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.
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.
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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