When Should I Talk to my Doctor about Menopause?
The best time to talk with your doctor about menopause is early and often. Women should start thinking about menopause and discussing it with their doctor in their late 30s and early 40s. Most women don't enter peri-menopause until approximately age 45, but lots of women start earlier and have symptoms long before they attribute them to menopause. A recent survey of 4014 women aged 45-55 who are currently or have previously experienced the perimenopause or the menopause revealed that revealed that 45% of women had not talked with their doctor about menopause. Even
among women with five or more severe symptoms, 29% had not spoken to their doctor. Hesitancy to discuss menopause with your doctor can arise from multiple concerns. Our culture seeds deep-seated shame into women about our "private parts," which makes talking about our symptoms, particularly if they are sexual, difficult. Additionally, the trope is that women are supposed to tolerate any symptoms of menopause (or pregnancy or postpartum) as part of being a woman, not something that we shouldn't have to suffer. And unfortunately, significant cultural stigma is associated with aging for some women, and many women choose to avoid signs that they are reaching the threshold of menopause. Finally, in worst-case scenarios, women rightly fear being dismissed by their doctors, talked down to, or sent off with a quick prescription.You deserve to get the support you and your body need during menopause and perimenopause.
How Do I Find the Right Doctor to Help with Menopause?
A survey of residency programs, across internal medicine, family medicine, and gynecology residents, found that there was only 1-2 hours of education about menopause. Twenty percent of doctors said they received no menopause education, and only 7% said they felt prepared to treat menopausal women. If you find that appalling, you're right. Half the planet goes through menopause so it really is unacceptable that healthcare providers have so little training. In the survey of women described above, 31% of women agreed that it took many appointments for their doctor to realize they were experiencing symptoms attributable to peri-menopause or menopause - the numbers rose to 45% for women of color and 42% for women with 5 or more severe symptoms.
In this morass of doctors unequipped to provide quality healthcare for half the population of the world during menopause (and by the way, most women are in menopause longer than they were of reproductive age), how do you find a doctor who has the tools and knowledge needed to help?
Search the database for the North America Menopause Society. This directory includes licensed healthcare professionals with interest and expertise in menopause.
Look for a menopause clinic. There are some clinics that specialize in menopause medicine.
Get a referral. If your current doctor can't provide the necessary support, ask them for a referral to a menopause specialist.
What Information Should I Be Prepared to Provide for my Doctor?
When was your last period? How regular your periods have been over the last few months? Have your periods been shorter or longer, heavier or lighter, different in some other way? How old were you when you had your first period?
When was your most recent Pap smear, bone density test, mammogram, colorectal screening? What were the results? Have you ever had an abnormal pap smear?
Which medications are you currently taking? For what issues? Do you take supplements? Which ones?
How much exercise do you get in a week?
Provide your medical history. Tell the doctor about all of your illnesses, operations, medical conditions, and other doctors you see. Have you been pregnant? Given birth? How did you deliver? Postpartum issues? Fertility issues?
Are you having pain with sex? Any other concerns with intimacy? Sex is no longer a taboo subject, and your problems should be shared with your doctor.
Describe any menopause symptoms that you have? Vaginal dryness, weight gain, mood swings, irritability, night sweats, hot flashes, trouble falling or staying asleep, dry skin, brain foginess, decreased sex drive, urinary issues (leaking, trouble starting, frequency), memory loss, joint pain, depression or anxiety, headaches, something else? Any other symptoms that you have but think might be related to something else? Which symptoms are most bothersome?
Have you tried anything to manage the symptoms? Did it make it better, worse, no change?
Does having your period seem to make the symptoms better, worse, or no change?
Provide your family medical history. Did you mom or grandmother have osteoporosis? Breast, ovarian, uterine, vaginal/vulvar cancer? Any history of colorectal cancer?
What are you using for birth control/STI prevention?
Which Questions Should My Doctor Answer?
Do I need a test for menopause? Should I get my blood checked if I take menopause hormone therapy (MHT)? If you are over 45, there is no need to test specifically for menopause. The condition should be diagnosed based on symptoms. Blood tests for sex hormones (whether on MHT or not) are generally not worthwhile since the day and time impact results significantly and can lead to erroneous conclusions...and the lab tests are pricey! Your doctor should consider your symptoms when deciding whether to use MHT and whether to change (increase) the dose. Of course, there are always exceptions to the rule so follow the advice of your doctor, but be wary of doctors ordering repeated testing for sex hormones. No reputable medical association, including NAMS, supports regular blood testing while using MHT.
Are there other explanations for my symptoms? There is no doubt that other causes might be to blame for your symptoms. Since some of these conditions are serious, you should talk with your doctor about every symptom you are experiencing so nothing is overlooked.
