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If you’re in midlife and are still managing your medical health like you did in your early 20s, then it’s time for a reboot. We are past the age of relying purely on just-in-time medical care and only queueing up the corner walk-in clinic whenever the sniffles or a sore throat gets us down . . . and getting by fine on that alone.
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By the time you hit your 30s and beyond, it’s time to take a more proactive and decisive approach to your healthcare. Part of that means no longer being reactionary to potential problems – only going to the doctor when you think something is wrong. It requires a shift in mindset and a new understanding that you need to get proactive about your well-being.

Being proactive means to get ready for something before you need to. It means anticipating, predicting and preparing ahead of time.

One of the most proactive things you can do for your health is to get an annual physical. An annual physical is exactly what it sounds like; it is a yearly visit to a primary care doctor to do a general review of your health status and to check on the vitals that keep you running. The doctor who performs a physical may go by different titles, such as general medicine physician, adult medicine doctor, internal medicine physician, general practitioner (GP) and family medicine doctor. Whatever the name, these doctors are basically generalists who have broad-based knowledge about the body, its systems and its functions. This is different from, say, a specialist whose expertise lies in a specific organ, system or part of the body, like a cardiologist focuses on the heart, a psychiatrist deals with the brain, an endocrinologist concentrates on hormones and an oncologist addresses cancer.

Ideally, a physical should happen every year. Why? Because the initial physical helps to establish your baseline and every future visit then can be used to monitor current health but also reflect on patterns that merit more consideration.

What Happens During a Physical?

A physical is nothing to fear. Even for the most doctor-phobic, a regular yearly physical is little to feel apprehensive about. This is what usually happens:

You sign in and let the staff know you’re there. You may need to provide additional information, like your insurance card and ID. You may also need to complete forms about your health history and current medications. After this, you may wait for a bit – maybe 15-30 minutes on average. (If it takes 45 minutes or longer to get called back, this may be a sign the practice has poor scheduling practices [overbooks], poor patient service skills or other issues that may be worth seeking another doctor later on.)

A nurse will usually call you back. Once in the clinical area, you will typically be weighed, asked about your height (or measured) and your blood pressure will be taken. Then you are escorted to the actual patient room, usually asked to disrobe from the waist up and wear a paper gown, and will wait for the doctor. (Again, the wait should not be too long – 20-25 minutes max.)

The doctor will come in and greet you, and introduce himself or herself if it’s the first encounter with you. They will ask you some general questions about your health history and the information you’ve already indicated on intake forms. Usually this will relate to prior surgeries, current medications, any allergies and any recent health problems or ongoing diagnoses / conditions that are being managed.

You should have the opportunity to ask questions or bring up any concerns about your health. This is a good time to bring up any symptoms you’ve noticed, changes in the effectiveness of any medications you’re on or general questions about your health and wellness.

The doctor will typically perform a few cursory examinations – listening to your pulse, heart and lungs; checking your ears and eyes; checking your reflexes; looking at your skin; appraising your general demeanor (though this will go unmentioned usually); and asking about your mental health, sexual health (behavior), fitness level and dietary habits.

The doctor will then typically order routine bloodwork. The things they check for in these labs are usually the complete blood counts, blood sugar, indicators of kidney function, cholesterol and, in some cases, thyroid. Note that you can request any labs you desire. If you want a hormone panel, ask for one. If you want to check for an autoimmune condition, ask for those labs. If you need a clear head about your STD status, ask for those tests, too.

Assuming no potential problems are noticed, your appointment will conclude uneventfully. You will be told that your lab results will be available via the patient portal (if the practice has one) or that they will call you with the results or send them in the mail. It is important to read the lab results for yourself. Even if there are no current problems “on paper,” there could be signs that something is amiss or just not quite right, especially for numbers that are trending on the higher end of normal or the lower end of normal. The entire office visit for a physical may take about an hour and certainly no more than two hours, though this should be at the upper limit for sure.

Most insurance plans cover annual physicals in full, or they cover all of the costs except for the initial visit copay, assuming you go to an in-network doctor. Realize that on some occasions the lab work will later be billed separately, sometimes by a separate company or a different department within the practice. In those instances, insurance will usually cover most of the costs.

You should get a physical every year. Why? For starters, it helps to maintain an established relationship with your primary care provider. This is the go-to doctor for your basic needs, like antibiotics for a sinus infection or a UTI. They are also who you’ll need to go through, in many cases, if you end up needing a specialist; the primary care doctor provides the referral. Additionally, a lot can change in a year. Preventive care is often the first step in identifying and treating a medical issue before it becomes a bigger problem.

