Let’s be honest, for most of us perimenopause is a really confusing and frustrating time. There’s all these changes happening to us (physically and mentally) that we weren’t expecting and that we don’t really know how to deal with. Who do we turn to? How do we find doctors specializing in perimenopause?
We do a little google search only to be completely overwhelmed by the sheer volume of information (and misinformation). Then, more often than not, a visit to our family doctor does very little to alleviate this confusion.
For me, my doctor’s appointment actually left me feeling dismissed, more frustrated, and completely alone.
Lucky for me, when perimenopause hit me like a freight train, I was taking time off work to focus on my family and had the luxury of time on my hands. I was able to really dig in, do my research and try to figure out what was going on and who could actually help me.
So little time
As women we are wearing so many hats – we are professional career women, stay-at-home moms, caregivers to our aging parents, household managers, uber drivers, volunteers, wives, sisters and friends. With all these balls in the air, most women don’t have the time to prioritize themselves and their health. There simply isn’t time to siphon through the millions of pages of information online or dig into a good menopause book.
We need answers and we need them quickly.
Since I know not all of you have the luxury of time that I did, I wanted to share with you what I learned to help you quickly find the support you need when perimenopause starts to rear its ugly head.
Why do you need a doctor who specializes in perimenopause
I’m sorry if I’m the one breaking this to you, but it can be hard to find a doctor who specializes in perimenopause. Despite the millions of women that experience perimenopause and menopause each year, “the newest generation of medical graduates and primary care providers lack the training to manage menopausal symptoms an increasing number of women will experience during the next decade,” according to an article from the New England Journal of Medicine. But that’s a whole other story.
Despite this challenge, it is really important to find someone who can help you understand the physical and emotional changes that come with perimenopause, and who can provide solid advice on how to manage them.
Doctors specializing in perimenopause
A perimenopause specialist can provide simple lifestyle, diet, sleep and exercise changes that might help to reduce the severity of perimenopausal symptoms. And if these changes don’t work, they can also support you with medical advice, medications, therapies and other protocols to reduce symptoms like hot flashes, night sweats, mood swings and other menopausal symptoms.
With perimenopause, some women may also experience uncomfortable changes like vaginal dryness, itching and (no surprise) a reduced libido. Perimenopause specialists can offer guidance on how best to manage these changes and may suggest treatments such as lubricants or hormones to restore sexual desire and pleasure.
Perimenopause specialists can even support women with critically important mental health issues and mood changes that we can experience in perimenopause. If you haven’t been feeling yourself lately, you’re not crazy and you’re definitely not alone. Low moods, the blues, anxiety and even depression are difficult and sometimes devestating symptoms of perimenopause. In fact, depending on the study you read, 19-36% of women may experience depression as a result of the raging hormonal tide we call perimenopause.
Doctors specializing in perimenopause will have the knowledge needed to offer counselling support as well as potential prescription medications for treating mental health concerns like depression or anxiety related to menopause.
If you are experiencing any of the following symptoms, it is critical that you contact your doctor immediately:
Depressed mood most of the day, nearly every day for 2 weeks or longer and/or
Loss of interest or pleasure in activities that the person usually enjoys.
Feelings of guilt or worthlessness
Recurrent thoughts of death or suicide.
Types of doctors who specialize in perimenopause care
Obstetrician-gynecologists are the most common types of doctors women are referred to, but you might also ask your family doctor for a referral to see an endocrinologists or nurse practitioner. Another option that doesn’t need a referral is to consult with a naturopathic doctor (NDs) who approach menopause with a multifaceted, non-drug approach.
Let’s break this down to help you decide which doctor is right for you.
Obstetrician-gynecologists (OB/GYN) are doctors specializing and qualified to diagnose and treat all women’s reproductive health; from puberty to pregnancy, and right through to post menopause. OB/GYNs can provide comprehensive care for perimenopausal patients, including advice on lifestyle modifications, and perhaps Menopause Hormone Therapy (MHT, also known as Hormone Replacement Therapy or HRT) to help manage menopausal symptoms.
Endocrinologists are another type of doctor that specializes in hormone related issues like menopause. They study more than just our reproductive hormones, estrogen, progesterone and testosterone, they also specialize in cortisol, insulin, thyroid and human growth hormone, how to regulate these hormones and the diseases associated with them. You might be referred to an endocrinologists for symptoms like fatigue, changes in muscle weakness, unexplained weight gain or loss, changes in hair growth/loss, anxiety or depression ~ symptoms of perimenopause, but also potentially diabetes, thyroid disorders and diseases, autoimmune endocrine diseases, infertility, growth issues, metabolic disorders, osteoporosis, some cancers, and disorders in the hormone-producing adrenal glands and pituitary glands.
Nurse Practitioners (NPs)
Nurse Practitioners (NPs) are registered nurses who have additional education and experience that allows them to:
- Autonomously diagnose and treat illnesses
- Order and interpret tests
- Prescribe medications
- Perform medical procedures
This means they can help support perimenopausal women and symptoms in similar ways to your family doctor. The offer a great alternative to the long wait times you may experience trying to get an appointment with your family doctor.
Naturopathic Doctors (NDs)
Naturopathic Doctors (NDs) are another great option for perimenopause care. Naturopathy is an holistic approach to medicine which focuses on the balance of body, mind, and spirit. They provide individualized treatment plans that combine natural therapies with lifestyle modifications, such as diet and lifestyle changes, stress management techniques, exercise routines, and sleep hygiene practices. NDs may advise patients to try acupuncture or to take herbal supplements to relieve perimenopause symptoms.
