Frequently Asked Questions About Menovia

Menovia offers intensive, personalized and accessible care, tailored to what this phase of life really requires. With our clearly structured and digital process, you always know where you stand.

‍What makes Menovia unique:
- Structured 6-month process with clear steps, so you know exactly what to expect.
- Guidance by a doctor with expertise in functional medicine and bioidentical hormone therapy.
- Combination of blood tests and an extensive intake, for a treatment that really suits you.
- Digital consultations so you have access to specialist care — no matter where you are. \
- Active and regular guidance and adjustment: your treatment grows with your body and needs.
- Aftercare option after the program ends: you choose whether to continue, switch to your doctor, or keep an annual check-up.

In short: Menovia is for women who want more than standard care. We help you navigate through a phase of life where hormonal imbalance no longer has to prevail — but where vitality, direction and well-being can once again be key.

Many women don't realize that perimenopause can start in their early 40s. This phase is often associated with vague or varying hormonal symptoms that are not always immediately recognized. If you experience such symptoms (see our list of perimenopause and menopause symptoms), you can already sign up with Menovia for research and guidance. Menovia is for women in the perimenopause and menopause who need personalized and evidence-based hormonal support:

- For women who want to have their hormonal balance examined and gain more insight into their health.
- For women who have never used hormones before and are looking for a safe and customized start.
- For women who are already taking hormones but are not satisfied with their current treatment and want to get a better grip on their therapy.
- For women who want to better understand their hormonal balance and want a broader medical approach.

With Menovia Compleet, we look beyond hormones alone: we also analyse glucose and fat metabolism, thyroid function and vitamin D and B12 status. This creates an overall picture of your health and a plan that really suits you.

After your registration, you will receive an intake interview based on a digitally completed medical questionnaire. The doctor will assess your eligibility for our digital counseling program and which program suits you best. If you decide to participate, you will receive blood and DNA tests sent home with clear instructions for collection and delivery. Once the results are known, a second meeting will follow with the doctor who will draw up a treatment plan for you. This is the start of your guidance process, which lasts a total of 6 months. Your hormones are shipped to your home by our partner pharmacy. Every 2 to 3 weeks, there is contact with someone from Menovia and blood tests and a medical consultation take place every 10—12 weeks, where your treatment plan can be adjusted. At the end of your process, you will decide together with you whether you want to continue care at Menovia or would rather be referred back to the doctor.

Chronological order:
- Intake interview
- Blood and DNA tests
- Medical consultation with treatment plan
- Hormones are sent home
- Check-in with Menovia every 2—3 weeks
- Blood tests and treatment plan adjustments every 10—12 weeks
- End of process after 6 months and discuss aftercare

After your registration, Menovia team members will contact you quickly to screen and schedule your intake. We don't have any waiting lists at the moment, so you can get help quickly.

Hormone supplementation via Menovia can only be started after the results of the blood test are known. This is often within 2 weeks after blood collection. With the results of the blood test, the doctor creates a treatment plan that will be discussed with you in a digital consultation. The prescriptions are sent to the pharmacy the same day. The delivery of the medication can sometimes take up to a week for personal preparations. At regular doses, medication can sometimes be delivered faster via your own pharmacy.

Yes, definitely. Perimenopause can begin in the early 40s and is associated with hormonal fluctuations, unpleasant symptoms and irregular periods. It's a myth that you can't start taking hormones until you've completely stopped menstruating. It is precisely in this phase that hormone supplementation will benefit you the most.

Based on your medical questionnaire, symptoms, and blood and DNA test results, the doctor can recommend additional supplements. These can, for example, be specific vitamins or supplements that support the natural detoxification processes. The costs for these supplements are not included in the program and are at your own expense.

In most cases, the studies within the Menovia program are sufficient. Sometimes, however, the doctor may recommend additional examinations, such as an ultrasound in case of repeated or heavy vaginal bleeding, or other tests if your symptoms cause it. We cannot request or carry out these additional studies from Menovia ourselves. In such cases, we refer you back to your doctor, who can arrange this or refer you to a specialist if necessary. In addition, we advise all women to comply with the guidelines for preventive population screenings in force in the Netherlands:

- HPV population screening (cervical cancer): every 5 years between the ages of 30 and 60.
- Breast cancer screening (mammography): every 2 years between the ages of 50 and 75.

For more information, please refer to Population screening in the Netherlands.

Perimenopause is the transition period that usually begins in the early 40s and can last a few years. In this phase, hormone levels (especially estrogen and progesterone) begin to fluctuate. This can lead to complaints such as irregular periods, hot flushes, sleeping problems, mood swings and headaches or migraines. Menopause is the time when menstruation stops permanently because the ovaries no longer produce eggs. Doctors speak of menopause when a woman has not had a period for 12 months in a row. The average age at which this happens in the Netherlands is around 51 years. In short: perimenopause is the run-up to menopause, where hormonal fluctuations and symptoms are often the most severe. Menopause itself is the time when menstruation has completely stopped and the ovaries are definitely no longer producing hormones.

