seriously, options explained clearly, and a plan for follow-up when treatment isn’t helping.

Updated guidelines are useful. Women also need access to clinicians who can put them into practice. And they need to reliably be able to fill their estrogen patch prescriptions!!

#menopause #perimenopause #womenshealth by @myhotflashmd

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3 days ago

Low absorption doesn’t mean zero absorption.

After my last vaginal estrogen reel, many of you shared that you noticed breast tenderness or other symptoms when you started using it. I wanted to explain how that fits with what we know about absorption.

Research has found that, with some vaginal estrogen products, absorption is higher initially and decreases with continued treatment. Thin, dry vaginal tissue may contribute to that early absorption. As the tissue thickens with treatment, less estrogen may pass through into the bloodstream. Many women are prescribed a loading dose of vaginal estradiol daily for 2 weeks. This can definitely increase systemic estradiol levels, but they should go down when treatment is cut back to twice per week.

With recommended low-dose vaginal treatment, ongoing blood estrogen levels generally remain low. That’s part of why it’s considered a safe option for most women.
Still, some women don’t tolerate it well. If you notice bothersome symptoms, let your clinician know. We can review the dose and formulation and consider whether something else could be contributing.

If you’ve had breast cancer and are using vaginal estrogen, the dose and formulation deserve careful attention. The goal is to relieve your symptoms with a low-dose treatment chosen with your care team. Report new or bothersome symptoms, including breast tenderness. Those symptoms don’t necessarily mean your estrogen level is elevated.

An estradiol blood test may occasionally help answer a specific clinical question, but it isn’t routinely needed. Timing and the type of test affect the result, and one level can’t tell us exactly how much you’ve absorbed or prove what caused your symptoms.
If something feels different after starting treatment, bring it up so we can work through it together.

References: • Santen RJ, et al. Systemic estradiol levels with low-dose vaginal estrogens. Menopause. 2020;27(3):361–370.  • Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. 2025. by @myhotflashmd

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3 days ago

Yesterday was a big milestone for My Hot Flash MD. I welcomed my very first patient! ❤️
It got me thinking about how you can make the most of your first appointment with a menopause specialist. A little preparation can help us spend more time on what matters most to you.

1. Write down your symptoms, even the ones you wouldn’t think are related to menopause.
2. Think about your periods and how they’ve changed, including timing, flow, or skipped cycles.
3. Bring a list of your medications and supplements, along with any hormone treatments you’ve tried and how you felt on them.
4. Gather what you know about your personal and family medical history.
5. Think about what you most want to improve. Better sleep? Fewer hot flashes? Feeling more like yourself?

You don’t need to have everything figured out before you come in. That’s what we’ll work on together. But these details help us understand what’s been happening and make a plan that fits you.

Save this list for your appointment!

#menopause #perimenopause #womenshealth by @myhotflashmd

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4 days ago

Have you been told that because you’ve had a blood clot, you can NEVER use estrogen?

The route of estrogen administration matters when considering menopausal hormone therapy (MHT).

ORAL ESTROGEN undergoes first-pass metabolism through the liver and increases the risk of venous blood clots. It is generally avoided in women with a history of DVT or pulmonary embolism (PE).

TRANSDERMAL ESTRADIOL (patches, gels, sprays) bypasses first-pass liver metabolism. Observational studies generally have not found an increased risk of blood clots compared with nonuse. However, these findings do not establish its safety in women with a history of VTE.

When evaluating someone with a previous blood clot, we need to consider the circumstances. Was the clot provoked by surgery, pregnancy, or immobilization? Was it unprovoked or recurrent? Is there a known clotting disorder?

Guidelines differ on this subject.

The 2025 European Society of Endocrinology guideline supports considering low-dose transdermal estrogen in selected women with prior VTE following an individualized risk-benefit assessment.

The Menopause Society’s 2022 position statement takes a more conservative approach, listing prior VTE as a contraindication to systemic MHT, including transdermal estrogen.

Randomized trial evidence regarding recurrent VTE with transdermal estradiol is lacking.

I am NOT saying transdermal estradiol is safe for everyone with a history of blood clots. I am saying it deserves a conversation with a knowledgeable clinician who can evaluate your individual risks, symptoms, and treatment options.

Have you ever been told estrogen was completely off the table because of a blood clot?

REFERENCES:

1. European Society of Endocrinology. Clinical Practice Guideline on Menopause and Perimenopause. Eur J Endocrinol. 2025;193:G49–G81.
2. NAMS Advisory Panel. The 2022 Hormone Therapy Position Statement. Menopause. 2022;29:767–794.

#Menopause #HormoneTherapy #Estradiol #MyHotFlashMD by @myhotflashmd

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5 days ago

Your doctor recommended birth control pills for perimenopause, and you thought, “They don’t understand menopause!”

Not necessarily!

Combined birth control pills can be a great option for some women during perimenopause.

Heavy or unpredictable periods? Birth control pills can reduce bleeding, regulate cycles, and help control perimenopausal symptoms.

Still need contraception? You can still get pregnant during perimenopause! Menopausal hormone therapy (MHT) does NOT prevent pregnancy.

What if you’re having hot flashes, night sweats, or sleep disturbances and your periods aren’t particularly bothersome?

MHT may be a perfectly reasonable choice!

Here’s something else worth knowing: Not all birth control pills contain the same estrogen.

Most traditional combined pills contain ethinyl estradiol (EE), a synthetic estrogen that affects liver proteins involved in blood clotting.

Nextstellis contains estetrol (E4) and drospirenone. Estetrol is an estrogen naturally produced during pregnancy. Research suggests it has less effect on certain clotting markers than ethinyl estradiol. That’s promising, but we don’t yet know whether it results in fewer blood clots.

Combined birth control pills aren’t appropriate for everyone. Medical history and cardiovascular risk factors need to be factored in. Heavy or abnormal bleeding should be appropriately evaluated first.

The bottom line? Birth control pills aren’t always the WRONG choice. Sometimes they’re the RIGHT choice.

Treatment should be individualized based on your symptoms, bleeding patterns, contraceptive needs, and medical history.

Were you offered birth control pills during perimenopause?

#Perimenopause #Menopause #HormoneTherapy #MenopauseEducation #MyHotFlashMD by @myhotflashmd

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6 days ago

Well, my estrogen Reel took off, and suddenly there are a whole lot of new faces here! So I thought it was time to properly introduce myself.

I’m Dr. Renee Nelson, a board-certified OB/GYN, and I’ve been taking care of women for over 25 years.

And here’s the crazy part: I learned more about menopause later in my career than I ever learned about it in medical school or residency.

That’s one of the reasons I became a Menopause Society Certified Practitioner and why I created My Hot Flash MD.

I believe women deserve better education, better conversations, and individualized, evidence-based menopause care.

My Hot Flash MD is my new virtual practice, where I provide perimenopause and menopause care to women throughout California.

But this page isn’t just about hormone therapy. It’s about understanding what’s happening to our bodies in midlife and what we can do now to protect our health for the decades ahead.

I believe midlife is an opportunity to take control of our health, focus on prevention, and set ourselves up to live longer, healthier, more fulfilling lives.

So, if you’re new here, welcome! I’m so glad you found me. And if you’ve been following along for a while, thank you for being part of this journey.

Here’s to making menopause fabulous!

My Hot Flash MD is officially open for scheduling. Visit myhotflashmd.com or click the link in my bio. by @myhotflashmd

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7 days ago