​I recently had the privilege of being featured on Menopause Coach Kitty Anderson’s YouTube Channel, Create a Menopause Recovery in the video titled “Keisha Is a Black Woman Using HRT in the United States: Perimenopause Was Traumatic Without HRT!”

I responded to Kitty’s call for women of color to come forward and share their experiences of recovery from perimenopausal or menopausal symptoms, especially those who are using hormone replacement therapy (HRT). I actually encountered Kitty Anderson before; I enlisted her help to coach me through some continued challenges I was facing after I had started HRT months before. I even featured her on The Real Peri Meno blog in the post “Kitty Anderson: Menopause As a Social Justice Issue,”profiling her own journey as a menopausal woman who uses HRT herself and her experiences in becoming an expert on the topic.

My journey, from the process of realizing I was perimenopausal and not suffering from some other malady, and the maze I went through in navigating the medical system, is here on my blog on the post titled “Shocked By Perimenopause? I Was, Too.”

I wish more Black women (and women in general) would go public about their perimenopausal woes and the solutions that are working for them. While I am using HRT, I don’t expect ALL women to do so. But I do explore the reasons why Black women seem less likely to pursue HRT in “Why It Seems Like Black Women Don’t Use HRT.”  Using HRT is a highly personal decision, just like choosing to use any prescription medication is.

Please watch / listen to the interview in depth. Here are a few points I considered after the fact that I want to state for the record:

Choose the medical practitioner, healthcare professional or physician who works for and with you! Regardless of color, too. That healthcare advocate who opts to partner with you in your care may not look like you, sound like you or any in way be like you, but they may be exactly what you need at that moment – and as a permanent ally in your long-term care. The best doctors in this journey for me have been an older (60+) white woman and a younger white man. It was a Black gynecologist who really let me down, along with a slew of others.

Be prepared to pivot. No day in perimenopause is guaranteed to be the same. Your symptoms may be well controlled and absent one day, and then they might pipe up the next. That may not necessarily mean that you need to reinvent the wheel, but it does mean that a versatile mindset is more important now than perhaps it has ever been. As symptoms change during perimenopause, and as hormones choose to cause a commotion every now and again (even while on HRT), realize that dosages may change, you may need to add in new medications and you may need to drop things that no longer work for you.
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If you speak out about perimenopause, be prepared for . . . silence. When I went public about my perimenopause experience, I knew it was going to require being vulnerable. I didn’t know how people would react or what they would say. So far, in terms of my personal sphere, the response has largely been one of silence. No one I know personally is really asking any questions or sharing any of their experiences, but I know they are reading the material here, taking notes and considering options. I started this blog to help others, even as I continue to help myself in the background.

​This may not be a popular or widely accepted idea – in fact, in some circles, it may even be considered controversial. But here it is: I don’t believe that CBT helps eradicate perimenopausal symptoms.

CBT stands for Cognitive Behavioral Therapy. The American Psychological Association (APA) defines CBT as “a form of psychological treatment that has been demonstrated to be effective for a range of problems, including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness.”

According to the APA, CBT helps people change their thinking patterns. The premise is that psychological problems are rooted in untrue or unhelpful thinking styles and behaviors. Additionally, the notion is that if people learn different ways of coping, they are achieve relief from symptoms and lead better lives.

It doesn’t elude me that the APA and other professional organizations whose members offer services like CBT have a vested interest in promoting it as a solution. Doing so keeps their appointments booked and a steady flow of clients who are hopeful that the remedies for what ails them is CBT.

So when I hear about women being recommended counseling or CBT for perimenopausal symptoms, I want to scream. Why?!

Perimenopause Is Not All In the Mind

Well, for starters, perimenopause is increasingly being considered as a complex, dynamic “neurological transition state.” Some go a bit further and classify it as a neuro-endocrine process that affects multiple body systems all at once – the brain, the reproductive organs, the adrenal system and all sorts of involved hormones and neurotransmitters.

What this means, exactly, is pretty involved. At a minimum perimenopause is not relegated to the reproductive tract. It affects more than the ovaries and includes the involvement of the brain, its structures and its chemicals, and every place and function in a woman’s body that estrogen touches. Estrogen-related systems include those responsible for temperature control, sleep and circadian rhythms, cognitive function, mood, bone health and more.

Some of the most common symptoms of perimenopause are not just those hot flashes and night sweats so many people hear about. Instead, some of the most disruptive consequences of the hormonal changes are the emergence of anxiety or depression, trouble with sleep, the onset of headaches, the occurrence of new aches and pains and even dryness of the skin, tissues and eyes.

