For the first time, I was excited to go to the doctor. At 49 and officially in menopause, I haven’t had a decent night of sleep in years. After a recent Covid booster shot, my hot flashes doubled. Everything is dry (and I mean everything), I have brain fog, I am more irritable and cranky, and my joints are stiff. Beyond seeking relief from the symptoms of menopause, I was excited to talk to a healthcare provider who knows midlife health care for women. And hopefully hear some good news about how to improve my overall quality of life and prevent future problems.
Midlife women are slipping through the cracks when it comes to health care. Sitting in my OB-GYN’s waiting room full of pregnant women, my menopause and midlife care feels like an afterthought. The short 15-minute yearly physical exam I receive gives the impression that there’s not much to discuss in this phase of life. But that couldn’t be further from the truth.
Perhaps my brief exam reflects the minimal training OB-GYNs receive in midlife care. Dr. Mary Claire Haver, a board-certified OB-GYN and menopause expert, reports that four years of OB-GYN training typically includes just 8 hours of menopause education. And the yearly continuing education requirement does little to boost menopause understanding.
It’s not your provider’s fault that they lack a depth of understanding to provide effective treatment for midlife women’s health. Medical schools and the medical education system have always viewed women as little men, which is a deeply problematic assumption.
Seeking more specialized care, I transitioned my care to a highly trained menopause specialist. In this post, I’ll share my experiences seeing a midlife specialist for hormonal changes. And I’ll share the surprising recommendations I received, given I thought I was having a “normal” menopause experience. At the end of the post, you’ll find a list of helpful menopause resources that you can use to educate and advocate for yourself. But first, let’s talk about what menopause is.
What is menopause
Menopause is a natural and normal part of life that marks the end of a woman’s menstrual cycle. You’re officially in menopause when a year has passed without a menstrual period. That normally occurs between 40 and 58 years of age, with the average age being around 51.
The phase leading up to menopause is known as perimenopause, which commonly occurs in your 40s. As the production of estrogen and progesterone begins to fluctuate, you have irregular periods. Your cycle may lengthen or shorten with a heavier or lighter flow until, eventually, your period stops.
In addition to irregular periods, starting in perimenopause, women may begin to experience a variety of common symptoms, including:
- Sleep disturbances and difficulty falling asleep or sleeping through the night
- Hot flashes and night sweats
- Mood swings, depression, anxiety, and irritability
- Vaginal dryness and uncomfortable or painful intercourse
- Poor focus and concentration
- Memory changes
- More frequent urination
- Thinning hair
- Heart palpitations
- Weight gain in the midsection
- Aching joints
Symptoms affect up to 80% of women and last, on average, seven to twelve years (3).
Women are suffering in silence, perhaps unaware that their symptoms are related to menopause.
Because menopause is a natural part of life and doctors focus minimally on the change of life, women may feel they should grin and bear it even when their symptoms significantly interfere with their days and nights.
When you go it alone, without consulting a midlife specialist, you may do yourself more harm than good.
A drop in hormones impacts every system in your body, not just the reproductive organs.
For example, a decrease in estrogen leads to a drop in bone density. The risk of osteoporosis and heart disease increases. Even frozen shoulder, an orthopedic condition that may lead to surgery (and one my mom had surgery for), is attributed to a loss of estrogen. Also, a decrease in estrogen can affect the brain, contributing to mood swings, memory problems, and an increased risk of developing Alzheimer’s disease (1). Plus, estrogen plays a role in maintaining the health of the urinary tract, and its reduction can lead to urinary incontinence or increased UTIs.
Taking preventative measures in your 50s sets you up for your best health later in life. You get the best effect from hormone replacement therapy if you begin taking it close to the onset of menopause or within ten years and before age 60 (2).
Nearing my 50th birthday, I worried that my best years were behind me. I’ve watched my mom struggle with high blood pressure, a heart condition, anxiety, and frozen shoulder and wondered if this was my fate. Remembering that action is the antidote to anxiety. I decided to get serious about educating myself about menopause and aging. That’s when I started looking for a physician with a special interest in midlife health care and made an appointment with a menopause practitioner.
What is a menopause practitioner?
A menopause practitioner has demonstrated expertise in the care of midlife women by successfully passing a certification exam offered by The North American Menopause Society (also known as The Menopause Society). The NAMS is a nonprofit organization with a multidisciplinary membership of leaders in the field who are committed to providing midlife information that is accurate and unbiased. This competency exam is available to licensed healthcare providers. Completing the exam leads to the credential of Menopause Society Certified Practitioner (MSCP).
The doctor I scheduled an appointment to see is an OB-GYN with the MSCP credential. She is the Director of our Midlife Health Center and the former Executive Director of the North American Menopause Society. She also researches hormonal and non-hormonal therapies for the treatment of vasomotor symptoms.
No special referral is required to meet with a midlife specialist. I had to wait for an appointment, and it worked out to schedule my appointment for a year and a day from my last OBGYN exam so insurance would cover the visit. I booked a full 60-minute consultation for an initial exam and to discuss the pros and cons of hormone therapy.