What can I do to lessen my symptoms? Prescription medication, lifestyle changes, changes in my exercise routine, therapy? Your doctor should be able to work with you to get to the cause of your symptoms. Often it's difficult at first to determine underlying causes. For example, your irritability may be caused by changes in your brain or by the fact that you aren't sleeping well. Similarly, your lack of sleep might be caused by night sweats, poor sleep hygiene, hunger, sleep apnea, etc. Properly managing symptoms ultimately will require teamwork between you and your doctor. Don't be satisfied by a doctor who quickly writes you prescriptions for anti-depressants and menopause hormone therapy (MHT) and sends you on your way. Those might be the right answers for you but a thorough investigation of all your symptoms and ruling out of other underlying causes should be completed first.
How long will these symptoms last? In general, you can assume that some symptoms, like hot flashes and moodiness, will resolve as you move further into menopause...although that might take as long as 10 years. Other symptoms, like vaginal dryness and brittle hair and nails, will continue for the remainder of your life.
Should I take testosterone? Maybe. According to consensus of most international medical groups, the only evidence-based indication for testosterone therapy for women is for the treatment of hypoactive sexual disorder (HSDD). All other treatment options should be considered prior to testosterone therapy. There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention. Blood total testosterone level should not be used to diagnose HSDD since many women with low systemic testosterone levels do not complain of distressing low libido or other symptoms. Treatment should only be with formulations that approximate premenopausal physiological concentrations - which excludes pellets and injections. High dose testosterone in women can lead to potentially irreversible side effects, including enlargement of the clitoris, deepening of voice, and male pattern baldness.
Should I use "compounded" or "bioidentical" MHT instead of the prescription kind? There is confusion due to marketing terms used for menopause hormone therapy (MHT). Here are some tips:"Bioidentical" refers to the molecular structure of the active ingredient of a product. A product is said to be bioidentical when the molecular structure of the active ingredient is exactly the same as the hormone your body produces.“Natural” is a term that has long been associated with bioidentical products, but it is a misperception. Some bioidentical estrogen products are derived from wild yams. However, those yams are altered in a lab through a chemical process to create the final product. This is true for yam-derived bioidentical FDA-approved products and bioidentical compounded products. Bioidentical products are not necessarily safer or more effective. In order to become FDA-approved, there are several hurdles a potential therapy/product has to clear to prove its safety and effectiveness. Compounded products are not subject to the same hurdles. Compounded hormone therapy refers to the non-FDA-approved bioidentical options made in compounding pharmacies. Compounded hormones should be considered in three situations - the patient is allergic to one or more of the ingredients used in an FDA-approved product, available FDA-approved products don’t offer a certain dosage level of a medication, or there are no FDA-approved options.
When should I come back to see you? In general, after the initial few months working with your doctor on the best treatments for you, you shouldn't need to see your doctor more than once per year. You should notify your doctor if you have new or worsening symptoms. Menopause is a process, not a destination. You can expect that the symptoms you have today will not be same (or the same severity) as the ones you have in a few months. See a doctor immediately if you have unexpected, heavy vaginal bleeding or feel like you may be a danger to yourself or others.
Is there any blood work that I should have checked regularly? There are tests to check your overall health rather than whether or not you are menopausal. Some tests you might be offered include complete blood count (CBC), lipid panel, comprehensive metabolic panel (CMP), C-reactive protein (CRP), thyroid panel, iron panel, hemoglobin A1C, vitamin B12, and vitamin D. Menopausal women are more prone to high levels of inflammation (CRP), low levels of iron, disruptions to their thyroid function, diabetes (hA1C), and deficiencies in vitamins B12 and D. Many of the symptoms associated with those conditions mimic those of menopause so your doctor is best suited to determine which tests are appropriate for your situation and the frequency with which they need to be done. The USPS task force recommends routine testing every 3-5 years for women over 50 unless there are unexplained symptoms and/or risk factors for cardiovascular disease.
How often should I get a pap smear, mammogram, bone density scan? Mammograms are recommended every other year for women in their 40s, annually after 50 years old, and no longer necessary for women over 75. Women over 30 should get a pap smear every 3-5 years, based on screening guidelines. Pap smears can be stopped after age 65 if the previous 3 pap smears were normal. Bone density scans are generally performed every 3-5 years for women 65 and older (earlier/more often with risk factors).
How long will it take for the treatments to work? What should I do if I don't see an improvement? What side effects should I expect? How should I handle those side effects? The answers depend on which treatment is chosen. In general, you should report any serious side effects immediately. If the treatments are not effective at reducing your symptoms, your doctor should work with you to find alternate treatments that will work. There is no reason to suffer when there are many options for you and your doctor.
Remember, you are important member of your healthcare team. In order to get the best care possible, look for a menopause specialist in your area, clearly, thoroughly, and honestly (this is no time to be embarrassed - your doctor has heard it all!) describe your symptoms, and follow your doctor's instructions. You deserve to be heard, have your concerns and questions answered, and receive the best evidence-based medical treatment available so that you can be the healthiest you.
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