The Most Important Person During the MPT, and Beyond
The MPT Team: The Doctor
For the majority of my adult life going to the doctor was never about being sick, and really not about taking care of myself. Essentially as an adult I went to the doctor so I could get a renewal on my birth control prescription. And I have been lucky to have never had to spend time in a hospital or take medication. But I knew things were going to change and I should take charge before they did. So I set out to find a doctor who would be my partner in aging as a woman.
So let’s talk about my relationship with a doctor starting with early adulthood…
Primary Care
I always had a primary care doctor, a doctor who was a woman (my choice), and that is who gave me my annual exam. ObGyn’s in my viewpoint were for women who had babies, or wanted to, and neither of those was me. That honestly is pretty much still my opinion ~ not because of how I thought in my 20’s, 30’s, and 40’s, but because as a now menopausal woman I have learned a thing or two. [Side note, I did go to an OB’s office once for an annual exam at the recommendation of a mom friend and most of what I remember about the experience was nearly passing out and being taken to a room to lie down. I always say the sight of all those pregnant women in the waiting room made me almost pass out!].
Women-Centered Care
But I did start to think in my late 40’s that advancing from a primary care physician to someone who had expertise in women-centered care for the ‘someday I would be in menopause’, and as I ‘aged’ would be important.
There was no information at the time on how to find a doctor to help me with this goal, so I intuitively did my best and sought out a well-regarded female doctor who treated women. I literally searched the internet and looked up bios and pictures and did my best. A method today I am glad other women shouldn’t have to resort to (more on that below).
So in 2018 when I was 47 I started looking for a new doctor. I found one at the M Health Fairview Women's Clinic and scheduled myself an appointment.
2019 ~ My New Doctor
My new doctor was an ObGyn who had a special interest in menopause. On February 27, 2019, when I was 48, I had my first visit with my new doctor. I really liked her and she seemed knowledgeable, but we had very little time together (which I believe was entirely not her choice, but the reality of healthcare today).
What I did not understand at the time was that I already WAS in LATE perimenopause, which meant I was in the menopause transition (what I call the MPT). I had specific notes for this visit that I wanted to discuss, one of which was ‘refill birth control’, but also other things I will talk about in another story. Specifically something that I now know to be a symptom of menopause (that I had been having for 3 years by that point!). I did get a new prescription for this menopausal issue, because I believe my new doctor knew exactly what was going on with me. But the problem is, because she was allotted so little time to spend with me, I didn’t really realize how important this prescription was for me and what exactly was going on with me ~ again, the MPT.
2020 ~ A Pandemic Pause
So off I went with my new prescription that I only used for awhile. I dutifully scheduled my next annual exam for 2020 and then, Covid 19. I was unable to keep my 2020 appointment and would not make it in to my new doctor again until 2021. I see now that having a global pandemic hit at exactly the same time you are going through the menopause transition did me absolutely no favors. But I also know that when I finally made it to my next doctor visit in 2021, I wasn’t much further along with my care, in fact I missed some critical moments.
My 50th Birthday was March 17, 2020. By the end of that week my celebratory dinner reservation had been cancelled. And around this time I noticed that all of the sudden I had a ‘belly’. My wedding ring also no longer fit (which it still doesn’t and I don’t understand why), and my fingers hurt (I thought it might be arthritis). Because of the lack of information available on menopause, I attributed this weirdness to pandemic stress and cortisol (which I had never heard of until the Pandemic). These things bothered me, but as the Pandemic wore on I just accepted them more as hopefully a temporary situation than the long-term one it has become. [If anyone can tell me why my wedding ring still doesn’t fit ~ I would love to know!]
2021 ~ A Maroon Folder
By September of 2021 I finally made it back to my new doctor. Clearly she knew I was in the menopause transition, but I absolutely still did not grasp what that meant in our brief time together. We discussed if I wanted to stay on birth control as that was a good option to continue to take and then she mysteriously mentioned considering progesterone ‘next year’. The doctors notes from that visit were:
Continue OCPs for contraception/HRT, refill ordered today
Offered FSH level at the end of placebo week, consider at next appointment if interested
Resources given: menopausal folder, NAMS website
I still have no idea what the FSH level note is about so looked it up, here is more info if you are interested. Again, the doctor was not given enough time to explain this to me.
And this menopausal folder… It was a maroon folder filled with informational packets and pages with what I am sure were all the things she didn’t have time to tell me. I looked through it, but that is not the same as having a conversation with someone to be sure. Did I grasp what all of it meant? Still, not really because wasn’t menopause mainly about hot flashes and just happens one day? No.
