When a woman is hit like a deer in headlights by perimenopausal or menopausal symptoms, she often is at her most vulnerable. With almost no warning or often without any foreboding sharing of information from elder women or healthcare providers, women find themselves sweaty and sleepless, anxious and depressed, dried out and all cried out – with virtually no answers or informed, trusted sources to help them.
Women in this position, at least for the few among us who find the strength to advocate for themselves and seek help, are willing to try almost anything. This often means a succession of visits to conventional medicine practitioners – a tour with stops to the internal medicine doctor, an OB/GYN, maybe second opinions of the former . . . and then this is where most women stop. They frequently give up because these doctors have no real solutions or real education on this critical juncture that all midlife women – basically half of the world’s population – will one day face. All too often, physicians tell these women to exercise more, dress in layers, reduce stress or even grin and bear it until it passes.
For the women who give up on mainstream doctors, they may turn to over-the-counter offerings, like various supplements, teas and other untested and unregulated concoctions, seeking relief from evening primrose oil, “menopause vitamins,” black cohosh and other oils, tinctures, herbs and pills.
Still finding little to no relief, said women then may turn to what may be her final frontier: functional medicine doctors and naturopaths.
Sadly, these practitioners often take advantage of perimenopausal and menopausal women by offering hyperbolic hopes, grandiose promises and incredible cures, usually under the umbrella of “natural,” “customized” or “personalized” care. And it doesn’t come cheap, with repeated rounds of testing, reports, office visits and so much more.
So, are naturopaths and functional medicine doctors the equivalent of healthcare quacks? Are they selling snake oil and preying on legions of vulnerable, desperate midlife women?
What are their credentials?
Naturopathic doctors are not necessarily trained or credentialed. Going into the pool of naturopathic medicine providers is like jumping into a hurricane; one may need to survive the harsh, whipping winds before reaching the more tranquil eye of the storm. There is no universal standard for licensing naturopathic practitioners. Some states require that they attend a four-year program, study basic sciences similar to those taught in medical school and pass a state licensing exam. But others have no training at all, being unskilled, unlicensed and with no education whatsoever.
Functional medicine doctors, on the other hand, have usually completed medical school and then earned additional credentials from functional or alternative medicine organizations, such as The Institute for Functional Medicine.
How do they approach perimenopause or menopause?
If menopause and perimenopause communities on Facebook or Reddit are any indication, functional medicine doctors and naturopaths have an interesting approach to managing midlife hormonal symptoms. Their approach often involves repeated, rigorous testing of hormone levels and other metrics, such as vitamin levels, thyroid counts and much more. Women have left untold numbers of remarks about paying $600-$1,000 for a single office visit. They are frequently “prescribed” expensive vitamins and supplements (some of which they later find could have been purchased online for much less), and they may get compounded hormone treatments (available through compounding pharmacies with which these naturopaths have established agreements or relationships). The compounded hormones are not the same as FDA-approved and regulated hormone replacement therapy (HRT) in the form of pharmaceutical grade gels, patches or sprays, and oral micronized progesterone (or Prometrium).
Naturopaths and functional medicine doctors are said to habitually link perimenopause symptoms with other alleged and unproven conditions, like thyroid issues, gut health and adrenal fatigue.
Science-Based Medicine writes: “The problem with ‘functional medicine’ is that at its core it is close to being as nonsensical as the more ‘obvious’ forms of quackery. It just hides it better, given the number of fancy-sounding laboratory tests.”
Is functional or naturopathic medicine evidence-based?
Conventional medicine is based on years of data and research, including clinical trials, empirical case studies, lab experiments and more. That’s how medicine arrives at standards of care for various conditions, and that’s also how prescribed medicines finally reach the level of consumer access, after efficacy and relative safety are vetted. This is not to say there aren’t problems with “Big Pharma” and that all too many physicians reach for the prescription pad and lowest common denominator too readily before actually listening to and looking at the woman before them in the examination room.
But is functional medicine or naturopathic medicine actually based on proven science? Well, both purport to be more “integrative” and “holistic” than their competition. This is described as “addressing the web-like interconnections of internal physiological factors,” and “seeking a dynamic balance among the internal and external factors in a patient’s body, mind and spirit.”
