Menopause Support

If you feel like you know nothing about menopause, watch this now

The M-Factor PBS Documentary

The menopausal transition is an opportunity to refocus attention & energy on your health & wellbeing. For some, this can mean making lifestyle changes to improve day-to-day quality of life & prevent chronic disease. For others, hormonally-mediated symptoms may motivate a search for relief through menopausal hormone therapy (MHT) or other therapies.

Navigating the immense quantity of information from internet, medical providers, & friends can be overwhelming; all women can benefit from individualized education, counseling & evidenced-based therapies only a certified menopause specialist can provide.

Schedule a Menopause Consultation

Services Provided

Education & counseling on menopause including up-to-date health-related research focusing on women >40.
Individualized, screening recommendations & proactive preventive care based on assessment of personal/family medical history & evaluation/management of current complaints, including:
- Diet & lifestyle assessment & counseling in accordance with tenets of “Health at Every Size”.
  - For those that meet clinical criteria, medications may be an option
- Screening for & treatment of conditions that co-exist, mimic, or exacerbate menopausal symptoms:
  - vaginal & urinary tract symptoms, genitourinary syndrome of menopause
  - breast & bone health,
  - thyroid, blood sugar, cholesterol issues,
  - nutritional deficiencies,
  - issues related to fertility & contraception.
- FDA-approved ‘bioidentical’ menopausal hormone therapy & testosterone

It’s recommended to have PCP to seek regular care for any acute illness/needs that are not listed above; referrals here

HELPFUL TO SEND RECENT TEST RESULTS & CURRENT MEDICATIONS/SUPPLEMENTS BEFORE FIRST APPOINTMENT.

Schedule a Menopause Consultation

Menopause Frequently Asked Questions

Are my symptoms related to menopause?

Menopause is not like a light switch, where one moment you are pre-menopausal, the next you are post-menopausal. Unfortunately, it is quite the opposite: erratic hormone production fluctuates from day to day, month to month, thereby causing changeable and varied symptoms.

Menopause is the spontaneous, permanent ending of menstruation, literally one day, typically the day that is one year after the final menstrual period. This usually occurs age 50-52, but can be anywhere between age 40-60. Symptoms may begin up to 15 years before the final menses & may last for several years after. Many factors impact this transition, from genetics to lifestyle habits and some enter menopause through surgery or medication.

Special consideration should be given to issues related to fertility. Pregnancy can occur even in presence of menopausal symptoms & menstrual irregularity throughout the 40’s. Others may have difficulty achieving/maintaining pregnancy in absence of these symptoms at any age. Contraception and/or fertility-preserving strategies should be a part of every woman’s assessment & plan during perimenopause.

When one suspects perimenopausal symptoms, it is an excellent time to have a complete medical examination by a qualified health professional. Diagnosis of perimenopause can usually be made by reviewing a woman’s medical/menstrual history in addition to specific symptoms and treatment recommendations can be made accordingly.

Do I need hormones?

Not all women need menopausal hormone therapy (MHT). This decision should be based on conversations between a woman and her physician. Therapies like diet and lifestyle that can impact perimenopausal symptoms and risks for chronic disease should be addressed. Screening for other conditions that can cause similar symptoms, like hypothyroidism, should be done.

A considered assessment of a woman’s potential benefits vs. risks should be conducted. While risks are possible with any use of MHT, symptoms can negatively impact a woman’s day-to-day quality of life, affecting relationships with family and friends and performance at work & the degree to which this happens may outweigh potential risks. Medical organizations devoted to the care of women agree that there is no question that MHT has an important role in managing symptoms during menopause. What we’ve learned so far about the benefits and risks comes from large groups of women, but each woman is unique. The question is whether it is the right choice for YOU. Only after you and your doctor have a thorough discussion about your individual risks, benefits, and preferences can you make a decision that’s right for you.

Why do I need to see a menopause specialist?

Maybe you don’t. Not everyone needs treatment for menopausal symptoms. This is not rocket science or magic, menopause is a stage of life and, like menstruation & pregnancy, is not a disease that requires treatment for all. However, like menstruation & pregnancy, some have symptoms associated with menopause that can be managed to improve overall comfort & quality of life. A certified menopause specialist can provide individualized risk assessment & evidenced-based treatment of menopause-related symptoms, including osteoporosis, anxiety, depression, insomnia, cardiovascular disease, diabetes, migraines, contraception & sexual dysfunction.

