I originally posted this article in November when Elevated Nesting was a newly launched baby website. In fact, this was the FIRST menopause-focused article I wrote!! Last weekend, I was looking at our growth and thinking about the new Elevated Nesting community members. I realized that some of my earliest content has critically important “getting started” information that I want to be sure these newer readers have. I’ve also learned so much from so many of you in the last few months, so I’ve updated my original article with some fresh wisdom! In the coming weeks, I will be re-introducing a handful of those early topics and adding a lot of very important info to them for purposes of orienting our new readers and refreshing our day-one members.

So, Friends . . . Let’s Re-Visit and Ask the Question . . .

Is it Time to Break Up with your OBGYN?

There’s a reason I kicked-off Elevated Nesting with this article.  We’re going to talk a lot about perimenopause and menopause and navigating the path to thriving in midlife.  To begin this process, I want you to have access the best possible medical care.  I want you to be be able to tell your healthcare provider about your symptoms, ask your questions, and seek solutions without hearing the response “that’s normal” or “you’re just at the stage in life where you have to push through it.”  We are going to talk a lot about solutions, and it is vital that you have a physician or nurse practitioner who will partner with you to choose safe solutions that will help you feel your best through this massive hormonal shift.  So, read on, friends, because it may be time to break up with your OBGYN!

Many of us have reached the point in our lives where the “obstetrics” portion of an OBGYN practice no longer applies to us. Hopefully, we’re only about half-way through our lives, but the doctors who we are supposed to rely on for Women’s Health may not necessarily specialize in Aging Women’s Health. This isn’t necessarily their fault. The truth is that the traditional curriculum for medical education for an OBGYN is enormously focused on obstetrics, and minimally focused on perimenopause and menopause.

Why do we need Specialized Care in Perimenopause and Menopause?

Yes, obviously, obstetrics is super important. Bringing babies into this world is complex, complicated stuff. However, as women in mid-life, we are faced with enormous changes in our health due to diminishing hormone production. And, for some of us, this depletion of hormones feels like the equivalent of getting hit by a bus! Remember puberty and the chaotic changes in our bodies and brains that were the result of the onset of these hormones? Well, we’re experiencing puberty-in-reverse. But in the case of perimenopause and menopause, our bodies have been thriving with estrogen for most of our lives, and now we are experiencing the way our bodies and brains feel in its absence. And, friends, this is not small stuff.

Most of us know that we have estrogen receptors in the cells of our reproductive organs: ovaries, uterus, vagina, and breasts. But, did you know that we also have estrogen receptors in the cells of our:

• Brain
• Heart
• Lungs
• Immune Cells
• Liver
• Kidneys

All of these major systems in our bodies have been benefiting from the Protective Properties of Estrogen:

• Anti-inflammatory
• Cognitive Function
• Cholesterol-Lowering
• Vasodilating (keep our blood vessels, healthy, open, and stretchy)
• Bone Density
• Skin health
• Muscle Density
• Pulmonary Function (breathing)
• Hepatic Function (liver)
• Immune Support

So we can clearly see that this decline and depletion of estrogen can cause more than just hot flashes. Ladies, our “change of life” affects all of the major systems within our bodies. Maintaining our health throughout perimenopause and menopause requires expert care.

Facts on the Current State of Education and Training on Menopause for OBGYNs

Now, don’t get me wrong. In my experience in Women’s Health, I have worked with many wonderful healthcare providers (physicians and nurse practitioners) who have expanded their training and expertise to effectively and thoughtfully care for patients in perimenopause and menopause. But, unfortunately, many of the doctors who should be helping us navigate these massive, systemic changes have had minimal training and education in this area. Here are some alarming facts about the training and education of women’s health physicians:

• The International Menopause Society conducted a survey of current OBGYN residency programs found that only 31% of them had dedicated menopause education programs.
• Most of those menopause courses are electives, not required.
• Nearly 80% of OBGYN medical residents say that they are “barely comfortable” discussing menopause with patients.

(Krewson, 2023)

Unless they seek out additional expertise in menopause and prioritize care for women in midlife, the majority of OBGYNs are not equipped to effectively treat women our age. Think about that for a moment. Most of the doctors who specialize in women’s health are only trained as experts in the areas that pertain to younger women.

How Can We Help Ourselves?