Before my appointment, I’d been educating myself about midlife health, hormone replacement therapy (HRT), and reading the book Estrogen Matters, so I was ready to have an educated discussion about it.
Here’s what happened in my appointment with a menopause practitioner
Walking into my appointment, I had a list of things to discuss. My cholesterol has been rising, which happens for women with declining estrogen levels. I was ready for another perspective after receiving two different opinions about how to deal with it from other practitioners. Cardiovascular disease and osteoporosis are in my family history. I also have extremely dense breast tissue, making it harder to detect abnormalities.
With so many physicians giving minimal attention to midlife healthcare, I was relieved and delighted when my doctor said she had read every piece of research that’s been published on menopause. She was also very familiar with my medical history since I had all my medical records sent to the office, including mammograms, breast ultrasounds, lab results from my OB-GYN and primary care doctor, and infertility treatment.
During the hour we met, we reviewed my family history, menopausal symptoms, and my experience with perimenopause, including treatment I’d received for a period of prolonged bleeding in perimenopause. We talked about changes to my urinary habits and genital health as it relates to incontinence, vaginal dryness, and pain. I asked questions about my dense breasts and also how to prevent bone loss. She did a physical exam where she listened to my heart and lungs, examined my breasts and abdomen, and did a pelvic, vaginal, and my first-ever rectal exam.
She requested labs to assess my hormone levels.
My surprising recommendations
A few surprising takeaways from the appointment made it completely worth it. Reviewing my medical records and previous labs, she could see that I entered menopause early, which increases the risk of heart disease and osteoporosis. For me, the benefits of taking HRT to the average age of the onset of menopause, 51, outweigh the risks in terms of preventing future heart and bone problems. We’ll reassess my continued use of them at 51.
Regarding bone health, menopause typically triggers a period of more rapid bone loss, followed by a more gradual, ongoing decrease in bone density. Early loss of bone may lead to early bone fractures. Since I’m in premature menopause and haven’t been getting 1200 mg of calcium with Vitamin D a day, my doctor recommended I get a bone density DEXA scan to see if I have any bone loss. Additionally, she gave me a doable plan for hitting the 1200 mg of calcium target. The strategy involves getting 600 mg from a nutritious diet and 600 mg from a supplement. It’s important to note that too much calcium from a supplement can lead to plaque buildup and cardiac issues. Exceeding 1200 mg of calcium daily from any source increases the risk of kidney stones. Along with this, regular exercise and strength training are essential for maintaining bone health.
For cholesterol, we will watch it and see what happens with the introduction of HRT.
To assess my extremely dense breast tissue, a contrast-enhanced mammogram is a good option to consider. I didn’t know that was even a consideration.
Self-education and self-advocacy in perimenopause and beyond
If the OB-GYN you’ve been seeing throughout your reproductive years glosses over your menopause symptoms, tells you this is your “new normal,” and spends very little time on your midlife health, it may be time to look for a midlife specialist.
The Menopause Society offers a searchable database of practitioners caring for women from perimenopause and beyond.
What if there isn’t a physician in your town who holds the MSCP designation? Your self-education is even more important so you can partner with your current doctor and advocate for the right care. But you don’t have to go it alone. There’s a revolution happening in women’s midlife healthcare, and it’s taking place at the grassroots level on Instagram. Many physicians are advocating for women’s midlife care and providing educational information.
Here are some accounts to follow:
Looking for other ways to educate yourself?
Download and read The Menopause Guidebook put out by the NAMS.
This 70-page guidebook covers premature menopause, common menopause signs, symptoms and strategies, treatment options, body changes in midlife, postmenopause health and aging, and ways to stay healthy.
This book provides a very thorough review of the history of hormone replacement and the problematic interpretations of the science that led to fear about taking hormone replacement therapy. You’ll understand why there’s confusion about how to care for midlife women. And gain insights into options for your best care.
Even if you’ve stopped having periods and sailed into menopause without a single hot flash or symptom, it’s essential to take steps to prevent future bone and heart issues. Cardiovascular disease is the leading cause of death worldwide. One in three women in the US will die of heart disease, and more women will die of it than men (3).
By sharing my experience, I hope you’ll feel encouraged to educate yourself about perimenopause and menopause and to see an OB-GYN menopause specialist or partner with your current physician to get the best midlife care.
Please bear in mind that the decisions made about my care are individual to my unique age, presenting symptoms, onset of menopause, and family history. Every woman’s menopausal transition is unique, and the recommendations that are right for me may not apply to you.
Don’t let fear stop you from taking charge of your health, questioning your treatment, and making the best decision for your unique situation.
- Schnabel J. Estrogen exposure may protect women from Alzheimer’s. Cornell Chronicle. 2021 Nov 4.
- Bluming A, Tavris C. Estrogen Matters: Why Taking Hormones in Menopause Can Improve Well-Being and Lengthen Their Lives–Without Raising the Risk of Breast Cancer. 1st ed. New York: Little, Brown Spark; 2018.
- North American Menopause Society. The Menopause Guidebook. 9th ed. OH: The North American Menopause Society; 2020.