I haven’t updated this blog in months. That much is obvious.
My retreat wasn’t planned or deliberate – it just happened. It happens that as my symptomatology resolved, I felt less inclined and driven to write about my experience and post information about the still-unspooling world of perimenopause.
I was so stunned, shocked, upset and in utter disbelief about my entrée into perimenopause that I felt I had no choice but to shout from the rooftops. My form of shouting took the form of starting this blog, researching fervently and attempting to share my story with others.
I could not believe the medical community was so clueless about a transition that will affect more than half of the population. I could not believe that I had to see 10 doctors in various disciplines before finally diagnosing myself properly and getting the help I so sorely needed.
I could not believe that I had been having night sweats and daytime sweating when doing basic things, like running the vacuum or folding laundry, and doctors couldn’t connect the dots – even though I was a woman in her early 40s, the age range deemed perimenopausal by default. I was dismayed that I had endured a near-breakdown and somehow had mustered the resilience to wade through it on my own, with little to no sound medical guidance.
I could not believe the extent to which I had to lead the way. Most of the physicians I consulted with were shooting in the dark, incredulous at the idea of perimenopause and apparently unschooled on the potential 30+ manifestations of perimenopause, of which my main life-debilitating symptoms were sudden-onset insomnia and a level of anxiety that finally convinced me that anxiety can be, in fact, a real condition (previously I thought it was an excuse for those who needed to pull themselves together, toughen up and develop better coping skills).
I could not sleep. My mind was in a continuous whirl. I was more sensitive to sounds and noises. My body trembled. My appetite declined. And I was paralyzed with fear as nighttime approached.
* * *
Now that I am more than a year removed from that harrowing and life-changing event, I can now describe and see my prior symptoms and previous state for what they were. I can detail it in words without the fear of stigma and without the cloak of shame.
I am not without symptoms. Do not get me wrong. By all predictions, I am still in the thick of this phase. I am likely years from reaching actual menopause.
I still sweat at night, sometimes. And I occasionally get turned up and start thinking about random topics at the most inopportune times. But my symptoms have abated by about 90 percent, and that is a world of difference from where I was before.
I’ll take it.
I’ve had to make peace (still working on it) with going from being who I was to who I now am. I think this experience has changed me almost just as much as having children did. I have transformed my mind to realize there was Former State Me who is no more, to the forthcoming Future State Me. And in the meantime, I have to find contentment and resolve in the Current State Me. The Current State Me requires medications and a panoply of life changes to retain homeostasis and structure. The Former State Me was prescribed no meds that I took on a regular basis, and I could be much more freewheeling with my days and decisions.
These days, I know that certain things are essential to my well-being, and my cadence is at times procedural and fixed.
I know I have to work out 60-90 minutes a day, if not for my body for my mind. This is a non-negotiable. It’s what I do in the morning after drinking coffee.
I now take prebiotics and probiotics, and drink kefir, because I’ve read enough about the gut being the “second brain,” and I know these are things I can do to help optimize my well-being.
I don’t drink any afternoon coffee anymore because I just can’t risk it.
I swipe testosterone cream on my thigh every morning. It’s given me a boost and a calm that I cannot explain. When you know, you know.
I maintain my requisite HRT regimen of which the testosterone is a relatively new component.
I also take an antidepressant that has conquered the midlife headaches I developed (I was having 5-6 headaches a week), resolved most of the anxiety I had and ensures a peaceful nighttime.
I say no more often. But more than saying no, I fall back and don’t put my peace on the line as much anyway.
I thank God each and every morning. I really do. They are the first words out of my mouth.
I do not know what the future holds. But this I do know: “[S]he is a new creature; the old things passed away; behold, new things have come.”
Perimenopause and menopause are being featured in headlines and mainstream media coverage perhaps like never before. Every week, some health magazine, lifestyle publication or mainline news outlet is covering perimenopause and menopause, it seems. Reporters are tackling topics like hormonal mood swings, midlife weight gain and sex after the age of 40 week after week. In most of these cases, menopause is the centerpiece or, at the very least, it gets a passing mention.
Believe me, I believe it is better for perimenopause to be ushered out of the shadows, kicked out of the closet and the tape removed from its proverbial mouth of silence than the alternative. For far too long, women have felt ashamed of their symptoms, scared to speak to their friends about it and isolated, feeling absolutely crazy and about to lose the plot.
But as I examine this new heyday of perimenopause, part of me considers the profitable ecosystem surrounding all of this fanfare. As much as women need and deserve to be helped and heard, many businesses, companies and individuals are looking to get paid. The profit motive is real.