I can confidently say that my doctor absolutely knew what she was doing. But the fact that she didn’t have time to explain it, or ask me to schedule a separate appointment to discuss it all (which I will discuss below), was not advantageous to my MPT journey.
GenX Women Speak Up
And then GenX women started talking and there was an explosion of information not only about menopause, but late perimenopause and the menopause transition. Most importantly, I found the Hit Play Not Pause Podcast (HPNP) and it opened up my world. And it was from this podcast that I started to understand I needed to find another doctor and make a different kind of appointment. This was thanks to two main guests on HPNP:
Dr. Heather Hirsch. In this episode Dr. Hirsch spoke about other symptoms than just hot flashes (which I have never had).
Dr. Lauren Streicher. In this episode at minute 52:10 was an ‘aha’ moment for me when they start talking about how your doctor may not be the best doctor for what you need at this time.
Dr. Heather Hirsch
Heather Hirsch’s podcast became an important resource for me. This was well before she had her book, had been on Oprah, and began her own online practice. After listening to the HPNP episode with Dr. Hirsch I listened to a LOT of her episodes while doing work for the small business I had at the time. Specifically, Episode 67 Where Can I Find a Menopause Doctor had an impact on me in regard to how I approached my visits with my doctor and how I could find the right one.
Dr. Hirsch also has a YouTube Channel where I found a lot of helpful information. She has this helpful video: How to Find a Menopause Doctor and What a Good Doc Should Do! I can see from my YouTube history it looks like the first video I watched from Doctor Hirsch was on February 11, 2023 and about joint aches and pains, which I was having in my hip.
Dr. Hirsch also came out with a book, Unlock Your Menopause Type, which released in June of 2023. I checked out this book from the library and read it in August 2023 (before menopause books had long lines in the e-reader queue at the library, which is a good thing).
Dr. Lauren Streicher
I started listening to select episodes of Dr. Streicher’s podcast Inside Information after the HPNP episode I link above. Dr. Streicher can sound a bit harsh sometimes, but she knows her stuff and tells it like it is.
Dr Streicher has recently come out with an entire episode on finding a MPT doctor, How to Find a Clinician Who is Not Clueless. I listened to this podcast and thought it to be a very clear and concise resource for the end of 2024. Again, Dr. Streicher can be a bit terse to listen to, and I did not find 100% of what she said to be useful in my situation, but she knows her stuff.
A couple points I personally understand Dr. Streicher mentioned in this episode in my case I did not find relevant to me.
Academic appointment at a medical school. The doctor I found in 2019 was part of a university medical system and an associate professor, which although I have no doubt made her extremely knowledgeable I did not feel lent to us having what could have been beneficial conversations and were missed opportunities to guide and educate me (especially during a time of very limited resources for the average woman about the MPT).
A doctor who isn’t like you. Although Dr. Streicher is completely right about the fact that you do not need a female doctor, personally I would never go to a male doctor (and never have as an adult). I ultimately believe no one knows a woman’s body better than a woman (outside and in). But along those same lines… My 2019 doctor I believe is a bit older than me and either had gone through or was going through the MPT transition. My current doctor is younger than me and although has not been through the MPT I feel very comfortable with the additional education and interest she has in menopause.
I not only wanted, but deserved, more. Finding My Next New MD
Thanks to the increasingly good resources available to me (I always say I was getting my MPT PhD), I learned so much ~ specifically how to make the right kind of appointment to actually talk to a doctor about menopause, and how to find that doctor.
For my new doctor search I learned three key things (at the time):
Look for a NAMS Certified Practitioner (The North American Menopause Society) website where you can search by zip code. [NAMS is now called The Menopause Society]. There are a number of Menopause Society requirements a doctor needs to have in order to be listed on the website. Dr. Hirsch explains this very clearly on her podcast, Where can I find a menopause doctor? Starting at minute 7:20.
That Doctor should be licensed and board certified. Dr. Streicher explains this clearly on her substack.
Make your first appointment for a ‘Menopause Consultation’, NOT your annual exam. This was so critical as this is likely why I was not getting the time and conversation I felt I needed from my first doctor. I wish she would have told me, but at least through my resources I learned this.
After looking on the NAMS website by zip code I narrowed down my search to three people. And then I sat on doing anything for quite awhile ~ months. It was not until I had the Summer of 2023 where I was dealing with extreme fatigue and poor exercise performance that I finally decided to make an appointment with one of these three doctors. What it really came down to is where I could get in and when (from what I recall).
My Menopause Consultation with my new doctor was scheduled for August 23, 2023.