The transition can express itself in many different ways. Complaints vary from woman to woman in nature and severity, and may change over time.

Common complaints:
Hot flushes and hot flashes
Night sweats
Trouble sleeping or insomnia
Mood swings and irritability
Tiredness and lack of energy
Vaginal dryness and sexual complaints, such as decreased libido
Memory and concentration problems

Other common complaints:
Joint and muscle pain
Headaches or worsening of migraines
Heart palpitations
Anxiety or gloom
Weight gain, especially around the belly
Dry skin, hair, or nails
Bladder and urination problems, such as incontinence

Less common complaints:
Dizziness or light-headedness
Tingling in the hands or feet
Tense or tender breasts
Ringing in the ears (tinnitus)
Restless legs or leg cramps
Dry eyes or mouth
Changes in the perception of smell or taste

Rare complaints:
Serious mood disorders such as psychosis or mania
Seizures or worsening of existing epilepsy
Brain fog (“brain fog”)
Retain excess moisture
Hair loss
Skin tingling or a feeling like something is crawling over the skin

BHRT works best in conjunction with a healthy lifestyle. Think of a balanced diet, sufficient muscle-building training, stress relief and good sleep. In addition, we also look at your current medication and supplements and, where necessary, recommend additional support that matches your blood values and genetic profile.

Bioidentical hormone therapy (BHRT) uses hormones that are chemically identical to those produced by the human body, such as estradiol, progesterone, and testosterone. Because the molecular structure corresponds exactly to the body's own hormones, they can bind to the same receptors and exert the same physiological effect. This means that the body can recognize and process these hormones in a natural way. The difference with synthetic hormones is that they have an adapted molecular structure, so that they can react differently in the body. It is precisely because of these small differences that synthetic hormones can cause more side effects in some women, such as increased risk of thrombosis or changes in mood. Bioidentical hormones are more closely related to natural hormonal processes, which leads to better tolerability and more physiological effects for many women. BHRT is used to correct hormonal deficiencies or imbalances, for example during perimenopause or menopause, but also during andropause or certain endocrine disorders. It can relieve symptoms such as hot flashes, sleeping problems, mood swings, joint pain, decreased libido and concentration problems. In addition, it can contribute to maintaining bone density, muscle mass and metabolic health.

When properly prescribed, used and monitored, BHRT is a safe and effective treatment for menopausal symptoms. Side effects are usually mild and often disappear on their own within a few days or weeks. Through our pre-screening, regular blood tests and adjustments, we keep the treatment safe for our patients.What are the possible side effects of BHRT?
BHRT is generally well tolerated when prescribed carefully and monitored regularly. However, as with any medical treatment, side effects can occur.

Possible short-term side effects:
Tense or tender breasts
Fluid retention (fluid retention)
Mood swings
Headaches or migraines
Irregular blood loss in the first months of treatment
Changes in blood clotting (mainly depending on the type of hormone and form of administration)

Long-term risks:
The risks of hormone therapy depend on the type of hormone, dosage, duration of use and method of administration (oral, transdermal, vaginal). Data from major studies show that:

- Transdermal estradiol (patches or gel) combined with oral or vaginal natural progesterone generally does not lead to an increased risk of thrombosis, in contrast to synthetic variants.
- The risk of breast cancer may be minimally increased with prolonged use of hormone supplementation (>5 years), especially when combining estrogen with synthetic progestogens. Where, without hormone supplementation, 2 out of 100 women will develop breast cancer, with long-term hormone supplementation with synthetic progestins, this is 3 out of 100 women. So that's 1 woman out of 100 more. This risk seems much lower with bioidentical progesterone, but there is still insufficient data to say with certainty how low this risk is exactly.
- BHRT can actually protect the heart and blood vessels and improve bone density, especially when started around the menopause.

Minimizing risks:
At Menovia, treatment is always personalized based on blood tests and (if available) genetic profile, and regular monitoring takes place. This allows dosages to be precisely adjusted and any risks can be minimized.

This is different for each woman and depends on the severity of the symptoms and blood values. Scientific research shows that women who experience serious complaints benefit most from starting hormone supplementation early.

Side effects sometimes occur when you start bioidentical hormone therapy. They are often mild and temporary, for example breast tenderness, mild mood swings or fluid retention. However, it is important to always discuss this with us. Do not stop taking the medication on your own, but contact Menovia or your treating doctor. Together, we will look at whether the dosage needs to be adjusted, or whether a different form or method of administration suits you better. Through regular checks and good coordination, we can keep the therapy safe and effective.

That varies. Most women experience effects within a few days to weeks. For some women who have not had a hormone production for a long time, the process takes longer because they can react more strongly and the medication must be built up carefully. In most cases, women feel significantly better within 3 months.

We work with bio-identical estradiol, progesterone and testosterone. In Menovia Compleet, we can also add bio-identical DHEA if necessary. This is a hormone that is produced in the adrenal glands and is an important precursor to both estradiol and testosterone. In the Netherlands, only estradiol and progesterone are officially registered for use in menopausal women. Given the importance of testosterone and DHEA on health and the fact that declines in these hormones during menopause also contribute significantly to symptoms, we have chosen to also include these hormones off-label in our treatment. This is always done in consultation with the patient.