Perhaps the worst part of the profitability of perimenopause is that so many women still get bad advice or negligible help, sometimes after shelling out hundreds or thousands of dollars. So this made me think about the types of professionals and “experts” menopausal and perimenopausal women should consider avoiding – or proceeding with caution – when seeking and paying for their help.
Health Coaches. First of all, health coaching is a somewhat specious profession. There are various associations and organizational bodies that credential coaches, and sometimes such people have no experiential or high-level educational knowledge of anatomy, physiology, pharmacology, psychology, biology or chemistry.
Health coaching certifications can come from a range of providers, including personal training organizations, integrative health membership associations, holistic health societies and more. Most take only three to 12 months to complete. There are some programs at accredited colleges and universities, and many of those are actual associate, bachelor and master degree curricula, ending with an academic degree.
With health coaching being a field littered with ambiguity in how to get there, finding a veritable, trusted and knowledgeable health coach can be difficult. And even if you do find one, health coaches can only do so much. They can chat you up about nutrition, exercise and lifestyle, but they can’t prescribe medications or dispense medical information.
Health coaches usually charge $50-$500 per session, and insurance doesn’t cover their services. I believe the time and money women would spend on health coaches would better be used buying books, reading science journal studies and articles, and watching videos by experienced, established professionals and real women who share what’s worked for them (and are not selling anything).
Integrative or Holistic Health Providers. I previously explored this group in “Are Functional Medicine Doctors and Naturopaths Medical Quacks?” If I read more story, hear another anecdote or receive another email from a woman who’s been misguided and done wrong by a functional medicine or naturopathic “doctor,” I may scream.
More often than not, I hear about women paying hundreds or thousands of dollars on unnecessary – and possibly meaningless – lab tests. They are being coaxed into test after test after test, then being “prescribed” a growing list of expensive supplements and vitamins in the name of “balancing” every seen and unseen system in their bodies. Such tests may include measuring gut permeability, adrenal stress and heavy metals, among many, many others.
Some providers in this camp do provide perimenopausal and menopausal women with hormone replacement therapy (HRT), but often at microdoses (like 25mg of progesterone), inadequate delivery routes (progesterone creams, when progesterone is not well absorbed through the skin) and potentially dangerous options (like high-dose testosterone pellets that cannot be adjusted or removed once inserted).
The name of the game with naturopaths seems to be: “Let’s find a way to keep her coming back,” with the hopes of having a customer on the hook for life, test after test, imbalance after imbalance, lab after lab, and supplement after supplement.
I’ve literally communicated with dozens of women led astray by functional medicine and naturopathic providers that I no longer feel like I need to hold back on calling it like I see it.
Perimenopause and Menopause Tech Companies. Telemedicine has been a godsend for the delivery and access to medical care, replacing the needless commute, office wait time and total inconvenience of the typical doctor’s visit. And there are some virtual care providers in the perimenopause space who are bringing true value to their patients, including Evernow, which actually prescribes pharmaceutical, FDA-approved HRT along with non-hormonal options, such as SSRIs.
But some tech companies trying to cash in on the perimenopause gold rush aren’t providing much novel or new at all. More than anything, I believe women who are symptomatic with hot flashes, night sweats, insomnia, anxiety, depression, headaches and more want RELIEF. They want to be free from and rid of debilitating symptoms that compromise quality of life. They don’t need motivational speaking, more expensive supplements, beauty tips, exercise advice or creative recipes for cooking.
Let’s take a look at Phenology, which is offering “lucid lift refreshing mints” for $19, a “cooling mist” for $19 and a “fresh start skin roller” for, yes … you guessed it, $19! Wile is shilling “Hormonal” hats, sweatshirts and T-shirts, along with CBD oil and . . . more supplements!
Do we really need more of this?
I don’t think so. What we do need are more clinicians – general medicine, adult medicine and internal medicine physicians – who understand perimenopause and menopause. We need more endocrinologists, psychiatrists and OB/GYNs who do more than dabble in diabetes, bipolar disorder and delivering babies, respectively. We need trained providers with a sincere interest in and commitment to patient health, including the health of half of the world’s population who are women, apt to begin perimenopause by their early 40s and likely to outlive their male counterparts by quite a few years.
In the world of menopause and perimenopause, women have few verified, well-informed allies on our side by name. My story of navigating the world of doctors was quite dramatic; in fact, I still can’t believe I survived it at times.
I saw nine or 10 doctors before I finally landed on the main one who provided most of the help I needed. These included multiple general medicine physicians, two psychiatrists (one of whom agreed the issue may have been perimenopause and encouraged me to pursue that lead), a psychologist (who told me it was probably perimenopause), two OB/GYNs (one told me I was too young for perimenopause and another prescribed me some highly ineffective birth control pills), a neurologist and, finally, my big win: a reproductive endocrinologist who was speaking my language, totally “got it” and did not hold back on prescribing hormone replacement therapy (HRT) for me.
