Women's Hormone · Autoimmune · Metabolic · Sexual Health — Integrated, Finally.
Menopause Care for Women With Autoimmune Disease —
Your Body Didn't Fail You. Medicine Did.
- Board-certified physicians
- NAMS Certified Menopause Practitioner
- 60-minute evaluations, from home
- Telehealth · CA · FL · OR
There Is Another Way
From dismissed → to heard & believed.
Dismissed
→
↓
Heard & believed
Confused about your diagnosis
→
↓
Clear — with a written care plan
Flaring without explanation
→
↓
Inflammation controlled
Gaining weight despite effort
→
↓
Metabolically stable
"Labs are normal" dismissal
→
↓
Real answers from the right tests
Losing sleep, losing yourself
→
↓
Restored — feeling like you again
There Is Another Way
Menopause with autoimmune disease falls between every specialist's lane.
We are among the first practices in the US built to treat the whole intersection.
🏥 Menopause Clinics
🔬 Autoimmune Specialists
Manage flares. Ignore hormones. Add immunosuppressants when what you actually needed was a hormone conversation.
⚖️ Weight Loss Programs
And when you ask questions, push back, or don’t fit neatly into one specialist’s lane? Dismissed — told it’s anxiety, by a doctor with seven minutes and a checklist. This is not a knowledge gap. This is a system not built for you. We built something different.
Your Care Pathway
Your Hormone, Autoimmune & Metabolic Transformation
One physician-led plan for menopause, autoimmune health and metabolism, built around how you want to feel a year from now.
Step 01 · Clarity
Your Comprehensive Evaluation
60 minutes with a physician, from your home
- Hormone symptom assessment & menopause staging
- Comprehensive labs, through your insurance or at transparent cash pricing
- HRT (hormone replacement therapy: estrogen, progesterone, and other hormones when appropriate), when it’s right for you
- GLP-1 therapy (Ozempic, Wegovy, Mounjaro, Zepbound) if metabolically indicated Sexual health review
- Autoimmune disease activity review
-
Clotting, cardiovascular & metabolic risk assessment.
You leave with a written, personalized care plan that belongs to you
Your investment:
$550
Step 02 · Transformation
12 Months to Feeling Like Yourself Again
This is where the change happens. Over the next year, your physician works with you to bring your hormones into balance, quiet inflammation and rebuild your metabolic health. The goal is more energy, better sleep, steadier weight and confidence in your body.
5 scheduled visits — at 1, 3, 6, 9 & 12 months
- HRT fine-tuned to your symptoms, labs and autoimmune profile
- Expert GLP-1 guidance (Ozempic, Wegovy, Mounjaro, Zepbound) as part of a complete hormonal strategy
- Direct access to your physician between visits through the patient portal
- Personalized lifestyle strategy for sleep, nutrition and muscle preservation
- Progress check with lab reassessment at 6 months
- Medication refills handled every 3 months
12-month commitment
Your Investment
$195 /month
The Core Program
Step 03 · Thrive
Protect What You’ve Built
After your 12-month program You don’t start over. You stay well. Choose the level of support that fits your life.
Option A · Thrive Membership (Best for most women)
- 2 physician visits per year
- Ongoing physician messaging through the patient portal
- Medication refills managed between visits
- Annual labs ordered & reviewed
- Monitoring & dose adjustment as your body changes
- Additional visits at a member rate of $299
Investment: $99/month x 12 months
Option B · Pay-Per-Visit
For women who prefer to pay only for the visits they need
- Physician visits as needed, $399 per visit
- Portal messaging & medication refills, annual labs ordered & reviewed for $49/month
Your investment
$195 /visit + $49 /month x 12 months commitment
Every stage includes: HSA/FSA-eligible visits with a superbill by request · transparent pricing for visits, and cash-price labs if needed — no surprise bills · physician-led medication decisions at every stage · evidence-based protocols following current Menopause Society guidelines.
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
- Hot flashes, night sweats, sleep
- Brain fog, mood, memory
- Bone density & cardiovascular protection
- Musculoskeletal Syndrome of Menopause
🔴
Autoimmune Disease + Hormones
- Rheumatoid arthritis + menopause
- Lupus — safe HRT evaluation
- Sjögren's + hormones
- Hashimoto's + weight gain
⚖️
Metabolic Health & GLP-1
- Menopausal weight gain resistant to diet and exercise
- Insulin resistance & cardiometabolic risk
- Muscle preservation & inflammation reduction
💙
Sexual Health
- Pain with intimacy — GSM (genitourinary syndrome of menopause)
- Low desire & libido
- Vaginal dryness, recurrent UTIs (urinary tract infections)
A Comprehensive Hormonal Evaluation
Precision, not guessing.
Your care starts with one of the most comprehensive hormone, metabolic, and inflammation panels in menopause medicine — below are the labs we typically obtain. And because follow-up matters as much as the first test, your labs are re-measured on a structured schedule to prove your plan is working. We don’t guess. We measure, treat, and measure again. Pay through your insurance — or ask us for transparent cash pricing.