The hormones can be administered transdermally (cream/patch/spray), orally (capsules), vaginally and, in some cases, rectally. The method of administration is determined on the basis of the patient's wishes and the risk profile that is drawn up based on medical history, lifestyle and genetic risks.

Many women find that a better hormonal balance positively influences their energy level, metabolism and concentration. However, BHRT is not a “quick fix”: healthy food, sufficient exercise and sleep remain the basis for lasting results.

BHRT may have a negative impact on fertility. Women who want to have children are not suitable candidates for our programs.

Bioidentical hormone therapy is not suitable for everyone. There are situations where use is not permitted, such as in women with (a history of) breast or uterine cancer, unexplained vaginal bleeding, active thrombosis or pulmonary embolism, serious liver disorders or untreated cardiovascular diseases. In addition, there are circumstances where we take extra care and always make careful consideration. This applies, for example, to a strong family history of hormone-sensitive cancers, in women with migraines with aura, with poorly controlled high blood pressure, or in certain autoimmune diseases. Women with severe obesity and multiple chronic conditions are also not eligible for our digital counseling program. In short: at Menovia, we never start hormone therapy just like that. We always do an extensive intake first, including medical history, blood tests and genetic research where necessary. This is how we determine whether BHRT and our digital journey are safe and appropriate for you.

When you stop treatment, your hormone levels will adjust back to your natural situation. Menopausal symptoms often recur over time. That is why we recommend that you always reduce BHRT carefully and gradually, under medical supervision.

Hormones perform a wide range of functions in the body. It is therefore not surprising that a drop in hormone levels can lead to loss of function and complaints. There is no fixed limit or period of time after which hormone supplementation must be stopped automatically. The time to continue or quit is always personal and is best determined in consultation with your treating doctor, based on your health, complaints and wishes.

A total of three blood tests will be done during the program. The first research takes place during the intake phase. After you start taking BHRT, we'll repeat the blood test every 10—12 weeks. Within a period of 6 months, this means that two additional examinations will follow after the intake.

For the blood test, we refer you to an injection location near you. With the referral, you can make an appointment for blood collection yourself. You will receive the blood collection material in advance by mail; bring this package to your appointment.

After the blood collection, you get the package back and you have to mail it yourself. In doing so, please note the following:

On warm days (above 18 °C) or during frost: hand in the package at a PostNL point. On other days: you can also do it in an orange mailbox.

Yes, it is important to follow a number of regulations:

- Blood collection must take place between 8:00 a.m. and 10:00 a.m. Keep this in mind when making the appointment.
- You must be sober: this means that you should not eat at least 8 hours before the exam. You are allowed to drink water.
- On the morning of the blood test, you do not take any medication, hormones or supplements. After the blood collection, you can take it again as usual.

Yes. Your DNA does not change over your lifetime, so the study only needs to be done once. You can use the results over and over again, even for future treatments or check-ups.

No. The DNA research we do focuses on functional genes that are associated with the processing of hormones and nutrients. This data is stored securely and never shared with third parties. The information is only intended to personalize your treatment and has no consequences for your insurance.

The costs of a Menovia program consist of two parts:

The intake phase
Extensive interview with the doctor, discussing your health complaints and completed questionnaire
Blood tests
DNA research

The guidance process
Regular follow-up through questionnaires, blood tests and medical consultations

Rates
‍Menovia Base
‍Intake: €450
Counseling process: €150 per month

‍Menovia Complete
‍Intake: €550
Counseling process: €200 per month

‍Aftercare
‍Counseling program can be canceled monthly: €100 per month

At Menovia Compleet, the costs are higher because more extensive blood tests take place and the guidance is more intensive and complex.

This does not include the costs of BHRT and any supplements.

The costs of bioidentical hormone therapy (BHRT) depend on the medication that is prescribed and are partly covered by the health insurer and partly under your own account.

- Personalized doses (prepared by a pharmacy) are currently not reimbursed by health insurance and are therefore at your own expense.
- Generic drugs in standard doses are in most cases partially or fully reimbursed by the health insurer.

We always make this choice together with the patient. Generic medications often contain higher standard doses, which may be too strong for some women and may cause side effects. That's why we usually start with low, personalized doses that we carefully build up. When the treatment is properly adjusted, you can - if desired - switch to a generic drug that is reimbursed through health insurance.

Menovia's programs are currently not reimbursed by health insurance. We hope that changes in the future. For hormone supplementation, we often start with low, personalized doses of estrogens and progesterone. These are being built up step by step. When possible, we try to switch to generic variants and doses that are reimbursed by health insurance.

However, some women tolerate personalized medication better and choose to keep taking it. For them, the costs remain at their own expense. In addition, DHEA and testosterone are off-label in the Netherlands and only available in personalized preparations. There are no generic variants of this, so they always have to be funded by the patient himself.

If you decide not to continue after the blood test, we will discuss this together. We cannot reverse the costs of the blood test itself, but you are not tied to further treatment.