The irony in this is that both OB/GYNs I saw were “Certified Menopause Practitioners” by the North American Menopause Society (NAMS). Physicians who earn this credential are referred to as NCMPs, or NAMS-Certified Menopause Practitioners. In fact, for this reason, I had sought out those particular doctors.
NAMS is akin to a nonprofit professional association of physicians in this specialty, but it is also a clearinghouse for health guidance and information related to menopausal and perimenopausal women, and our adjacent issues, and could also be considered as a semi think tank of sorts. From here stem multiple clinical recommendations and best practices that should inform the work of those who treat women at this stage of life.
Interestingly, the doctor who confirmed what was happening to me and that I was not crazy was not NAMS certified, though she dealt with women’s hormones and reproductive issues every day. Given that my experience with a NAMS-Certified Menopause Specialist was such a bust, I have wondered what it even takes to become one.
Is it a rigorous process? Do you have to prove and demonstrate your expertise in women’s midlife issues? How much do you need to know about prescribing, dosing and tweaking HRT? It is only for OB/GYNs, or can other doctors belong as well? This information is not easily findable, but here is what I have been able to determine.
What kind of doctors are NAMS doctors?
NAMS-certified clinicians are not necessarily of a particular discipline. Naturally, one might presume that NAMS-credentialed doctors are OB/GYNs, fertility specialists or hormone experts. But this is not true. Among those who qualify for the credential are nurses, nurse midwives, nurse practitioners, pharmacists, physicians and physician assistants. Aside from the credential, NAMS also has among its 2,000 members professionals who are pharmacists, nurses, anthropologists, psychologists, complementary / alternative medicine practitioners, OB/GYNs, internal medicine doctors and others.
Why would a doctor become NAMS-certified?
The reasons doctors may pursue NAMS certification is not necessarily about helping women lead better lives. Among the benefits NAMS touts for being certified are “possibility of more patient referrals, job promotion and higher salaries” as well as more industry credibility, legitimate logos for presentations and literature, media relations, permission to use the NCMP acronym professionally and a certificate for framing. Obviously, these perks are about the total value proposition and don’t necessarily mean those who seek NAMS certification don’t fundamentally care about their patients first. NAMS doctors are also featured in a special NAMS provider online directory, a precious resource for women seeking care for their perimenopausal and menopausal symptoms, and basically a pipeline for doctors’ ongoing self-directed patient referrals.
What are NAMS practitioners supposed to know?
The program objectives to be NAMS certified include being well-versed and authoritative on a number of things, including:
How hard is the test?
The NAMS test features 100 multiple-choice questions, with each question having three presented answer options (e.g. A, B or C). Once earned, NAMS certification is good for three years, but individuals must attain 45 credit hours of continuing medical education (CME) within that time frame. One representative sample question is:
Which of the following is a risk factor for postmenopausal osteoporosis?
What does the test content consist of?
The NAMS Certified Menopause Practitioner exam breaks down the test content as follows: 19% on physiology and pathophysiology of the menopause transition; 20% on symptoms and concerns; 21% on health disorders of midlife; 19% on preventive care and counseling; and 21% on treatment options for common menopausal symptoms. The index of specific topics, concerns and issues covered under these headings appears to be quite comprehensive, which provides the impression that no provider who is NAMS-certified should be minimizing women’s symptoms or writing them off as unrelated to perimenopause.
How much does the NAMS certification test cost?
For NAMS members, the test fee is $200, and for non-members, it’s $400.
Why are women’s experiences with NAMS-certified providers so mixed?
I visited two NAMS-certified OB/GYNs. One agreed I was likely perimenopausal, but prescribed birth control pills, which are not recommended first-line treatment for perimenopause or the specific symptoms I was enduring. The other was skeptical that I was in perimenopause, told me I was “too young” and wanted to prescribe an SSRI antidepressant. From what I’ve seen online, mainly in virtual communities, women have very mixed experiences with NAMS providers. Some had very positive encounters and were treated seriously and given effective options, and many have had poor reports of not being taken seriously, being told perimenopause was an impossibility, being told to do more yoga and take deep breaths, and other unbelievable, incredulous things.
I believe there should be some reporting system in place, one wherein women could share with NAMS their experiences with such providers, both good and bad. Without this mechanism in place, and with such discrepancies in reported experiences with NAMS providers, the organization is risking its reputation by extension. There needs to be more quality assurance in place to ensure greater consistency and continuity among providers who hold the NAMS badge.
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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