Menopause Deserves Actual Medicine.
For women 40 to 60 who are done being told hot flashes, brain fog, and lost sleep are "just part of it." Orvi connects you with menopause-trained physicians who treat this transition the way it should be treated — with real labs, real conversations, and evidence-based protocols tailored to you.
You’ve Been Dismissed. We Won’t Dismiss You.
Most primary-care visits give menopause less than ten minutes. Most online clinics treat it like a vitamin aisle. In between — where you actually live — is a decade of being told your labs "look fine" while you’re waking up at 3 a.m. drenched, forgetting words mid-sentence, and watching your body change in ways no one warned you about.
That gap isn’t your imagination. It’s a gap in the medical system itself. Orvi exists to close it.
Three Stages. One Transition.
Menopause isn’t a single moment — it’s a multi-year hormonal transition that most women move through across their 40s and 50s. Orvi supports women at any stage of the arc.
Perimenopause
Typically begins in the early-to-mid 40s. Periods become irregular, sleep quality drops, mood shifts, and symptoms like hot flashes and brain fog start appearing — often years before the official "menopause" label. This is where most women are dismissed because their periods haven’t stopped yet.
Menopause
Formally diagnosed after 12 consecutive months without a period — average age in the U.S. is 51. Estrogen, progesterone, and testosterone have dropped significantly. Vasomotor symptoms often peak here, and longer-term considerations (bone density, cardiovascular health) move to the foreground.
Postmenopause
The years after menopause is reached. Acute symptoms may ease, but hormone levels stay low — which has implications for bone health, heart health, cognition, and quality of life. Hormone therapy in this stage is a decision made with your physician, based on your specific risk profile.
The Symptoms Most Providers Shrug At.
These are not "just aging" and they are not "in your head." Each one has a biological mechanism, and most respond to properly dosed hormone therapy in the hands of a physician who knows what to look for.
Hot flashes and night sweats
Vasomotor symptoms driven by estrogen withdrawal affecting the hypothalamus. Over 70% of women experience them. Often the first and loudest sign — and the most improved by treatment when it’s the right fit.
Sleep that isn’t restorative
Night sweats wake you, but so do hormone shifts themselves. You get the hours but not the recovery. A standard sleep tracker will show it; a standard primary-care visit often won’t.
Brain fog and word-finding
Estrogen is neuroprotective and modulates glutamate and acetylcholine. When it drops, cognition can feel noticeably slower — meetings take more effort, names take longer, you lose the thread mid-sentence.
Mood shifts and anxiety
Perimenopause is one of the highest-risk windows in a woman’s life for new-onset anxiety and depression. Hormonal volatility affects serotonin, GABA, and HPA axis function. It’s not a character flaw.
Vaginal dryness and painful sex
Genitourinary syndrome of menopause (GSM) affects roughly half of postmenopausal women. Highly treatable — including with low-dose vaginal estrogen that has minimal systemic absorption — but almost never discussed unless you bring it up.
Changes in libido and desire
Reduced estrogen and testosterone both affect libido, arousal, and orgasm. Testosterone in particular is under-studied and under-prescribed in women; Orvi physicians consider it when the labs support it.
Weight gain and body composition shift
Muscle mass drops, visceral fat rises, insulin sensitivity changes. The math of diet and exercise does not work the same way it used to — and willpower is not the problem.
Joint aches, heart palpitations, itchy skin
The long tail of menopause symptoms most women don’t hear about until they experience them. All driven by the same underlying hormonal shift. All worth evaluating.
From First Conversation to Feeling Like Yourself.
Most patients move from application to their first prescription in under two weeks. Here’s what happens in between.
Apply
A short, private application about your symptoms, medical history, and what you’re hoping to address. Reviewed personally within 24 hours. You hear back either way.
Intake consultation
If accepted, you pay the $297 onboarding fee and schedule an intake call with a menopause-trained physician in your state. This is a real conversation — forty-five minutes, unhurried — where the physician gathers the history no rushed appointment ever gets to.
Comprehensive labs
A lab order goes out the same day as your intake. You walk into a LabCorp or Quest near you. The panel covers estrogen, progesterone, testosterone, FSH, LH, thyroid, metabolic, and the safety markers menopause care actually requires.
Protocol consult
Once labs return, a second physician consult to review them together and design a protocol built on your specific results and goals — not a template. For most patients this includes bioidentical hormone therapy; for some it doesn’t, and you’ll hear that honestly.
Prescription and 30-day follow-up
Your prescription is filled by an state-licensed U.S. compounding pharmacy and shipped to you. Thirty days in, a structured follow-up with your physician to check in on symptoms, side effects, and early adjustments.
Ongoing care
From month two onward, $147/month covers monthly prescription fulfillment, refills, and a quarterly check-in with your physician to review how the protocol is working and adjust as needed. No auto-escalation, no upsells.
What We Actually Measure.
A menopause workup requires more than "your labs look fine." The Orvi panel is built for the specific hormonal questions a woman in midlife needs answered.
Estradiol (E2)
The primary active estrogen. Tells us how much natural production remains and serves as the baseline for any estrogen therapy.
Progesterone
Critical for sleep, mood, and endometrial protection if estrogen therapy is indicated. Drops before estrogen in most women.
FSH & LH
Follicle-stimulating and luteinizing hormones. Elevated FSH is one of the clearer biochemical signals of the menopause transition.
Total & Free Testosterone
Under-measured in women but frequently relevant for libido, energy, cognition, and muscle preservation. Often low in midlife.
DHEA-S
An adrenal precursor hormone that also declines with age. Useful context when building a full hormonal picture.
Thyroid Panel (TSH, Free T3/T4)
Thyroid issues mimic and compound menopause symptoms. Every Orvi panel screens for subclinical dysfunction.
