Waimea (Kamuela) · Hawaiʻi Island
The decade nobody prepared you for.
Perimenopause can begin in your late thirties and last ten years. Sleep fragments. Weight redistributes to the middle and stops responding to what used to work. Anxiety arrives without a reason attached. Cognition feels different in a way that is difficult to describe to anyone and easy to dismiss. Most women are told this is normal and sent home, and it is normal, and that is not the same as untreatable.
I am Dr. Kristy King, a board-certified physician in Kamuela. I treat this decade as what it is: a distinct physiological transition that deserves diagnostics, a plan, and someone who will still be here in six months.
New Patient Precision Medicine Consultation, $250
What changed
For twenty years, hormone therapy carried a boxed warning that frightened a generation of women and their doctors away from it. That warning came from a 2002 study whose findings have been substantially reinterpreted since, particularly for women who begin therapy within ten years of menopause.
In November 2025 the FDA announced the removal of those boxed warnings from menopausal hormone therapy products. In February 2026 the first label changes were approved.
Prescribing has roughly doubled since 2018. Among women aged 45 to 54 it has risen 184 percent. That is not a trend. That is twenty years of unnecessary suffering correcting itself.
Hormone therapy is not right for everyone, and I will tell you plainly if it is not right for you. But the reflexive no that many women received for two decades was not good medicine, and it is no longer the standard.
That is not a trend. That is twenty years of unnecessary suffering correcting itself.
Where to start
Perimenopause and menopause
Vasomotor symptoms, sleep disruption, mood and anxiety changes, cognitive complaints, genitourinary symptoms, bone health, and cardiovascular risk in the transition. Evaluation includes symptom mapping, relevant labs, and a review of what you have already tried and why it did or did not work.
Metabolic health
Insulin resistance, lipids, visceral fat, blood pressure, and the metabolic shift that accompanies the hormonal one. Midlife weight change is not a willpower problem and is not treated as one here.
After a GLP-1
More than half of people who start a GLP-1 stop within a year, and many regain. If you have come off one, or you are considering coming off, that transition deserves an actual plan: protein and resistance training to protect lean mass, metabolic labs, and an honest conversation about what maintenance looks like. This is one of the least well served situations in medicine right now.
What I prescribe, and how I talk about it
FDA-approved hormone therapy is my starting point. Estradiol patches, gels and sprays, micronized progesterone, vaginal estrogen. These are well-studied, well-regulated, insurance-billable if you have coverage, and for most women they are the right answer.
Compounded hormone therapy has a narrower role. I prescribe it in the circumstances the National Academies identified: a documented allergy to an ingredient in an approved product, or a need for a dose or dosage form that is not commercially available. I do not tell patients that compounded hormones are safer or more natural than approved ones, because the evidence does not support that claim. Compounded products are not FDA-approved and carry less safety data, not more.
I do not dose hormones from saliva testing. It is not validated for that purpose.
Weight-management medication, when it is appropriate, means the FDA-approved brands. Cash-pay pricing through the manufacturers now starts around $149 to $499 a month depending on the drug and dose, and I will tell you the real total cost including labs and visits before you commit to anything.
If you have read the phrase "hormone optimization" somewhere and it sounded like it was engineered to sell you something, your instincts were good.
How care works
Step 1
The consultation
$250, 30 minutes, virtual or in person. Full history, symptom mapping, review of prior treatment, and a decision together about what to investigate. This is a real physician evaluation, not an intake form.
Step 2
Diagnostics
Labs ordered based on your presentation rather than a fixed panel sold to everyone. We look at what will actually change the plan.
Step 3
The plan
Written, specific, and yours. What we are treating, what we are watching, what we expect and by when, and what would make us change course.
Step 4
Continuity
This is a transition, not an episode. Dose adjustment, symptom tracking and reassessment over months. Ongoing care is available through the $99 per month membership if we are a good fit, decided after your consultation rather than sold before it.
Who this is for
- Women in the perimenopausal transition, whether or not periods have stopped
- Women who were told their labs were normal and sent home
- Women considering hormone therapy who want an honest risk conversation rather than a sales pitch
- People navigating midlife metabolic change, including after a GLP-1
- People who want one physician who knows their whole picture
What I will not do
- Sell you a fixed panel of tests that everyone receives regardless of presentation
- Tell you compounded hormones are safer than approved ones
- Dose your hormones from a saliva kit
- Promise you a number on a scale
- Prescribe to a questionnaire without meeting you
Questions
Start with a conversation.
The New Patient Precision Medicine Consultation is $250 for 30 minutes, virtual or in person. It is a physician evaluation, and sometimes the honest outcome is that what you need is not something I offer, in which case I will tell you that and point you somewhere better.
New Patient Precision Medicine Consultation, $250
Embody Your Medicine · Kristy King, MD · Big Island WellCare LLC · Waimea (Kamuela), Hawaiʻi Island
This page is for general information and is not medical advice, a diagnosis, or a treatment recommendation. Hormone therapy and weight-management medication are not appropriate for everyone and require an individual evaluation. Individual results vary. Compounded medications are not FDA-approved. No outcome is promised or implied.
© 2026 Big Island WellCare LLC. All rights reserved.