But this is tantamount to a “get out of jail free” card “for basically anything practitioners want to do,” according to Science-Based Medicine.
Insurance usually doesn’t cover naturopathic or functional medicine.
Going to a naturopath or functional medicine doctor is expensive – and generally not covered by health insurance. Most practitioners don’t (or don’t have the authority to) order conventional blood testing, so they use other means, like saliva testing, in an attempt to build out the spider web of imagined conditions their “patients” are suffering from. Plus, lab tests are not necessary to diagnose perimenopause.
“The reason insurance doesn’t cover most of these tests and that conventional physicians won’t order them is because they are unhelpful, useless and / or not based in science and evidence.”
Some of the tests often recommended or ordered include those for heavy metals, micronutrients, methylation, inflammation, gut permeability, adrenal stress and metabolism. These tests are sometimes followed by the caveat that they are not intended to diagnose or treat a disease or to substitute for a physician’s expertise.
Why don’t they just prescribe regular hormone replacement therapy?
Many women are still afraid to take standard HRT, largely based on the continued reputational damage done from the now-misguided 2002 WHI study, which caused millions of women to abandon hormonal treatment almost overnight. Oncologists like Avrum Bluming are now going ultra-public about the safety and benefits of HRT for the symptoms of perimenopause and menopause, including longer-term brain, heart and bone health, as are many gynecologists, women’s health specialists and even psychiatrists. In fact, HRT is now known as the “gold standard” for addressing perimenopause and menopause difficulties, many of which can be life-altering and debilitating.
But naturopaths and functional medicine doctors continue to corral mistruths about HRT’s safety and effectiveness, preying on women’s fears and desire to be “as natural as possible.” Dr. Jen Gunter blows up the confusion they add about “body identical” vs. “bioidentical” hormones in “Stop Using ‘Body Identical’ and ‘Bioidentical’ to Refer to Menopausal Hormone Therapy” in this piece.
One such practice in Metro Atlanta proclaims: “We offer complete counseling and diagnostic testing to help you determine which treatments are right for you. We always prefer to treat patients with the most natural, least invasive therapy possible. Dietary supplements such as Estrovera are effective at relieving the symptoms of menopause. Other therapies such as acupuncture, biofeedback and dietary changes can also have a profound impact on patients’ symptoms.”
This same practice requires a log-in to view the prices of the dozens of supplements they “prescribe.” But a quick online search of Estrovera reveals it costs about $123.00 for 90 pills – about the same or more than what a typical HRT prescription of bioidentical estradiol and progesterone cost without insurance. This product does seem to have mostly positive reviews, but many of the reviews are tainted by women’s expressed fears of going on HRT, trying to stay away from HRT as long as possible, or seeking relief of hot flashes only (when there are 100+ known symptoms of perimenopause that HRT mostly can address, including vasomotor symptoms).
So is a naturopath or functional medicine doctor right for you?
Only you can decide if seeing a naturopath or functional medicine doctor is right for you. In this case, as with all things that are potentially expensive in both time, energy, emotional labor and monetary cost, buyer beware.
Given the increasing amount of evidence about the tried-and-true solutions for perimenopausal symptoms, those with the greatest amount of efficacy remain FDA-approved HRT and low-dose antidepressants (for those who can’t or won’t use HRT, or for those who still have breakthrough anxiety, depression or insomnia).
Supplements, vitamins, exercise and nutrition have their place in the total continuum of well-being, whether you’re perimenopausal or not. These can be adjuncts to HRT, or in the case of exercise and nutrition as the foundation of health, serve as building blocks.
But there is little defensible grounds for paying hundreds or thousands of dollars on minimally proven – or even outright disproven – homeopathic “prescriptions” to treat menopause and perimenopause.
In a previous post, I covered the main components of a total healthcare team that midlife women need begin building as they get serious about their long-term well-being. Just a few of those slots should be devoted to providers such as a primary care physician, a dentist, a gynecologist familiar treating women beyond the realm of fertility and pregnancy, and a dermatologist, among others.
