Perimenopause and menopause are phases that occur naturally throughout a woman’s life.

Perimenopause is the phase leading up to menopause in which hormone levels begin to fluctuate. Symptoms include irregular periods, hot flashes, mood swings and trouble sleeping. Perimenopause usually starts in a woman’s 40s and can last anywhere from a few months to over a decade, ending when a woman has her last period.

Menopause marks the official end of menstruation. You’re usually confirmed to be in menopause after one full year without a period. Symptoms like hot flashes, vaginal dryness, and mood changes usually continue throughout this phase.

Menopause typically starts in your late 40s to mid-50s. Most women in the U.S. experience perimneopause between the ages, and transition into menopause around age 51 in the United States.

Several factors can influence the timing of menopause, causing it to start earlier or later than average. When menopause starts before the age of 45, it is considered an early or premature menopause.

Factors that could lead to an early menopause can include:

• Genetic or family history, particularly if a person's mother experienced early menopause
• Smoking
• Regular, intense physical activity
• Low sun exposure
• Starting their menstrual period before the age of 11
• Multiple pregnancies
• High blood pressure (hypertension)
• Insufficient caloric intake

Factors that could lead to a later menopause can include:

• Alcohol consumption
• Regular, light physical activity
• High caloric intake rich in fruits and protein
• Multiple births
• Late first pregnancy
• Life-long irregular menstrual cycles
• The use of oral contraceptives (birth control)

Not everyone enters menopause naturally. In some cases, menopause can result from certain surgeries and treatments, like chemotherapy. This is known as induced menopause. In these instances, the exact age and duration of perimenopause and menopause can vary significantly.

Bioidentical hormone replacement therapy (BHRT) is a type of hormonal treatment. It involves taking compounded hormones that are chemically identical to the natural hormones that decline during menopause. These bioidentical hormones, such as estradiol and progesterone, are typically derived from plants and are formulated by compounding pharmacies to help relieve symptoms like hot flashes, night sweats, mood swings and vaginal dryness.

BHRT comes in pills, patches, creams, and gels. It can be prescribed if deemed appropriate by your Sesame provider. It is important to note that BHRT is prescribed and dispensed outside of formal FDA regulation and standardization. Studies have not shown that BHRT is safer or more effective than traditional hormone replacement therapy.

The cost of medication is not included in the program, so prices will vary depending on the pharmacy you choose and whether or not you have insurance coverage. Your clinician can help make the most affordable and effective plan for you.

You will also receive a prescription savings card from Sesame to help you access the best possible price for your medication. The prescription savings card is often cheaper than a co-pay on your prescription, so we recommend comparing your insurance co-pay to the savings card price before filling your prescription.

Your provider may order lab tests during your initial menopause video visit. Here's what the process looks like:

1. Choose a testing facility: Your provider will help you locate the lab location closest to you.
2. Get tested: Take your lab order to the specified location for testing. In most states, lab orders are sent to Quest Diagnostics.
3. Discuss results with your provider: Once your results are ready, your provider will review them and determine next steps.

Please note that exceptions apply for patients in the following states:

• If you live in AZ, OK, SD or WI, your lab order will be sent to LabCorp
• If you live in HI, your lab order will be sent to Clinical Labs of Hawaii
• If you live in NY, NJ or RI, your lab order will be sent to Quest Diagnostics, but you will be responsible for paying Quest directly due to state regulations
• If you live in ND, you can take your lab order to any lab, but you will be responsible for paying the lab directly for the cost of the lab tests

If you have any additional questions, you can contact Sesame’s Customer Support team at support@sesamecare.com.

No! Sesame is available to everyone regardless of insurance status, and we do not bill health insurance in order to keep prices affordable for all. This means you don’t need to worry about surprise bills, specialist referrals or insurance coverage to access high-quality menopause care.

If medication is prescribed during your appointment, you’ll also receive a prescription savings card to show to your pharmacist, which can help reduce the cost of your medications.

If you do have health insurance, the cost of any prescribed medication or lab work may be covered depending on your plan.

The one-time health assessment fee covers a comprehensive evaluation of your symptoms and health to create a personalized treatment plan, including:

• Complete health assessment: Your provider will conduct an evaluation of your symptoms and medical history
• Lab testing, if needed: Essential labs are included, if ordered by your provider
• Treatment planning: Development of your personalized care plan and treatment
• Results interpretation: Your provider will review your labs and tailor treatment as needed
• Medication recommendations: Your provider will recommend and prescribe medication for your condition if appropriate

Please note that the one-time health assessment fee is separate from your monthly subscription, which covers your ongoing care, including provider visits, medication management, unlimited messaging, and health resources throughout your treatment journey.

The following labs are included within your one-time health assessment fee if your provider orders them:

• Complete blood count test (looks at red and white blood cells, infection, anemia, and platelets for clotting)
• Hemoglobin A1c test (checks your average blood sugar over the past 2–3 months.)
• Thyroid function test (checks how well your thyroid is working)
• Lipid panel (measures good and bad cholesterol/triglycerides)
• Comprehensive metabolic panel (checks blood sugar, kidney & liver function, and electrolytes)

Please note that any additional lab work or tests beyond these basic labs are not included in the price of your menopause subscription.

In NJ, NY, and RI, state regulations require patients to pay lab facilities directly. As a result, the cost of basic labs is not included in the one-time health assessment fee for residents of these states.

Sesame’s commitment to providing a convenient, high-quality menopause subscription is matched by our dedication to fair and transparent customer service practices. Our refund policy for subscriptions and medications is outlined below:

Subscription refunds

• If you sign up for Sesame's menopause subscription and cancel at least 3 hours prior to your initial visit start time, you will receive a full refund. No refunds will be issued for the first month or health assessment fee if the initial visit has occurred.
• You can self-cancel your subscription at any point. To avoid future charges, cancellation must occur before the next billing cycle starts. Fees paid for previous months are not refundable.
  
  Requesting a refund
• To request a refund, please contact Sesame’s Customer Success Team at support@sesamecare.com. Provide your name, contact information, and details of the service for which you are requesting a refund. Our team will guide you through the refund process based on the terms above.
  
  

Please note that this refund policy is subject to change, and we advise our patients to review it regularly. Your continued use of our services following any changes indicates your acceptance of such changes. For questions or clarifications regarding our refund policy, please contact Sesame’s Customer Support team.

Sesame’s menopause subscription offers a wide range of treatments, but it's important to understand limitations and safety considerations. While many conditions can be effectively managed via telemedicine, severe or complex cases may require in-person evaluation.

Your initial consultation will determine if the program suits your specific needs. Providers on Sesame cannot prescribe controlled substances online. Before starting any treatment, it's critical to discuss your complete medical history with your provider. This includes current medications, diagnosed conditions and any other concerns you may have.

If you're pregnant, planning to become pregnant, breastfeeding, or recently gave birth, inform your provider as some medications may be harmful in these situations. Your provider will use this information to create a tailored, safe treatment plan.