The Menopause Consultation
I knew from the MPT PhD I was getting to come well prepared with notes, and that I sure did! I had a two page document arranged accordingly so I was sure to remember everything I needed to:
Overall visit goal
Symptoms I was having
Supplement list (because I had been working with Rasa)
Dr’s Visit Notes since 2019
Period History (I had been documenting this for the last couple of years when I was noticing a change in regularity)
To my pleasant surprise at this visit for the first time in a long time I did not feel rushed at this appointment. My new doctor spent a FULL HOUR with me!
Conversation: First we had a full conversation. This included my long list, but also filling her in on my bloodwork and working with Rasa, as well as discussing the other MPT medication I was on (that I will discuss in another story).
Exam: I was given an exam.
The Plan: Most importantly after having the conversation and the exam, my doctor discussed a go forward plan with me. We agreed it was time to stop birth control and begin hormone therapy (MHT or HT) [Which I was well educated on by this point and felt very comfortable taking. More on MHT in an upcoming story].
Resources: I loved that my doctor included additional resources in her after visit notes such as:
This article from the New York Times is also a good one: Women Have Been Misled About Menopause - The New York Times (nytimes.com) [I had already read this article and agree, it was groundbreaking at the time. This link is a gift link so you can read it].
Good books: Menopause Manifesto by Jen Gunter, MD, You Are Not Broken by Kelly Casperson, MD (also has a podcast of the same name). Estrogen Matters by Avrum Bluming, MD. Good Books on desires and sexuality: Better Sex Through Mindfulness by Lori Brotto, PhD, Anatomy of Desire by Gina Lake, Mating in Captivity by Esther Perel, MD, Come As You Are by Emily Nagoski, PhD, She Comes First by Ian Kerner, PhD. [I immediately checked out the Menopause Manifesto from the library and read it].
I LOVE the "You Are Not Broken" podcast by Kelly Casperson, MD. Episode 222 is an interview with Avrum Bluming, MD, auther of Estrogen Matters. [I remember listening to this driving around the gravel roads by the Crash Pad].
Ongoing Conversation: My doctor urged me to reach out to her with any additional questions and we did have an ongoing conversation via MyChart (the messaging system my medical providers have all used for a number of years).
Follow Up: Because I was starting out on MHT, a follow up was required to see how I was doing and if any adjustments were needed. I was offered in-person or virtual but wanted to do in-person. I will talk more about what was decided at the follow-up in my story on MHT.
Cost: I should mention that this visit for me was not really covered by my insurance (don’t get me started). We had high deductible insurance and I ended up paying a few hundred dollars out of pocket for this visit (one of the MANY hidden costs of menopause that I will be writing about). But I will say it was 100% worth it and I would do it again. I would strongly urge you to maybe pass on some other non-essential needs in your life and use that money for this crucial visit if you also have to pay out of pocket.
Luckily subsequent (‘regular’) visits have been covered by my insurance as you would expect.
The Value of Finding THE Right Doctor
It has now been 1 1/2 years, and three in-person visits, since I started seeing my new doctor. I absolutely have made the right decision to switch doctors and am so glad I found her. In November of 2024 I again came with a list of things I wanted to discuss, we had a conversation, my doctor spent around an hour with me again, and I left knowing if my mind changed on something we discussed, or things changed with my body, or I had questions ~ I could always reach out and get an answer and we could make educated decisions together (which we have).
I really like my new doctor. She is most of all kind and equally well-educated on menopause.
Critical Referrals
As it turns out menopause for me has resulted in needing all sorts of recommendations for other medical professionals. I have really had to lean on my Doctor for quality referrals and am very thankful for them. Turns out I have needed a village to get through this time of life, and I am glad I am finding it with the help of my doctor, and all under the same medical system (in my case HealthPartners. I switched systems when I switched doctors and am so glad I did!).
I have been very clear with my doctor about the type of person she is referring me that I want: I want a woman, an athlete (someone who works with cyclists), and someone who is knowledgeable about menopause. My new doctor has given me stellar recommendations, such as my current physical therapist (a now critical part of my MPT team that I will be writing about), and other professionals to help me with needs outside of her treatment area; these people have become a crucial part of my MPT medical team, or I have the names of when I am ready (i.e. potentially working with a mental health pain specialist who works with athletes).
Conclusion
I would highly suggest finding a doctor through the Menopause Society website. Then check out their bio and picture and see if there is enough information there to think you will ‘click’ with them. I always like to read about what they do in their free time, if they are an outdoors person and athletic, that goes a long way for me. Make yourself an appointment not when you are in menopause, but when you are in perimenopause (for me I now realize that would have been in my early 40’s). Having someone to essentially walk alongside of you during one of the most challenging times/transitions of your life is incredibly valuable. Don’t underestimate the value of a good partner/doctor during this time. You deserve the best care, find it.