Women's Hormone, Autoimmune, Metabolic & Sexual Health Program
Menopause · Autoimmune Disease · Metabolic Health · Sexual Health
Integrated. Finally. By Board-Certified Physicians.
Your body didn't fail you. Medicine did.
Do you feel exhausted? Achy? Foggy? Gaining weight? and You are told it's stress. You are told it is
aging. You are told your labs are normal.
There is another way.
There is another way.
DismissedHeard & believed
Confused about your diagnosisClear — with a written care plan
Flaring without explanationInflammation controlled
Gaining weight despite effortMetabolically stable
'Labs are normal' dismissalReal answers from the right tests
Losing sleep, losing yourselfRestored — feeling like you again
You've seen enough doctors to know how this usually goes. Seven minutes. A checklist. Labs that come back
normal. And you — still exhausted, still achy, still told it's stress. What if the problem was never
you? What if it was that no one was looking at the whole picture? Scroll to understand why — and
what
integrated care actually looks like.
— THE REAL PROBLEM WOMEN FACE —
The Real Problem for Women with Perimenopause, Menopause — and Especially Women with Autoimmune
Disease
Here is what actually happens to most women navigating this stage of life:
Menopause Clinics
Treat hot flashes. Ignore autoimmune disease. Prescribe HRT (Hormone Replacement Therapy) without
evaluating clotting risk, disease activity, or immune status — or deny it entirely out of fear, not
science.
Autoimmune Specialists
Manage flares. Ignore hormones. Add immunosuppressants when what you actually needed was a hormone
conversation.
Weight Loss Programs
Prescribe GLP-1 or cut calories without addressing the real drivers: estrogen loss, insulin
resistance,
and inflammation. The weight returns because the root cause was never touched.
This is not a knowledge gap. This is a system that was never designed with you in mind. So what does
a system that was designed for you look like? It starts with one physician who holds all four pieces at
once.
— WHAT WE TREAT —
Four Areas. One Physician. One Plan.
Most practices treat one of these. We integrate all four — because in your body, they are not
separate.
Menopause & HRT
(Hormone replacement therapy)
Most women are either overtreated with fear or undertreated with silence. There is a precise,
evidence-based middle — and most doctors aren't trained to find it.
We are.
Autoimmune Disease
If your autoimmune disease is flaring and no one has asked about your estrogen levels, you have not had a
complete evaluation. Full stop. Rheumatoid arthritis, Sjogren's disease, Hashimoto disease are impacted
by hormones, menopause and perimenopause.
Metabolic Health & GLP-1
GLP-1 works. But in menopausal women, it works incompletely without addressing the hormonal driver
underneath. Here's what that means for your results.
Genito-Urinary Symptoms
(Urinary tract infections)
Pain with intimacy. Low desire. Changes you stopped mentioning because no one ever asked. These are
medical symptoms. They are treatable. And they belong in every evaluation — not as an afterthought.
What exactly happens when all four are addressed together? That's what your evaluation reveals.
NAMS Certified Menopause Practitioner · Board-Certified in Four Disciplines
Telehealth in California · Florida · Oregon
Board Certifications & Credentials
2025
The Menopause Society — NAMS Certified Menopause Practitioner (NCMP)
2015
American Board of Internal Medicine
2022
American Board of Obesity Medicine
2023
American Board of Lifestyle Medicine
Why We Built This Program
Dr. Titianu said "I became a menopause specialist because I was a patient first. I was the doctor who
couldn't explain why she felt broken. Fatigue that didn't make sense. Brain fog, I was embarrassed to
admit. Joint pain I kept dismissing as stress. I was an internal medicine physician, and nobody had
connected my symptoms to my hormones. When I finally understood what was happening to my own body, I was
furious. Because I had seen hundreds of women in my clinic with the exact same story. Symptoms that
didn't match any diagnosis. Labs that came back 'normal.' Dismissed as anxious. Dismissed as tired.
Dismissed as aging.
What they were was hormonal.
So I went back and trained. Lifestyle Medicine. Obesity Medicine.
Menopause Certification through The Menopause Society — the gold standard.
I became what I couldn't find for myself. A doctor who connects autoimmune disease and hormone health in
one conversation. In one care plan."
As Seen on NBC — Dr. Titianu has been featured on NBC discussing the intersection of menopause,
autoimmune disease, and hormone therapy.
Clinical Focus Areas
Perimenopause & Menopause
Hormone Replacement Therapy (HRT)
Autoimmune Disease & Hormone Co-Management
Musculoskeletal Syndrome of Menopause
Medical Weight Loss — GLP-1 and metabolic therapies
Sexual & Vaginal Health
Bone Density & Osteoporosis
Cardiometabolic Risk & Menopause
Real Women. Real Results.
