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Tips for Getting the Perimenopause and Menopause Care You Need

January 2024¹

1. Look for a Menopause-Informed Provider(s).

• You may have a good relationship with your GYN and may have an even longer one with your primary care doctor. But if neither is knowledgeable about menopause—including the symptoms, stages, and treatment options—then it may be time to find providers that specialize in menopause.  
• The Menopause Society (formerly NAMS) certifies practitioners who get additional menopause training. Here is a link to find a NAMS-certified practitioner in your area.
• Menopause can affect many aspects of our health because hormones impact every system in our body. Some symptoms impact our skin, bones, and joints, while others involve mental health changes, dry eyes, migraines, and heart palpitations. So, be aware that new symptoms may have hormonal changes to blame! Therefore, it is not just your GYN that needs to know about menopause. It is important that your general practitioner and the other practitioners you see regularly are menopause-informed and mindful of the way symptoms can present during this transition.
• Menopause care can be a complicated puzzle that may require special training and skills. Unfortunately, most medical schools do not teach this subject well. Advocate for yourself and your unique menopause needs. If you are able, switch providers or seek out a specialist to help you through this transition.

2. Recognize You May Need to Schedule Multiple Appointments

• It is important to manage your expectations.  Getting the individualized care you need may require multiple medical appointments. A preventative annual visit with your gynecologist or internist may entail many screening tests and questions—all of which are time-consuming. There may not be time to discuss all your menopausal symptoms during one appointment. This undoubtedly can be frustrating but worth persevering!
• Therefore, it may be important to book a follow-up visit, so your health care provider can give you and your concerns the time and attention you deserve.

3. Know Your Symptoms

• Learn More
  Learn as much as you can about menopause from trusted, reliable sources, including:

Let’s Talk Menopause

The Menopause Society

Society For Women's Health Research

International Menopause Society

• Track Your Symptoms
  ‍Track your symptoms for a few weeks before your appointment. Let’s Talk Menopause has created a symptom tracker to make this process easier:

LTM Symptoms Tracker-English  

LTM Symptoms Tracker-Spanish

And check out this useful rating scale:
The Menopause Rating Scale: Menopause Rating Scale (MRS)

Order your symptoms according to which are worrying you the most or having the greatest negative impact on your health and life.

4. Prepare for Your Appointment

• Write down your questions and concerns before your appointment.
• Start with your most pressing concerns—the issues worrying/bothering you the most. For example, you might want to begin with your mood and sleep symptoms if they have been most distressing to you. Your list of symptoms will help your provider understand how you are feeling, why, and when you need additional medical evaluation. Remember, you are the expert in how you feel and the changes you are experiencing.
• Make clear any general preferences you may have. Some people are open to all or various options, others have certain treatments they want to avoid. For example: “I generally prefer to avoid all medications;” “I have tried various antidepressants in the past, and I certainly don’t want to go on those again,” or “I want to start hormone therapy.” This will help your provider offer the best treatments for YOU! Nonetheless, it is worth listening to what your provider recommends because there are a lot of myths and misinformation about menopause treatments.

5. Be Aware of Potential Red Flags

• The biggest one: your medical practitioner dismisses your symptoms and concerns or suggests, “They’re all in your head,” “This is normal for a person your age,” “It’s just perimenopause.”
• Selling you an expensive product. Ethically, a medical provider should not be selling you products. Beware of practitioners who sell compounded medications, require frequent hormone testing (except for testosterone testing to ensure appropriate dosing), or charge a monthly (or subscription) fee. Hormone therapy should not be costly. Hormones are not controlled substances that need constant monitoring; your symptoms (and symptom relief) are the best guide to the right dosing.
• Hormone testing during perimenopause: According to The Menopause Society and many menopause healthcare providers, hormone testing generally has little diagnostic value during perimenopause; your hormones fluctuate too much to make tests predictive of menopause. (Menopause is diagnosed after the fact, only when you have not had a period for one year). Beware of direct-to-consumer marketing of such hormone-testing products, as they are rarely needed to diagnose perimenopause. They also will not predict your last period or when menopause will happen. Hormone testing can result in unnecessary expenses that do not change (or help) management. Let the buyer beware!
• Compounded Products (often marketed as “bio-identical”): Not all pharmacies making compounded drugs are problematic, but consistency of ingredients and dosing, product shelf life, and even product contamination can be concerns when using compounded products. They are decidedly not safer than other products. In fact, there are more safety concerns because they are not subjected to rigorous testing and are not required to carry warning labels (even though they may have the same risks as FDA-regulated options at your neighborhood pharmacy). Finally, no compounding medications are covered by insurance, so they will often be more expensive.
  
  For these reasons, it is recommended to use FDA-regulated, commercially available products when the option exists. For specific allergies, or in circumstances when no FDA-regulated equivalent product exists (i.e., testosterone for decreased libido), there are some excellent compounding pharmacies—but these situations should be

6. Good Articles/Medical Guidance

• Susan Dominus article in New York Times Magazine: “Women Have Been Misled”
• Jennifer Gunter article in NYT: How to Have a Feminist Menopause
• Why is Perimenopause Still a Mystery-NYT
• Let's Talk Menopause, Further Reading
• Guidelines for Perimenopausal Depression
• ​​North American Menopause Society (NAMS) Hormone Therapy Position Statement
• The 2023 Nonhormone Therapy Position Statement of the North American Menopause Society
• The 2020 Genitourinary Syndrome of Menopause (Vaginal Dryness, Painful Sex, UTIs, Urinary Frequency) Position Statement of The North American Menopause

¹ Written and Approved by Robin Noble, MD, Medical Director, Intermed; Chief Medical Advisor, Let’s Talk Menopause; and Heidi Flagg, MD, Spring OBGYN; Medical Advisor, Let’s Talk Menopause.

² Note, in certain circumstances, specific hormone tests may be necessary: if there are fertility issues, thyroid concerns, a woman stops menstruating at an early age, or when the clinical situation is confusing (in the setting of a prior hysterectomy, after an endometrial ablation, with amenorrhea from a levonorgestrel IUD)