Hormonal & Thyroid
- Estradiol
- Progesterone (LC/MS)
- FSH & LH
- Testosterone — free, bioavailable & total
- DHEA
- Prolactin
- Sex hormone binding globulin (SHBG)
- TSH + Free T4
Metabolic & Cardiovascular
- Hemoglobin A1c
- Fasting insulin
- Lipid panel — triglycerides & HDL-C
- Apolipoprotein B
- Lipoprotein(a)
- Comprehensive metabolic panel
Inflammation & General
- hs-CRP
- CBC with differential
- Iron, TIBC & ferritin
- Vitamin D (25-OH)
Who Is Behind This Program
Dr. Mirela Titianu, MD — she was a patient first.
Mirela Titianu, MD
NAMS Certified Menopause Practitioner · Telehealth in CA · FL · OR
2025
The Menopause Society — NAMS Certified Menopause Practitioner (NCMP)
2023
American Board of Lifestyle Medicine
2022
American Board of Obesity Medicine
2015
American Board of Internal Medicine
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 she was embarrassed to admit. Joint pain she kept dismissing as stress. An internal medicine physician — and nobody had connected her symptoms to her 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, and 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.”
Perimenopause & Menopause
HRT
Autoimmune + Hormone Co-Management
Musculoskeletal Syndrome of Menopause
Medical Weight Loss · GLP-1
Sexual & Vaginal Health
Bone Density & Osteoporosis
Cardiometabolic Risk
📺 As seen on NBC — Dr. Titianu discussing menopause, autoimmune disease, and hormone therapy.
"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
Telehealth — From the Comfort of Your Home
Dr. Titianu is accepting new patients in three states.
CA
FL
OR
- No travel, no waiting rooms — your appointment from home
- Full physician-led telehealth visits — same standard of care
- Video visit on any device — phone, tablet, or computer
- All prescriptions sent electronically to your pharmacy
- Follow-up communication directly with your physician
Expanding soon — subscribe to be notified when your state is added. The broader ROC rheumatology practice serves 20 states.
Patient Voices
Real women. Real results.
“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.
— Linda R.
— Diane T.
— Jennifer A.
Follow along: Instagram · YouTube · 245K+
Why We Are Different
Integrated care vs. cookie-cutter medicine.
Rheumatologist OnCall®
- 60-minute evaluation — the full picture, from your home; 30-minute follow-ups for HRT/GLP-1 optimization
- HRT evaluated with full autoimmune risk stratification
- GLP-1 within a complete hormonal + metabolic strategy
- Sexual health addressed at every evaluation
- Same physician every visit — knows your full history
- Labs via your insurance or transparent cash pricing
- Structured 3-stage pathway with measurable outcomes
- Two board-certified specialists collaborating
- Current Menopause Society–certified, evidence-based practice
- Telehealth from home — CA · FL · OR
Traditional / Primary Care Clinics
-
7-minute visit — prescription written by minute 3, or sent without proper
evaluation - HRT prescribed — or denied — without an autoimmune assessment
- GLP-1 prescribed in isolation — the weight returns
- Rarely asked about, almost never treated
- Different provider each time — start over every visit
- Fragmented labs, surprise bills, repeated tests
- Vague follow-up: "come back in 3 months"
- Referrals to strangers with 6-month waits
- Still operating on 2002 WHI fear — denying HRT
- In-person only, limited hours, long commutes
Need Autoimmune Confirmation First?
A rheumatology-level evaluation before your program begins.
If your autoimmune diagnosis is unclear or seronegative, or you need expert risk stratification before HRT, Dr. Diana Girnita — board-certified rheumatologist and founder of Rheumatologist OnCall — provides a dedicated diagnostic consultation before your program begins.
Dr. Diana Girnita, MD, PhD, FACR — Rheumatology Consultation
- Full record review & autoimmune disease evaluation
- HRT safety risk stratification for your specific autoimmune profile
- Clotting & cardiovascular risk assessment
- Written autoimmune care roadmap + coordination with Dr. Titianu
1-hour diagnostic consultation
$849
Frequently Asked Questions
Everything to know before your first visit.
Can I take HRT if I have rheumatoid arthritis or lupus?
Does menopause worsen autoimmune disease?
How much does the initial evaluation cost?
What states do you serve?
Do you offer GLP-1 medications for weight loss?
Do you address sexual health concerns?
Do you prescribe bioidentical hormones?
What is the Musculoskeletal Syndrome of Menopause?
Is this covered by insurance?
You have been dismissed long enough.
If you have been told your labs are normal while you feel anything but —
If you have been dismissed as anxious, overtired, or “just aging” —
If your joints are flaring and no one has asked about your hormones —
If you’ve gained weight despite doing everything right —
If intimacy has become painful and you’ve been told to just accept it —
You are not imagining it. You are not weak. You are not alone.
What you are — is under-treated. At the intersection medicine wasn’t built to handle.
