In the United States, most adult men are married. As of the year 2019, 53 percent of adults ages 30-34 were married, followed by 62.5 percent between ages 35-39, 66.1 percent aged 40-44, and 65.6 percent between 45-49 years old. This means that many men are married to women who are likely perimenopausal, as female hormones can start their decline from the mid-30s onward.
We are seeing an increase in coverage about menopause and perimenopause. From across the pond, the UK government is going to lower the cost of HRT, Davina McCall is launching a call for more workplace protections for women going through menopause, and a widower is now calling upon all men to be mindful of the mental health implications “the change” can introduce, after losing his wife to suicide.
And even singer and ‘80s chart-topper Rod Stewart is speaking out, saying that if men learned more about menopause, their marriages would survive.
Here, in the States, we’re seeing slightly more traction about perimenopause and menopause, with celebrities like actress Tracee Ellis Ross going public about perimenopause and former supermodel Paulina Porizkova almost baring it all in recounting her menopausal journey. Such coverage should help amplify the voices about perimenopause and menopause that are growing louder, larger and looming over conversations and dialogues about women’s health. And, it is.
Countless online groups and communities are each brimming with tens of thousands of women in search of answers, explanations and solutions for unmanaged and mismanaged symptoms. They are seeking recommendations for doctors and providers. They are leaning on each other for emotional and moral support. They are sharing lifestyle regimens and supplements taken.
But what is missing from this percolating brew of a perimenopausal uprising? The voices of men.
For months, I’ve mentioned to my husband that the treatment of women entering perimenopause and in the throes of menopause would be an absolute game-changer, only if more men got up to speed and spoke out about how it affected – or could affect – the women in their lives. So much would change: Industry would have to adjust. The workplace would re-think what health and wellness really includes. Science would commit to new understandings. Big pharma would develop sustainable solutions that fine-tune hormone replacement therapy beyond its current incarnations – perhaps even one that couples the best of HRT and the best of antidepressants into one seamless pill for the women who need both. There would be fewer suicides of midlife women, fewer midlife divorces and less misunderstanding in general.
If one considers that the average man has not only a wife, but also a mother, aunts, nieces, female cousins, daughters, and friends, co-workers, supervisors, neighbors and acquaintances of the opposite sex, the web of potential influence expands dramatically. So why aren’t men using their gender capital to support women in this phase of life? How can they heighten awareness that will lead to change in policy, medicine, science and daily living?
Let me count the ways.
Create online support groups. There is a major void in the virtual perimenopause landscape – a watering hole for men who need the insight, resources and camaraderie to support not only themselves, but also their wives and girlfriends through this period of change. As they rally together, their voices will coalesce and magnify awareness and the need for more options, both socially and medically.
Propose policy changes. Men are overrepresented in government and business at all levels; as such, they have the numbers and representation to drive serious conversations about policies in the workplace, government (and related programs) and the educational system about perimenopause and menopause. Women are not necessarily seeking special accommodations, but they are interested in wellness programs and workplace-sponsored resources that provide education and advocacy, as well as insurance plans that cover treatments like HRT.
Speak with their primary care physicians about aging. Men go to the doctors, too, albeit usually less frequently. After all, they are human beings who get physicals and other routine checkups. Even though it might not be on the agenda of a typical office visit, men can ask their primary care, internal medicine and family medicine physicians what kind of menopausal medicine options they offer to patients. You know, asking for a friend? Or, if that’s too direct for comfort, they can ask about getting their own testosterone levels checked as a gateway for more conversation. Such inquiries could heighten the awareness and pique the curiosity of doctors, one by one, perhaps eventually creating a groundswell of expanded understanding to serve their women patients.
Talk to their guy friends. Most married men are friends with fellow married men, who have wives of a certain age. Though men are comfortable talking shop about sports, current events, music and celebrities, they tend to tread lightly when it comes to more personal matters. It will take some brave souls to bring up the topic of perimenopause among a crew of cronies, but whomever does will likely be surprised by the shared observations and experiences they’re having with their wives, fiancées or girlfriends.
Start a campaign. Most of the awareness about perimenopause and menopause is being done by women, predictably so. The few male voices in this space tend to be anti-aging, reproductive and naturopathic doctors who have some monetary skin in the game. If men launched a campaign to raise awareness, it would certainly stand out if for no reason other than the gender of those behind it.
What are you ideas for how men can become part of the change? Are the men in your lives supporting you during this time? If so, how?
Many women who have never used or considered experimenting with cannabis find their tunes changing when they hit perimenopause. Online communities have no shortage of women who admit to using cannabis products, in the form of CBD alone, CBD and THC combos, and THC-dominant offerings, to help with various symptoms.
