A solo membership telehealth practice for patients in California and Nevada, and she limits her work to three areas, which are perimenopause and menopause hormonal health, medical weight management, and lifestyle medicine. It states plainly that it does not replace primary, urgent or emergency care. Visits begin with a 60-minute evaluation followed by ongoing follow-up and direct access to the physician between appointments, with labs ordered to outside facilities and billed separately. Members in one Northern California city who have had at least three telehealth visits can buy a 90-minute home visit.
Dr. Otteno is an OB-GYN whose practice is mostly cosmetic and restorative gynecology, and hormone therapy is one part of it. She trained in female genital cosmetic surgery with Dr. Michael Goodman. For menopause care she starts with an hour-long in-person hormone consult, then writes a plan that can use pills, patches, gels or creams. Bioidentical hormones are one of the options she discusses. Regular follow-up visits are used to check how treatment is going and adjust the dose. Women who are not good candidates for hormones get other options and lifestyle advice instead.
Sacramento Women's Health is a seven-physician OB/GYN partnership on Fair Oaks Boulevard, running in the same practice line since 1960. Dr. Mikacich joined in 2009 and is the one the practice names as its menopause and weight loss specialist, and she is also a diplomate of the American Board of Obesity Medicine. The services list says menopause management here uses FDA approved bioidenticals. She finished a master's in public health at UC Berkeley in 2024 focused on food and nutrition, and she describes her own practice as centered on menopause and metabolic health. She has been a medical consultant for Grey's Anatomy since 2005 and co-founded a perinatal mental health program in Denver before moving home to Sacramento. New patients call the office and bring a completed paper packet to the first visit, and she speaks fluent Spanish.
