Clinical Reference Guide for Registered Dietitians

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For Registered Dietitians providing telehealth MNT. Covers nutrition care across the reproductive and hormonal lifespan — fertility, pregnancy, lactation, PMOS, menstrual health, menopause, bone health, and endometriosis.

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Purpose

A practical, evidence-based learning resource for adult outpatient, telehealth-only MNT delivered by a registered dietitian for nutrition concerns that are exclusive to or predominantly affect women across the reproductive and hormonal lifespan: preconception and fertility, pregnancy, lactation and postpartum recovery, polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome or PCOS), menstrual health, perimenopause and menopause, osteoporosis and bone health, and endometriosis.

How to Use This Guide

Complete Section 1’s assessment for every patient. Read “How This Guide Fits With Other Guides” before selecting an intervention, since many patients seen under this guide also have a condition with its own dedicated guide (e.g. diabetes), and that guide remains the primary reference for that condition. Use Sections 3 through 11 based on the specific concern the patient presents with; most patients will need only one or two of these sections, not all of them.

Clinical Position

Nutrition needs shift meaningfully across the reproductive and hormonal lifespan due to hormonal, metabolic, and physiological changes specific to female physiology; these changes warrant individualized assessment rather than default application of general adult nutrition guidance.

This guide does not address cancer prevention or survivorship; a comprehensive Oncology guide, when developed, will be the primary reference for cancer nutrition.

Guide Outcomes

• Reproductive and hormonal: Menstrual regularity, fertility-relevant markers, pregnancy and lactation adequacy, and symptom burden across perimenopause and menopause
• Metabolic: Glycemia, lipids, and insulin sensitivity when relevant to the presenting condition (PMOS, gestational diabetes)
• Bone health: Calcium and vitamin D adequacy, bone density trend when available
• Nutrition adequacy: Energy, protein, iron, folate, and other nutrients with elevated or shifting requirements across the lifespan
• Patient-reported: Symptom burden, quality of life, confidence, and satisfaction with care
• Care coordination: Whether the patient has appropriate medical, obstetric, or specialist involvement for the condition being addressed

Scope Boundary

The RD provides MNT, nutrition education, behavior-change support, and monitoring of nutrition-related outcomes. Diagnosing PMOS, endometriosis, osteoporosis, infertility, or any pregnancy or menopause-related condition is outside RD scope, as is ordering or performing bone density scans or reproductive imaging. RD ordering and interpreting authority for hormonal and other labs varies by state law and practice setting; regardless of who orders a given test, using the result to render a formal medical diagnosis remains outside RD scope. Medication and hormone therapy prescribing or adjustment, obstetric care, and fertility treatment decisions are also outside RD scope. Lab and test results used in this guide typically come from what the patient uploads or reports. As a telehealth-only service, the RD does not routinely communicate with the patient's prescriber, obstetrician, or specialist and may do so only when the patient has authorized and arranged that contact.

How This Guide Fits With Other Guides

Several conditions addressed here overlap with conditions that already have a dedicated clinical reference guide. In general, the dedicated guide for a condition remains the primary reference for managing that condition; this guide adds the reproductive- or hormone-specific layer on top. Examples: