Finding supportive healthcare during perimenopause
It’s hard to switch healthcare providers, but the person who supported you in your 20s or 30s may not be the right person to take you through the hormonal fluctuations of your 40s and 50s. Some healthcare providers have considerably more experience with perimenopause than others.
Keep in mind the research about this phase is relatively new, so many healthcare providers don’t know and won’t link the symptoms you are describing to fluctuating hormonal patterns. And, if you have read through this website, you know a lot about more about perimenopause than many healthcare providers. Armed with this knowledge and your cycle and symptom data, you will know when you’ve found a healthcare provider who is a good fit.
Many types of providers may be able to offer healthcare during perimenopause:
- primary care provider
- internist
- family medicine doctor
- gynecologist
- nurse midwife
- nurse practitioner
- acupuncturist
- naturopathic doctor
Here is a tool we created to help you optimize your healthcare during perimenopause.
Good signs that a healthcare provider is knowledgeable about perimenopause:
1. They know that symptoms can begin while you are getting a monthly period.
2. They know that shortening cycles (periods coming closer together) is a sign that hormonal patterns are starting to change.
3. They know that the first hormonal changes can be related to erratic and higher estrogen levels and lower progesterone levels, rather than only low estrogen levels.
4. They recognize a wide range of symptoms beyond hot flashes and changing in menstrual bleeding including changes to sleep and mood.
And ideally he or she also:
— acknowledges that a lot about this time of fluctuating hormonal patterns isn’t well understood
— makes you feel heard, listened to, and validated
— knows that some things work for some people and is willing to iterate through various remedies until something works
The perimenopausal healthcare visit is challenging for both patients and providers
Unfortunately, perimenopause presents a knowledge and research gap for our health care providers too. They aren’t taught it can begin with still regular periods. They aren’t taught that symptoms go way beyond the hot flash. That research is recent.
And believe it or not, it takes 17 years for new research to become a part of clinical practice.
So, several factors are stacked against these visits ending in satisfaction.
Update July 2023: To better understand what leads to satisfaction or dissatisfaction with these health care interactions, we analyzed comments from WLB survey participants about their health care visits and published what we found.
It’s no wonder then that a doctor who doesn’t understand that the hormones may change before cycles change thinks it’s all in our heads — that puts a huge burden on women..
— Jerilynn Prior, MD
Founder – Centre for Menstrual Cycle Ovulation and Research
Although your clinician should be opening the door to a discussion of menopause symptoms . . . please feel empowered to bring it up yourself…If your clinician shuts you down, find a new one.— Sheryl Kingsberg, MD
Chief of Behavioral Medicine at MacDonald Women’s Hospital/
University Hospitals Cleveland Medical Center
“Women need to advocate for themselves when what they’re being told and what they’re experiencing don’t match … If you suspect that your doctor doesn’t know enough about perimenopause, find one who does.— JoAnn Pinkerton, MD
Executive Director – North American Menopause Society
Optimize Your Health Care Visit
with the
Locate a Healthcare Provider Near You
THE MENOPAUSE SOCIETY: This organization has a certification program that designates clinicians as menopause providers. They offer a way to locate providers geographically.
THE AMERICAN COLLEGE OF NURSES AND MIDWIVES: This group provides a locator as well. Midwives primarily help with birthing babies but some also care for women as they traverse the perimenopause-menopause path.
THE ASSOCIATION OF NURSE PRACTITIONERS: Talking to a nurse practitioner during the menopause transition is another option. The association website offers a great locator tool that allows you to a choice of overall focus (e.g. OBGYN) and age range to find an NP near you.
Personal Perspectives
I continue to go to the midwifery practice that I delivered my children with for my woman-care. I am grateful for the way they have normalized and contextualized physiological change over time, offering anticipatory guidance about what to expect with hormone fluctuations in perimenopause. — TK
I was getting my periods closer and closer together, to the point where I was bleeding every two weeks for almost two weeks. I worked with a functionally-trained MD, who ran some tests and learned that my endocrine system was out of whack. Together we developed a regimen of high-quality supplements for hormone balance and adrenal support. In a month or so, my periods were regular again, and I had my energy back. I felt like myself again. — KH
I went to see a Certified Nurse Midwife (CMN). She had me fill out a detailed questionnaire, and spent 45 minutes with me reviewing my concerns and my experience. She was incredibly knowledgable and reassuring. I walked away with a much better understanding of my symptoms and with some resources to alleviate them. Honestly the best resource will be my relationship with this provider, who encouraged me to call her at any time with questions or changes. “I’m here for you through this transition” was the last thing she said. It doesn’t get any better than that! — KP