Here is what actually happens to most women navigating this stage of life:
"Finding Dr. Titianu has been a life-changing experience. Navigating perimenopause with autoimmune
disease was overwhelming — she gave me clarity I had searched years for."
— Sarah M.Perimenopause + Rheumatoid Arthritis
"Dr. Titianu is a great physician — compassionate, a great listener, and up to date with the newest
guidelines. I spent three years being told my labs were normal. One visit changed everything."
— Linda R.Menopause + Hashimoto's
"The weight I couldn't lose for four years started coming off once my hormones were properly addressed.
She listens. She investigates. She fixes the actual problem."
— Diane T. Perimenopause + Metabolic Weight Gain
"Finally a doctor who understands that my joint pain and my menopause symptoms are connected. I feel seen
for the first time in years. The structured program makes a real difference."
— Jennifer A.Sjögren's + Perimenopause
— YOUR CARE PATHWAY —
A Structured Investment — Not Reactive Visits
Three stages that build on each other. You are not starting over at every appointment — you are
progressing
toward measurable stability. Telehealth from the comfort of your home.
STEP 01 Foundation
Comprehensive Evaluation
60 min evaluation
Hormone symptom assessment & menopause staging
Autoimmune disease activity review
Clotting, cardiovascular & metabolic risk
Comprehensive labs — billed to your insurance or transparent pricing via our practice
✓ HSA and FSA eligible visits — superbill by patient request
✓ Transparent pricing for visits and cash price labs if needed, no surprise bills
✓ Physician-led medication decisions at every stage
✓ Evidence-based protocols — current NAMS guidelines
On Sexual Health
On GLP-1 & Menopausal Metabolic Health
"Sexual Health is part of Your Health. Pain with intimacy. Low desire. Dryness. Changes you've
stopped
mentioning because no one ever asked. These are treatable. Not inevitable. And they belong in your
care.
Hormones change everything — including this. We address it at every visit."
— Dr. Mirela Titianu, MD
"Menopausal weight gain is not a willpower problem. It is a hormone problem. GLP-1 works—but not
without
addressing the estrogen decline that drives the resistance in the first place. We prescribe it the
right
way: after a full hormonal, metabolic, and autoimmune evaluation."
— Dr. Mirela Titianu, MD, Board-Certified Obesity Medicine
✦ Estrogen loss drives insulin resistance — the real engine of menopausal weight gain
✦ GLP-1 alone produces incomplete results without hormonal correction
✦ Muscle preservation built in — GLP-1 without hormones accelerates muscle loss
✦ Cardiometabolic risk reduction — especially important in women with autoimmune disease
— NEED AUTOIMMUNE CONFIRMATION FIRST? —
Dr. Diana Girnita, MD — Rheumatology Consultation
If your autoimmune diagnosis is unclear, seronegative, or you need expert risk stratification before HRT
(Hormone Replacement Therapy), Dr. Girnita provides a dedicated rheumatology-level evaluation before
your
program begins.
What makes you different from online menopause clinics?
Every visit and plan here is led by a triple board-certified doctor, NOT a midlevel or rotating
team. We specialize in both menopause and autoimmune care, and offer transparent, upfront pricing
with labs included for concierge members.
What makes this menopause and autoimmune program unique?
Led by a triple board-certified physician and menopause specialist (Internal Medicine, Obesity
Medicine and Lifestyle Medicine), not a midlevel, with specialty training in menopause, autoimmune,
and hormone health.
Can women with autoimmune diseases safely take hormone replacement therapy (HRT) here?
Yes, hormone replacement therapy (HRT) is tailored specifically for immune health, RA, lupus,
scleroderma, MCTD, psoriatic arthritis, Hashimoto��s, and others—with personalized oversight and
comprehensive labs.
Are labs and meds included?
The first set of labs is free in the Signature Program if you enroll after a visit and pay the
program in full. Patients who choose only one consultation, or follow-ups can also receive
discounted transparent rates or bill their labs to their insurance. Medications are always sent to
your pharmacy for insurance coverage.
Can I get reimbursed by insurance?
Yes! You��ll receive a superbill after each visit with a physician (except Medicare, which we cannot
accept at this time).
Do you accept insurance or Medicare?
We provide a superbill after every prepaid visit for possible insurance reimbursement that patients
can submit to their insurance; however, we do not get involved in this process, and we cannot
guarantee reimbursement from your insurance.
How does ongoing support work after 6 months?
Continue at the member rate, or transition to our advanced HRT consultation rates, retaining all
your records and ongoing access as needed.
Is this program available in my state?
We currently welcome residents of California, Florida, and Oregon via telemedicine/virtual/online
consultations.
— A MESSAGE FOR YOU —
You Have Been Dismissed Long Enough.
Your evaluation is 60 minutes. From your home. One physician. All four pieces. A written plan you leave
with.
That's what medicine was supposed to feel like.