By some estimates, including surveys conducted by the North American Menopause Society (NAMS), one in four women surveyed are using cannabis-derived products to self-medicate menopausal and perimenopausal symptoms. It is described as self-medicating because, even in legal states and for those with medical cannabis cards, few physicians are actually prescribing dosages, forms and frequencies of cannabis products for perimenopause symptoms. However, in some online communities there can be found a few physicians encouraging women to experiment with it at low doses, "off the record," of course.
With the legal landscape around cannabis in the U.S. constantly in flux, different states have different levels of legality, permissible uses of and modes of access to THC-based cannabis products. Because cannabis remains classified as a Schedule 1 substance under the Controlled Substances Act at the federal level, many people remain hesitant to consider it, even in states where it is now legalized for medical and / or recreational use.
This federal restriction / prohibition also means that cannabis in general and THC in particular have not been adequately studied in the U.S. for its medical uses and therapeutic benefits. Even so, some researchers have sounded the alarm that cannabis is an endocrine disruptor - one that affects and changes levels of key hormones (yes, even estrogen), which can cause negative side effects during times of change, like perimenopause.
Cannabis derivatives and THC-CBD products have been associated with improvement in sleep, pain, mood and libido. While there are fewer official U.S. medical trials and studies to validate efficacy (given its federal status barring most research), the testimonies of hundreds of women online reveal that multitudes are trying cannabis as a way to avoid using other prescriptions, in combination with prescriptions and in place of prescription medications that have failed them, or carried too many side effects.
In the end, women have to decide for themselves if they want to experiment with cannabis-derived products or not. In legal states, it may be easier to do so without many stipulations on access and with guidance from experienced users, clinicians and staff at cannabis retailers. In states where use is illegal or restricted to medical only. using cannabis is still a minefield with little guidance and, certainly, no official prescriptions that specify formulations or dosing.
Note: This list of resources is continually updated.
Cannabis and Perimenopause: Help through the Transition – United Patients Group, March 10, 2016 – https://unitedpatientsgroup.com/blog/cannabis-and-peri-menopause-help-through-the-transition/
Cannabis and Perimenopause – It’s a Hormone Thing – Leafly, Colleen Fisher Tully, Nov. 8, 2021 – https://www.leafly.com/news/canada/cannabis-and-perimenopause-symptoms
Cannabis and Perimenopause: What You Need to Know – Sacha Cohen, Sweet Jane – https://sweetjanemag.com/cannabis-and-perimenopause-what-you-need-to-know/
Does CBD Oil Work for Menopause Symptoms? – Aaron Kandola, Eloise Theisen, RN, Medical News Today, Nov. 1, 2020 – https://www.medicalnewstoday.com/articles/322078
Ellementa L.A. Presents: How to Feel Like Yourself Again – Ellementa Woman, April 24. 2020 – https://www.youtube.com/watch?v=qt5Arc_WEBo&list=WL&index=4&t=6s
Everything You Always Wanted to Know about Cannabis and Menopause – Adriana Velez, Melanie Bone MD, Endocrine Web, May 18, 2020 – https://www.endocrineweb.com/cannabis-menopause
From Fibromyalgia to Menopause: How Cannabis Can Help You with Dr. Michele Ross – Aug. 26, 2020 – (discussion on menopause begins at 46:26) – https://www.youtube.com/watch?v=NzL-zI9q0A4&list=WL&index=4
Medical Marijuana and Menopause – Tyler McMurray, CannaMD, March 3, 2019 – https://www.cannamd.com/medical-marijuana-menopause/
Midlife Women Using Cannabis to Manage Perimenopausal Symptoms – MGH Center for Women’s Health, Oct. 13, 2020 – https://womensmentalhealth.org/posts/cannabis-perimenopause/
More Women Trying Pot to Manage Menopause – Jennifer Clopton, WebMD, Oct. 19, 2020 – https://www.webmd.com/menopause/news/20201019/more-women-trying-pot-to-manage-menopause
Why Some Experts Say Cannabis Can Be Effective in Treating Menopause Symptoms – Bob Curley, Healthline, Sept. 27, 2020 – https://www.healthline.com/health-news/why-some-experts-say-cannabis-can-be-effective-in-treating-menopause-symptoms
Getting an HRT prescription can be like running across a battlefield and dodging landmines in enemy territory before finally reaching the safe zone. So pervasive and unnecessarily complex are the hurdles perimenopausal women face when they ultimately figure out that their hormones are in decline, and they try to take the next logistical step to help: replacing them.
Many women start at the first reasonable stop on this juncture – their primary care physician, family medicine doctor or gynecologist – often only to leave with bad advice (“dress in layers,” “start doing yoga,” and “drink herbal tea,” among them) or undesired prescriptions for antidepressants. And this frequently spells the end of what had previously been a pleasant, diplomatic patient-doctor relationship, as women feel minimalized, marginalized and made to feel absolutely crazy.