NDs can also provide comprehensive mental health support; offering counselling services or referring patients to other mental health professionals when necessary. Additionally, NDs have access to bio-identical hormones which are derived from natural sources verses synthetic sources (are controversial for sure; more on that in another story) and can be tailored for each patient’s specific needs. Bio-identical hormones can be used safely in combination with other natural treatments like botanicals or dietary supplements for a more personalized approach.
When considering naturopathic care for perimenopause it is important to ensure the doctor is certified by their provincial regulating body, for example the College of Naturopaths of Ontario.
It is also important to note that NDs are not covered by provincial health care programs and all appointments, tests and treatments plans must be covered personally.
A couple other options you might consider:
There are menopause clinics throughout the country that specialize in supporting women who are experiencing significant symptoms like hot flashes, night sweats, new sleep problems, mood changes, vaginal dryness, new joint pain, and abnormal uterine bleeding. Here is where you find doctors specializing in perimenopause. They are an awesome resource of support, unfortunately wait times for these clinics can be 6 months to a year and the referral process can be rigorous.
Online Health Portals
One of the benefits of the recent pandemic is the availability of online health support. If you are short on time or live in a remote part of the country, you can get support, a diagnosis, test referrals and prescriptions through a virtual telehealth appointment with a doctor licensed in your province.
When to go see a perimenopause specialist
Most Canadians reach menopause between the ages of 45 and 55, with an average age of 51. The reality is that many women can begin to experience any of the more than 30 different symptoms of perimenopause in their early-to-mid 30s. If you are noticing changes to your mood and body that you just can’t seem to explain or control, it’s a good time to make an appointment with your family doctor. The reality is that you probably won’t get diagnosed on your first visit (I was dismissed more than once because I was too young) so get in there right away to start the conversation.
Before your appointment, you really should do a little work (I know, I know. You have no time!) to make sure you can answer the doctors questions and that are asking them the right questions. Now more than ever, we need to become the heroes of our own health stories.
What to do before your appointment
1. Track your period
Even if just for a month, track your period using a calendar or period tracking app. It’s important to not only track start and end dates each month, but also blood flow and colour, mood and physical symptoms in the days leading up to and during your flow. The longer you track, the more information you’ll have to demonstrate inconsistencies, changes and disruptions to your life.
Why is this important? As Laura Briden points out in her book, the Fifth Vital Sign, “your menstrual cycle is a vital sign, just like your pulse, temperature, respiratory rate and blood pressure – and it provides essential information about your health.”
2. Review Treatment Options
There are a number of treatment options available for perimenopause depending on the type and severity of symptoms. You might want to ask your practitioner to see if Menopause Hormone Therapy (MHT), Selective Serotonin Reuptake Inhibitors (SSRIs) or antidepressants, birth control pills or IUDs are right for you. Or, you may want to explore the ND route of supplements, diet, lifestyle and exercise. Either way, it’s good to have a basic understanding about your options before you meet with your practitioner.
3. North American Menopause Society (NAMS)
Since your family doctor is going to refer you to a specialist, it’s a great idea to make sure you’re being referred to someone who specializes in perimenopause and menopause. A great resource is to look up North American Menopause Society (NAMS) – North America’s leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. While not all menopause specialists are NAMS certified, the NAMS list provides a good starting point to find a doctor who can help you.
What to look for in a doctor who specializes in perimenopause care
When looking for an experienced perimenopause specialist, make sure they have experience treating women with hormonal imbalances related to menopause as well as mental health concerns associated with this stage of life.
It’s also a good idea to look at reviews online from patients who have had experience with the doctor and determine if they were satisfied with the care provided. You should also be aware of any red flags like indications that their knowledge about menopausal health is not up-to-date or accurate. Taking proactive steps to research and find the right doctor for your needs will ensure optimal health during this important transition in your life.
What to expect from your doctor who specializes in perimenopause care
When you go see a doctor who specializes in perimenopause care, you should expect a comprehensive approach to treatment that includes both physical and mental health components.
1. Review Medical History
Your doctor should take the time to discuss your symptoms and medical history.
2. Order Tests
They may order blood tests, pelvic exams, mammograms, ultrasounds, Pap smears, bone density scans (DEXA scan), pelvic floor dysfunction evaluation (PFD evaluation) and more. Although there really isn’t a test to diagnose perimenopause, these tests can provide a benchmark to reference changes over time.
3. Take Time to Answer Questions
Your doctor should be willing to answer any questions or concerns you may have about your health, menopause-related issues and potential treatment options.
4. Help You Find a Solution
Every woman’s perimenopause journey is unique and so it’s important that your practitioner help to build an individualized plan that works best for you. This may include lifestyle changes, nutritional and dietary modifications, exercise recommendations, hormone therapy, psychological counselling, and/or natural remedies such as herbal remedies, supplements, or acupuncture.
5. Ongoing Support
Regular checkups with a perimenopause specialist can help monitor changes in hormone levels and symptoms and ensure adjustments to treatment as needed.
Become the Hero in Your Health Story
The truth is only a quarter of doctors will talk about menopause proactively, so don’t count on your doctor to bring it up. There is no reason to suffer in silence or grin and (try desperately) to bear it through these 6 to 8 years of transition into menopause. Oh did I forget to mention that?
You took the first step, reading this blog and the other stories we share on This Is Perimenopause. The next steps is finding the right doctor who will take the time to get to know you and your symptoms and help you map out the best treatment plan for you.
There are many incredible doctors out there, so make sure you take a just a little bit of time to find the right one for you. I promise it will save you days, months and even years of misery, frustration and uncomfortable symptoms.