So, what are we as patients AND consumers to do? We need to, first and always, advocate for ourselves and seek out the best care available for where we are in life and what our medical issues are. Friends, this means we may need to find a new OBGYN.

If your OBGYN is telling you that you need to suck it up through hot flashes, joint pain, sleep disturbances, heart palpitations, mood changes, bladder issues, vaginal pain and dryness, diminished libido, headaches, migraines . . . it’s time to find a new doctor. It’s not that they are bad people or even bad doctors. It’s that they have not expanded their knowledge base and expertise to include the facts of what we know NOW about perimenopause and menopause.

Research studies have found that replacing our body’s estrogen and progesterone has a significant effect on maintaining optimal performance and protecting us from disease in most of our body’s systems. Estrogen has been proven to prevent disease and dysfunction in the brain, cardiovascular system, musculoskeletal system, endocrine system, urinary and gynecological systems. . . to name a few.

If your doctor is not guiding you through these topics and discussing your options with you, then it’s time to find a new one.

Now let me be very clear in saying that for some women HRT is not recommended or safe. There are many medical conditions that preclude women from taking estrogen or progesterone. This fact is critically important to know. I’m not even going to begin to list these conditions because they are so individually rooted in your personal health history. If you have a diagnosis that prohibits you from utilizing HRT, your doctor should thoroughly explain it to you. I want you to understand all of the “why’s and how’s” of your condition. As your own health advocate, please do your due diligence, research your diagnosis, and, if necessary, seek a second opinion.

Once you thoroughly understand the ins and outs of your situation, it’s time to discuss the options that are safe and available to you.

If your peri or menopausal symptoms are negatively impacting your life, and HRT is not a safe option for you, your doctor should be discussing safe treatment alternatives with you. If they aren’t working with you to address and treat your symptoms, it’s time to look for a new physician.

So how do we find the right physicians who have expertise in perimenopause and menopause? In addition to expertise, you want a care provider who is going to listen to you, take their time with you, address all of your questions and concerns, and be readily available for follow-up. You deserve to know how good it feels to be heard and to work with someone who is respectful of your time, questions, and concerns. Take a look at the following resources to get started on your search.

Finding a Healthcare Provider

• Wake Her Up is a fantastic site with the largest global directory (link) of hormone therapy providers.  The list has been created “by women for women” and only includes providers with whom patients have had good, positive experiences.  Their “Full Directory” allows you to search by your zip code and set your desired radius to find physicians near you.
• The North American Menopause Society (NAMS) has compiled a list of physicians who list menopause as a key focus within their practice. Their website has a Practitioner Search Feature by Zip code. (link)  Here’s the honest truth about this site.  While NAMS is doing great work in advocating for improved healthcare for women in midlife, their directory of menopause specialist gets mixed reviews.  Why? Because the doctors can list themselves and there’s not really a vetting practice.  However, I am including it because it is a resource, and I want to include as many options for you as I can.
• Google “Hormone Specialists” in your area. Many OBGYN’s out there have shifted their practice to focus strictly on hormones.  So if you’re not finding a match with the specific resources I’ve listed, this is another way to broaden your search beyond OBGYN practices.
• Consider a Functional or Integrative Health physician. They take a combined approach of traditional western medicine with nutritional and holistic treatments.
• Talk to your primary care physician, your other healthcare providers, even your pharmacist.
• ASK! . . . your girlfriends, family members, colleagues.
• Finally, when you get names of providers, read reviews! Of course, there are occasional patients who had a singular bad experience, and may write a scathing review. However, in many cases you may see a pattern of negative reviews that echo a recurring problem. Use these to help guide you in your decision. Hopefully, you will run across positive reviews that report qualities you’re looking for.

Most of us have been conditioned to prioritize our children’s health over our own. Many of us are caregivers to aging parents, and so we put their health before our wellbeing. Ladies, we cannot pour from an empty cup. We cannot care for others if we’re not adequately caring for ourselves. It may push our comfort zone or feel “selfish” to make our own health a priority, but we deserve to Elevate our health and wellbeing to thrive through this next phase of life!

Thank you so much for continuing to show up here to learn about thriving in Perimenopause and Menopause.

I have loved revisiting this topic with you! I hope you have a great Tuesday, and I’ll see you back here on Thursday!

Resources:

*Celeste Krewson, A. E. (2023, August 11). Survey shows menopause curriculums lacking in residency programs. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/survey-shows-menopause-curriculums-lacking-in-residency-programs