Sadly, far too many stop here. They give up and give in to all sorts of unproven antidotes for their hormonal symptoms of anxiety, insomnia, hot flashes, migraine headaches and more. They assemble a medicine cabinet full of tinctures, herbs and supplements like magnesium, chasteberry, St. John’s Wort and black cohosh. They order all sorts of lotions and creams that supposedly contain progesterone and estrogen from online retailers with absolutely no regulatory skin in the game.
And they continue to suffer.
Fortunately, the ubiquitous nature of online shopping has intersected with telemedicine. And this means that women can now shop around like a well-informed consumer with choices in obtaining a prescription for hormone replacement therapy (HRT). Here are some of the best-known virtual HRT providers, all staffed by actual physicians, nurse practitioners and registered nurses.
Defy Medical – Focuses on compounded, customized (not pre-packaged the ones you get off the shelf via prescription at the regular pharmacy) hormone therapy options, all intended to remediate perimenopause symptoms. These include estrogen in the form of capsules, creams, pellet implants, vaginal suppositories and injections, plus progesterone as capsules, creams, injections and vaginal suppositories. Unlike some other providers, Defy also prescribes testosterone to women and focuses on other hormones, like thyroid and pregnenolone, too.
Evernow – Offers perimenopausal treatment in the form of estradiol patches, pills and vaginal creams, as well as oral micronized progesterone. They also offer combined estradiol / norethindrone pills and ethinyl estradiol / norethindrone birth control pills (generic Loestrin 1/20). For those interested in non-hormonal options, Evernow has Brisdelle (generic paroxetine), which is a low-dose SSRI used for treating vasomotor systems like hot flashes and night sweats, with some potential benefit for low-level depression or anxiety, too. Finally, they also have venlafaxine, which is the generic for the SNRI antidepressant Effexor, which, too, treats hot flashes and night sweats. Evernow often runs a special promotion that allows women to try whichever treatment best suits them for free (paying only about $6 in shipping) for the first month.
Gennev – Provides virtual perimenopause care at a rate of $55 for a 20-minute appointment or $85 for a 30-minute appointment with a trained menopause specialist. Some online reviews suggest a level of dissatisfaction among women who wanted actual HRT but were prescribed standard birth control pills instead. However, Gennev claims to offer hormone replacement therapy, in addition to a range of supplements, like vitamin D, omega-3 and others.
HelloAlpha – Prescribes supplemental estrogen and progesterone in the form of capsules, patches and gels, offering name brand prescriptions and generics, with a fully transparent price list. They also offer combined pills and conventional birth control pills as options. For perimenopausal sleep problems, they have doxepin and Ramelteon. And if non-hormonal options are a need or preference, HelloAlpha offers brand name and generic Brisdelle (paroxetine) and Effexor (venlafaxine).
Winona - An emerging player in the HRT market, Winona offers the full panoply of hormone management options for women. They have estrogen in the form of tablets, patches and body creams, as well as vaginal estrogen. Progesterone is available as a combined cream with estrogen, as standalone oral capsules or as a body cream. Winona also has DHEA, which may help women who need a testosterone boost. Winona stands out in that they offer both FDA-approved, regulated hormone products as well as custom-compounded formulas.
Now, many people will wonder if these providers accept insurance? In most cases, the answer is likely “no.” Most providers require or expect out-of-pocket payment for HRT, though some may be willing to provide a statement developed for a patient’s potential insurance reimbursement. Some patients use HSA (health savings account) funds toward their HRT; some grapple with their insurance to cover at least part of it and, most, sadly, pay for it themselves – even if they have “good” insurance. The headaches of bickering with insurance administrators and going back and forth to doctor’s offices in person just isn’t worth it to them.
So, for those interested in HRT who have faced unreasonable hurdles with conventional, in-person doctors, there are alternatives available. The online HRT providers are staffed by medical personnel and most use FDA-approved body-identical hormone replacement products, not unscrupulous, questionable products from “the streets” or underground.
As with most things, buyer beware. Research online reviews, have an informational visit with a provider, check the doctors' credentials and history with the medical board in the state in which they are registered, ask as many questions as you need, comparison shop and even see how what they recommend corresponds with science and best practices. And then make a decision.
The Real Peri Meno is devoted to all things perimenopause - the science, treatments, care, understanding, personal experiences, relationships, culture and more. The brain child of Keisha D. Edwards, The Real Peri Meno developed out of her own shock-and-awe experience with perimenopause and navigating the disjointed U.S. medical system in search of answers, support and relief.
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