When women present to their doctors with these symptoms, many are often told one of two main things:

1. “You’re too young to be in menopause.” This is frequently said by doctors who are pretty unfamiliar with the difference between perimenopause and menopause, and who have limited knowledge of the fact that hormone changes begin in the 30s. They tend to think of menopause as the end of menstrual cycles – and only that – discounting the many associated symptoms that can offer beforehand.
2. “Let’s get you an antidepressant.” This is usually offered by gynecologists and general medicine doctors who are afraid to prescribe hormone replacement therapy, who know almost nothing about perimenopause or who are going for the lowest common denominator in terms of menopause management.

Sadly, when some women hear this, they walk out of the doctor’s office feeling dejected and unheard. And, moreover, they begin to think that maybe all these symptoms really are in their minds – that they need some emotional help – aid that comes in the form of therapy.

Perimenopause Is a Time Ripe for Spending Money Unnecessarily

Also, even more sadly, there are many social workers, counselors and therapists ready and willing to take women’s money and time, claiming that therapy sessions will help resolve their physical perimenopause symptoms. Some promote the concept that 1:1 counseling will temper the night sweats, the racing heartbeats and the sudden feeling of doom. The problem with this is that these perimenopause symptoms are physiological in nature – that means they stem from the way we, as human organisms, and our actual internal bodily systems, are working (or not working). Most of the time, these disruptions boil down to the same thing: the consequences of erratic and shifting hormones.

Fortunately, more is coming out about the ineffectiveness of CBT. For example, “After analyzing 70 studies conducted between 1977 and 2014, researchers Tom Johnsen and Oddgeir Friborg concluded that CBT is roughly half as effective in treating depression than it used to be.” The paper, titled The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment Is Failing: A Meta-Analysis, is long and extensive and available online.

There’s even information about CBT for menopausal insomnia, known as CBTMI. Between 30-60% of perimenopausal and menopausal women experience insomnia, sometimes related to night sweats and often not related to any vasomotor symptoms. CBT for insomnia features strategies like sleep restriction (limiting time in bed), stimulus control (going to bed or the bedroom only when time for bed – no other activities) and sleep hygiene.

Every perimenopausal woman I’ve heard of who suffered from insomnia has tried these tactics on her own, often with no success. Why? Because the issue, at its core, is hormonal!

What CBT Might Help

While I don’t believe CBT does anything for the actual physical manifestations of hormonal changes endemic to perimenopause, it may help for specific issues women are apt to have during this time of life. For example, if a woman is having trouble accepting the fact that she’s aging, therapy could help her reframe her thinking to see maturing, instead, as a welcome life stage. It may help her see this time as a period for renewal and novelty rather than one of irrelevance and burdens.

Similarly, CBT may help those struggling with empty-nest syndrome, changing marital dynamics, finding a sense of purpose and modifying their lifestyle.

What Works (often, anyway)
Perimenopause is a time of vulnerability and fragility for many women. It is a time of mystery and inconvenience, as some are completely caught by surprise by the alien experience they now have in the bodies they occupy and cannot predict how they may feel from one day to the next. CBT and other forms of counseling may help women feel better about this transition and help them start to view the situation more objectively. But it cannot treat the actual physical, physiological symptoms of perimenopause.

For those symptoms, I suggest doing this instead (if medically possible):

• Get on hormone replacement therapy (HRT). HRT for perimenopause usually consists of estradiol and progesterone – the former in the form of a transdermal patch or gel, and sometimes a pill, and the latter as an oral capsule. Research increasingly supports that the sooner, the better with the initiation of HRT before the age of 60. The old WHI study linking HRT with catastrophic health outcomes for healthy women has long been decried as faulty and harmful, even by the North American Menopause Society (NAMS).
• Get on an antidepressant, too, if you need it. For some women, who either 1) are not candidates for HRT, 2) don’t want HRT or 3) are already on HRT but need more support, antidepressants can provide added relief. Antidepressants can help reduce hot flashes and night sweats. They can also help with mood (anxiety or depression) and sleep. In these cases, they are usually prescribed at much lower doses than used for treating standard anxiety or depression. Some are even used off label to help with headaches. I know of two perimenopausal women in their 40s who had never been on antidepressants in their lives until now. One is on an antidepressant for hormonal headaches, which have now abated. The other was put on one for hot flashes, and says she hardly has any now, plus she realizes she had a low level of depression that has lifted.

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If you want to seek therapy, by all means, go ahead and do so. It may help you better contextualize perimenopause and cope with the changes it entails more fluidly. But it will not help with the actual physical symptoms of this change of life. As with all things, one’s mileage may vary, and buyer beware.