These core practitioners should be able to fulfill and treat the most pressing and common healthcare needs we face going into middle age and beyond. These are the type of providers who are usually covered by your insurance within your networks, with the only payments rendered being whatever it takes to meet your deductibles and contribute your co-pays.
But what else is out there? What other tools should middle-aged women have in their well-being grab bag?
Well, there is more. This could be looked at negatively or positively, depending on your viewpoint. You may be thinking, “Great! At least there are all sorts of trained people out there to meet my needs.” Or you may instead be saying to yourself, “What kind of BS is this, and how expensive is this going to be.”
No matter your paradigm, the truth is that our holistic mind-body needs can be vast. And conventional doctors, even specialists, are not always the best, most comprehensive resources for information when it comes to things that cannot be prescribed and picked up at the pharmacy, or that are not necessarily part of a diagnosable condition, illness, disease or pathology.
Other types of wellness providers that may be discretionary (depending on your situation) and “nice to have” include:
Acupuncturist. Acupuncture has been indicated as being helpful for menopause symptoms. Some research has linked improvement in sleep problems, vasomotor symptoms and overall mood with acupuncture. For those who don’t know, acupuncture is a form of alternative medicine rooted in Chinese medicine. It involves superficially inserting small needs in the body. Ranges for the cost of acupuncture vary, often between $50-$95 per session.
Dietician. Despite their name, dieticians do much more than just put clients on diet. Dieticians are experts in nutrition who usually have an undergraduate degree from an accredited university or college with coursework that has been vetted by the Accreditation Council for Education in Nutrition and the Academy of Nutrition and Dietetics. Many dieticians have master’s degrees, have completed industry internships, have passed national examinations and are required to complete continuing education requirements. A dietician helps people focus on healthy eating habits and sound nutrition practices. These specialists can help women struggling with midlife weight loss or medical conditions that make weight loss or weight maintenance challenging.
Massage Therapist. Massage therapists are trained to understand bodily mechanics as they use touch to manipulate the muscles and soft tissues of the body. Massage therapy has been associated with stress reduction, circulation improvement, lymphatic system stimulation, recovery from injury and a general feeling of well-being. Medically, massage can help with nerve pain, fibromyalgia, anxiety and other physical pain syndromes or symptoms. According to national averages, the typical cost for a massage session is $50-$150.
Personal Trainer. Personal trainers are credentialed to provide custom workout plans and supervised exercise sessions for clients. They often serve individuals interested in specific goals, usually weight loss, muscle gain, injury recovery and foundational bodily function. Based on their training, the not only provide motivation, accountability and support, but they also know how to prevent injury during training and to develop modifications based on a client’s limitations. Personal trainers are usually certified by one of the prevailing industry bodies – NASM, ACE or ISSA.
Therapist. Therapists are not psychiatrists – they cannot prescribe medications. Sometimes a therapist may also be classified as a psychologist or social worker, but not always. Therapists help people deal with particular issues, such as addiction or marital challenges, but they also provide overall support for a variety of emotional, mental or physical health problems.
* Some insurance carriers will cover the cost of dieticians or nutritionists.
Whether you’re approaching or are already in midlife, one thing is for sure: it’s important to begin taking your health and well-being seriously. This includes various lifestyle enhancements, like getting serious about diet and nutrition, taking up regular exercise, reducing stress and getting basic checkups, like annual physicals.
The truth is, middle age is when health problems usually start making an appearance. After the age of 50, the most common diagnoses are hypertension, high cholesterol, diabetes, arthritis, osteoporosis, cancer, and anxiety or depression. Other relatively common medical problems that can pop up from age 40 onward include kidney stones, urinary tract infections, food allergies, overactive bladder and, yes, perimenopause.
With so much going on and so many health issues at stake, it’s critical to find a quality healthcare provider. But where to start? Of course, there are the practical concerns, like finding a physician who accepts your insurance, but what else?
The most important variable, in my estimation, is finding a good doctor. In my experience, a truly good doctor is like finding a needle in a haystack. The odds are better than winning the lottery, but the climb is still steep.