Metabolic & Lipid Panel
Glucose, A1C, cholesterol, triglycerides. Baseline for safety and for catching adjacent issues menopause often surfaces.
Vitamin D & Safety Markers
Vitamin D status, basic CBC, liver function. Standard in any well-run hormone workup — and important for monitoring over time.
This Probably Isn’t Right For You If...
We’d rather tell you up front. The program isn’t a fit for everyone — here are the honest reasons someone might not be the right match.
...you’re under 40.
Orvi is built for perimenopause, menopause, and postmenopause. If you’re in your 20s or 30s with hormonal symptoms, the root causes are usually different — and different specialists are a better fit.
...you’ve had certain hormone-sensitive cancers.
Some oncology histories make systemic hormone therapy inappropriate or higher-risk. Your physician will evaluate this thoroughly; where systemic therapy isn’t right, we still may be able to help with non-hormonal options.
...you want a quick fix.
Dialing in a hormone protocol takes months, not weeks. Some symptoms ease quickly; others take time. If you need dramatic results by next week, the realistic timeline may disappoint.
...you won’t do labs.
Everything we do is lab-driven. If you won’t visit a LabCorp or Quest for baseline and follow-up panels, we can’t build a responsible protocol.
...you want specifically non-hormonal care.
Some women prefer non-hormonal approaches to menopause for personal or medical reasons. That’s valid — but Orvi’s physicians specialize in evidence-based hormone therapy, and other clinics will likely serve you better.
...your insurance has to cover it.
The program is cash-pay. If that’s a deal-breaker, we understand — most traditional OB-GYN practices take insurance and can provide a starting point.
One Flat Onboarding. Simple Monthly Care.
No insurance games. No surprise fees. A one-time onboarding that covers everything it takes to get you started, then a flat monthly rate that covers everything it takes to keep you well.- ✓No insurance claims, no surprise bills, no coded explanations
- ✓The $297 covers the full onboarding — intake visit, lab order, follow-up consult, prescription setup, and 30-day check-in
- ✓The $147/month covers ongoing prescription fulfillment, refills, and quarterly physician check-ins after month one
- ✓Cancel anytime. No long-term contract. No auto-upgrade.
- ✓If labs show hormone therapy isn’t the right fit, the medication + lab portion of the onboarding fee is refunded; consultation work performed is earned at the time of service.
Start With a Free Application.
Five minutes to apply. Reviewed personally within 24 hours. The $297 onboarding is only charged if you’re accepted and decide to proceed.
Things Worth Knowing.
The questions most women ask before applying — answered honestly.
Is hormone therapy safe?+
For most healthy women within about ten years of menopause, current evidence (including reanalysis of the Women’s Health Initiative data) supports hormone therapy as safe and often beneficial. Every woman’s situation is different. Your physician will review your personal and family history thoroughly and explain the specific risks and benefits of any protocol before you start.
What about the old WHI study?+
The 2002 Women’s Health Initiative (WHI) study created a generation of confusion and caused many women to be denied hormone therapy. Subsequent reanalysis (Manson et al., JAMA 2017) and current consensus from The Menopause Society (2022 Hormone Therapy Position Statement) show the original concerns did not apply to the women most likely to benefit — those under 60 or within ten years of menopause. Citations available in our substantiation file on request. The science has moved significantly; much of primary care hasn’t caught up.
Bioidentical vs. synthetic — does it matter?+
The default is an FDA-approved bioidentical hormone product. There are FDA-approved bioidentical estradiol products (oral, transdermal patch, vaginal cream/insert) and an FDA-approved bioidentical micronized progesterone (oral, vaginal). The affiliated physician selects the FDA-approved product appropriate for your situation. A compounded bioidentical formulation from a state-licensed U.S. compounding pharmacy may be prescribed only when the patient’s chart documents a specific clinical reason — for example, an FDA-approved formulation being unavailable, an allergy to an excipient, or a documented need for a strength or route not commercially available. Compounded medications are not themselves FDA-approved products.
Do I need to come into an office?+
No. All consults happen via secure video. Labs are collected at a walk-in LabCorp or Quest near you. Medication ships to your door from an state-licensed U.S. compounding pharmacy.
How fast will I feel better?+
Varies by symptom and by woman. Hot flashes and sleep often improve within two to six weeks. Mood and cognition take a bit longer. Energy, libido, and body composition shift over months, not days. Your physician will set realistic expectations during your intake.
Does insurance cover this?+
No. The program is cash-pay: $297 one-time onboarding and $147/month ongoing. Most women find it less expensive than the sum of copays, specialist visits, and out-of-pocket lab costs in traditional care, but that math varies. We provide itemized receipts for HSA/FSA submission.
What if the protocol isn’t working?+
Your physician adjusts based on your quarterly check-ins and any feedback you give in between. Doses, routes, and combinations all can be tuned. Nothing is "locked in." If after honest adjustment the program isn’t serving you, we’ll help you transition off.
What if my labs suggest I don’t need hormones?+
Some women applying are early in the transition and don’t yet benefit from systemic therapy, or their symptoms are better addressed non-hormonally. If the labs point that way, the affiliated physician will tell you honestly. The medication + lab portion of the onboarding fee is refunded; consultation work performed is earned at the time of service.
Can I stay on this long-term?+
Yes, if it’s working and your physician agrees it’s appropriate. Current evidence supports long-term hormone therapy for many women when the decision is individualized. This is a conversation you’ll have ongoing with your physician — not a pre-set cutoff.
Start With a Free Application.
Takes about five minutes. Reviewed personally within 24 hours. The $297 onboarding is only charged if you’re accepted and decide to proceed.