I get asked about this more than you might expect.
A patient mentions she can get the same hormones that I am prescribing from an online telehealth platform.
Someone asks whether I feel threatened by the explosion of menopause telehealth platforms.
A colleague wonders how I think about my practice in relation to the broader digital health landscape.
My answer is always the same: I don't compete with them. And I don't want to.
That is not false modesty or a diplomatic deflection. It is a genuine reflection of how I think about what Camel City Women's Wellness is, what it is not, and what the women of this community actually need.
The Problem Is Too Big for Any One Model to Solve
Let's start with the scale of the issue. There are approximately 6,000 board-certified menopause specialists in the United States. There are roughly 55 million women currently in or approaching the menopausal transition. The “math is not mathing” as they say. There are simply not enough clinicians with deep menopause expertise to meet this need through traditional practice models alone.
The result (which we are living through right now) is that the vast majority of women in midlife are receiving inadequate menopause care, or no menopause care at all. They are leaving primary care appointments with their symptoms dismissed or undertreated. They are being told that what they are experiencing is normal aging and nothing can be done. They are searching online at midnight trying to understand why their brain and body feel unfamiliar to them and finding information that ranges from life-changing to dangerously wrong.
Any model that helps close that gap is doing something important. Telehealth platforms that make evidence-based menopause care accessible to a woman in a rural area who has no specialist within 200 miles, or to a woman whose work schedule makes in-person visits impossible, or to a woman who simply needs a prescription for vaginal estrogen and does not require the level of complexity I provide, that is a good thing. I mean that.
What Telehealth Platforms Do Well
The best menopause telehealth platforms have made real contributions to midlife women's health access. They have:
Brought evidence-based hormone therapy prescribing to women who could not otherwise access it
Normalized the conversation about menopause symptoms and treatment in ways that reduce stigma
Reached women who were previously invisible to the healthcare system on this topic
Offered pricing and subscription models that work for women who cannot afford or do not need a comprehensive practice like CCWW
Created a volume of public education about menopause that has shifted the cultural conversation meaningfully
These are genuine wins. The women served by these platforms are better off for having access to them.
What CCWW Offers That Is Different: Not Better, Just Different
CCWW is not a better version of a telehealth platform. It is a different kind of thing entirely.
What I offer is depth, continuity, and complexity. A woman who comes to CCWW is not getting a prescription. She is getting a clinical relationship, one in which I know her full history, have reviewed her labs in detail, have calculated her cardiovascular risk score, have talked with her about her breast density and what it means for her screening protocol, have addressed her sexual health, her sleep, her mental health, and her bone health alongside her hormones. She is getting a provider who is reachable between visits, who follows up on her results, who coordinates with her other specialists, and who will spend the time her clinical picture requires rather than the time a billing code allows.
That is not what most women need from every clinical interaction. It is what some women need from at least one.
The woman who uses telehealth exclusively because her symptoms are mild, her history is uncomplicated, and she simply needs access to basic hormone therapy is also doing something sensible. The woman who needs the full depth of what CCWW offers and finds it here - she is the person I built this practice for.
A Diversity of Care Models Is a Strength, Not a Problem
Over the last year, I have learned much about the legal and business side of medicine through my doctoral work. For this reason, I began to think about the landscape of midlife women's healthcare the way I think about an ecosystem. A healthy ecosystem is not one in which every organism is the same. It is one in which many different organisms occupy different niches, serve different functions, and collectively create something more resilient and complete than any single species could.
The ecosystem of midlife women's care needs telehealth platforms for access and scale. It needs primary care providers who are educated about menopause and willing to prescribe. It needs ob-gyns and gynecologic specialists. It needs pelvic floor physical therapists, mental health providers, and dietitians who understand the hormonal context of their work. It needs pharmacies that can reliably dispense hormone therapy. And it needs practices like CCWW: small, deep, relationship-based, and built around the full complexity of a midlife woman's health.
None of these models replaces the others. Each one serves a real need that the others cannot fully meet.
What I Actually Care About
I did not build this practice to capture market share. I built it because I watched (and in some ways participated in) women suffer through inadequate care for years and wanted to offer something genuinely different for the women in this community who need it.
That motivation does not require me to diminish what anyone else is doing. It does not require competition. It requires clarity: about what I offer, who it is for, and why it matters. It is a genuine commitment to the idea that more women getting better care, by whatever means and through whatever model reaches them, is the point.
When a telehealth platform prescribes vaginal estrogen to a woman who has been suffering for three years and never been offered treatment, I am glad that happened. When a patient comes to me after years of piecemeal care because she needs someone to see the whole picture, I am glad she found her way here.
This community is big enough and the need is urgent enough for all of it.
This post reflects the personal perspective and practice philosophy of Christina Saldanha, PA-C, founder of Camel City Women's Wellness.