Here are some things to consider in determining if a doctor is a good one:
They don’t have medical Board violations. In each state, you can look up doctors’ medical board records. This enables you to check on the licensing status of physicians and also see if there are any complaints or findings against them. You can also see basics, such as where they completed their education and residencies, as well as any supplemental information they’ve disclosed, such as medical publications.
They have positive online reviews. Just as you search social media and other sites for recommendations on restaurants, plumbers and carpet installers, you can do the same for doctors. There are a variety of sites that post reviews expressly about medical providers, but I find the data integrity of those results are somewhat questionable. From my perspective, there are often far too many gloating, overwhelmingly positive reviews on the medical review sites. This may be because there are ties to insurers or certain healthcare practices operating in the advertising or sponsorship backdrop. So, to that end, I think Google reviews can provide a more realistic snapshot of how doctors perform and how patients feel about them. You will want to pay attention to the overall star ratings but even more attention to the actual narratives of the reviews themselves. Be mindful of how patients report being treated, listened to and followed up.
Their office experience is up to par. Sometimes decent doctors deliver horrendous patient experiences. Just like you probably wouldn’t keep going to a restaurant with great food but horrible wait staff, you shouldn’t tolerate a negative patient experience in order to see a pretty good doctor. Signs of poor patient experience outside the clinical scope include ridiculously long wait times, onerous times to be able to get in and see a provider (e.g. calling in May for an appointment but unable to get on the calendar until December), inadequate insurance processing or improper medical billing, dirty patient rooms and unkempt waiting rooms, rude or dismissive front office staff, condescending or unfriendly nurses, and outdated facilities and equipment.
They went to quality medical schools. The average person has no idea where his or her doctor went to school. But some people would actually benefit from knowing. When you look up a doctor’s bio, or pull their Medical Board record, you can see where they went to school and did their training. For those interested in taking quality control up a notch, they can then see how the medical school ranks, what its reputation is and how rigorous its programs are considered.
You get a good personal referral. Just like the best jobs are usually captured through a personal reference, having a positive referral of a doctor from a trusted friend, relative, neighbor or colleague can be a good baseline for sound medicine. If someone you know well and whose judgement you have faith in attests to a doctor being great, that is an added boost of confidence.
The doctor – himself or herself – delivers on the promise of good patient care. Sometimes you won’t know . . . until you go. The best indication of whether a doctor is a good one is going to be your own personal experience and judgement call. Things to look for are the doctor’s bedside manner – that is, how he or she interacts with you. Did he introduce himself? Did she ask how you’d been? Make sure the doctor seems to have reviewed your chart before entering the room. See if they seem familiar with your medical history and the reason for your visit. Check and see if they listen to your concerns, not interrupting or minimizing any questions you may have. Monitor if they talk “on your level” – for some people, that may mean not feeling like the doctor is “dumbing down” or oversimplifying information in talking to them; for others, it can mean that the doctor speaks in commonsense, plain language, not medical jargon. Does the doctor look you in the eye? Do they not rush through the visit? Do they follow up with you as needed or as they said they would?
They promptly respond to medical portal questions and concerns. Most modern medical practices now have patient portals that hold information related to previous appointments, test results, prescriptions and more. They also often feature a messaging platform where doctors and patients can communicate about non-emergency matters. If you send a doctor a question, and they either respond after a very long time (over a week) or not at all (which is unconscionable), that can be a tell-tale sign that you cannot trust this person with your life. After all, that is what is really at stake in designating a doctor to monitor your health and make vital decisions as a result.
If all else fails, you can fire your doctor! One of the only good things about living in a capitalistic medical system is that people have choices. On that front, if you’re dissatisfied with your doctors, you can “fire” them. And one of the best parts about this is that it can be very undramatic. You don’t have to write a breakup note or give them notice. You simply find another doctor! Sometimes the best medicine is to vote with your feet and your wallet.
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.
All Antidepressants Anxiety Black Women Body Positivity Body Type Depression Doctors Emotions Healthcare Hormones HRT Insomnia Meditation Melatonin Menopause Mental Health Midlife Midlife Medical Minute NAMS Natural Remedies Perimenopause Personal Stories Relationships Reproductive Aging Research Serotonin Sleep Well Being Well-Being Women Of Color