A word of caution about those who claim to be menopause specialists and promote unregulated, expensive, unsafe therapies: pellets, injections, compounded hormones are not recommend by any professional society & are discouraged by the Am College of OBGYN, Menopause Society, the International Menopause Society, the Endocrine Society, the Am Society of Reproductive Medicine, the International Society for the Study of Women’s Sexual Health. (note: compounded MHT may be acceptable when FDA-approved options are not available)

Do you prescribe bio-identical hormones?

There is a lot of confusion regarding the term “bio-identical” MHT. In brief, hormones may be synthetic or bio-identical. “Bio-identical” refers to hormones that are chemically identical to those made by a woman’s body. There are studies that suggest bio-identical hormones seem to be somewhat safer than synthetic, but no systemic MHT should be considered risk-free.

Bio-identical hormones may be custom-compounded or prepared by pharmaceutical companies. Many years ago, when I graduated into the storm of the WHI study, patients and physicians chose compounded preparations because conventional bio-identical options were scarce. Today, however, several FDA-approved bio-identical HRT in an array of doses/formulations. Compounded hormones may be necessary when there is not an equivalent FDA-approved option or when a woman has an allergy to a component of a commercially-produced product, but this is rare

Compounded products are not covered by insurance and are not supervised as closely as the FDA-approved products and there is no evidence that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies; typically they are much more expensive and have more risks. As such, the FDA-approved products are a great choice for most women.

Are there non-hormonal treatment options available?

There are non-hormonal options for women who prefer to avoid HRT or in whom the risks outweigh potential benefits. There are several studies confirming the positive impact of diet, exercise, acupuncture, stress management and lifestyle changes for women with mild symptoms & should be included in any treatment plan. Vitamin and herbal supplements may be helpful in some women, like valerian for sleep or calcium and vitamin D if dietary sources are insufficient, but research is lacking on “menopause supplements” & they are expensive; best to skip them.

Finally, there are non-hormonal medications that may do double-duty in decreasing menopausal symptoms while treating other conditions, such as depression, insomnia, & anxiety. My goal is to help manage menopausal symptoms without needing a bag full of medications OR supplements by utilizing targeted therapies that are supported by research.

Aren’t hormones dangerous?

There are several benefits to using hormones including decreasing symptoms such as hot flashes, night sweats, insomnia, mood issues, “brain fog”, urinary symptoms, vaginal dryness and painful intercourse, preventing bone loss, lowering risk of heart disease & diabetes if started early.

However, despite claims, there is no such thing as “risk-free” MHT for menopause when used systemically. (note:: vaginal estradiol can used risk-free)

Generally, MHT may be an acceptable option for women in perimenopause, within 10 years of menopause, and healthy older women who continue to be bothered by menopausal symptoms. This goes for women who have had breast cancer (see Resources on right of page). Individualization is key in decision to use MHT. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors. Newer studies are frequently published, so this topic is constantly in flux, but the recent data is very encouraging for MHT use so long as it is beneficial.

Many are told that they must stop MHT by 65, but recent data indicates many women will continue to experience menopausal symptoms that negatively impact their quality of life well past this age and may benefit from continued MHT. These decisions are nuanced & must take into account several factors that are best considered with the help of a menopausal specialist.

What lab work or testing will I need?

For most, hormone tests are not helpful because levels change throughout the menstrual cycle (see graphic upper left corner of page). A single hormone level can be misleading since levels does not fall at a steady rate, but varies greatly during perimenopause: Levels cannot predict or confirm menopause or determine whether MHT can be beneficial. Normal hormone levels in presence of menopausal symptoms does not eliminate the likelihood that one is perimenopausal.

Testing may be helpful with, complaints of sexual dysfunction, fertility problems or when periods stop at an early age. Some lab tests can identify other causes of symptoms that mimic or worsen symptoms of perimenopause, such as thyroid disease or vitamin deficiencies, & diseases that can increase during perimenopause, such as cardiovascular disease and diabetes.

Though often recommended by many “menopause specilists”, salivary/urine hormone levels are not accurate & should not be used to evaluate or treat menopausal symptoms. Treatments should never be prescribed to treat hormone levels, but only to decrease symptoms & therefore levels are unnecessary to determine or adjust dosing. For more info on the lack of support for hormone testing in menopause, read this excellent explainer by Dr. Jen Gunter