​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:

• menopause terminology
• endocrine and physical changes associated with reproductive and physiological aging
• risk factors related to lowered ovarian hormones
• performing a physical examination and conducting a health history
• selecting and interpreting appropriate laboratory and diagnostic tests
• describing current research on complementary and pharmacological treatments
• helping patients make informed decisions
• addressing psychosocial issues
• recognizing when referral to other services is appropriate and more

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?

1. Genetics
2. Moderate alcohol consumption
3. Regular exercise

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.
 

Personal stories are one of the most powerful and relevant ways to know you’re not alone in your perimenopausal journey. All too often, women find themselves on the hunt for information about this midlife change because no one around them is talking about it. Even among friends and family members, women are mum and silent about whether they are menopausal or perimenopausal, of it they worried about what the “change of life” will be like for them . . . let alone actually being candid about their symptoms and what they’re doing about it.

As midlife women’s health advocate, educator and former practicing gynecologist Dr. Barbie “Menopause” Taylor says, “Silence is stupid.”

There is nothing golden about the silence that is so pervasive around menopause and perimenopause. That’s why personal testimonies are so critical. Here, I’ve amassed some stories of striving, persevering and overcoming by women who are willing to be vulnerable and share their own experiences. Every little bit helps in navigating this phase of life.

This list of resources is continually updated.

A Case Study for Menopause Awareness – ZRT Blog, Margaret N. Groves, Sept. 14, 2018 – https://www.zrtlab.com/blog/archive/a-neurotransmitter-hormone-case-study-for-menopause-awareness/

Come Celebrate My 14 Years of HRT Use and Turning 64 Years Old! – Create A Menopause Recovery, Kitty Anderson, July 15, 2021 - https://www.youtube.com/watch?v=GfRhG-un6EA&list=PLURYQrFSaTf9LvHZMZSm0grPmE6e3Xvgb&index=1&t=10s

Davina McCall Opens Up about Her Nightmare Perimenopause Symptoms – Loose Women, Oct. 12, 2020 - https://www.youtube.com/watch?v=up0vjSrcljQ&list=PLURYQrFSaTf9LvHZMZSm0grPmE6e3Xvgb&index=47

Gabrielle Union Says Navigating Perimenopause Symptoms Led to Suicidal Thoughts – Kayla Blanton, Prevention, March 9, 2021 – https://www.prevention.com/health/mental-health/a35773464/gabrielle-union-perimenopause-mental-health/

HRT Patches for Menopause – Taylor Made Beauty by Kris, March 12, 2020 – https://www.youtube.com/watch?v=1KTKiDwFdjc

I Miss What I Used to be Like: Women’s Stories of the Menopause – The UK Guardian, Hilary Osborne, Caroline Bannock, Aug. 25, 2019 - https://www.theguardian.com/society/2019/aug/25/i-miss-what-i-used-to-be-like-womens-stories-of-the-menopause

I’m 43 and I’m Scared to Lose My Best Feature during Perimenopause – Kelly Eden, MamaMia, Jan. 22, 2022 – https://www.mamamia.com.au/perimenopause-story/

I Stopped Taking HRT – Here’s What Happened! – HotandFlashy, June 25, 2019 - https://www.youtube.com/watch?v=4XvAlDgHGjE&list=PLURYQrFSaTf9LvHZMZSm0grPmE6e3Xvgb&index=2

I Wasn’t Me: 10 Women Candidly Share Their Experience of Menopause – MamaMia, Feb. 5, 2022 –
https://www.mamamia.com.au/menopause-stories/
 
Liz Earle’s Personal Menopause Experience – Liz Earle Wellbeing, May 15, 2020 - https://www.youtube.com/watch?v=qbcWx_ffrUM&list=PLURYQrFSaTf9LvHZMZSm0grPmE6e3Xvgb&index=11&t=1641s

Menopause: An Honest Chat – – Dawn’s Life, Over 40, April 9, 2021 – https://www.youtube.com/watch?v=GVOyYg_7o84

Menopause, MHT and Me – The Spinoff, Anna Sophia, July 27, 2021 - https://thespinoff.co.nz/society/27-07-2021/menopause-mht-and-me/

Menopause Update: Finding the Right Balance! – Hot and Flashy, Jan. 7, 2020 – https://www.youtube.com/watch?v=akQpg6K5Wr0&list=WL&index=1

Mission Menopause: “My Hormones Went Off a Cliff – And I’m Not Going to be Ashamed” – The UK Guardian, Kate Muir, May 9, 2021 - https://www.theguardian.com/society/2021/may/09/mission-menopause-my-hormones-went-off-a-cliff-and-im-not-going-to-be-ashamed

My Bosses Were Happy to Destroy Me – The Women Forced Out of Work by Menopause – Sirin Kale,The UK Guardian, Aug. 17, 2021 – https://www.theguardian.com/society/2021/aug/17/my-bosses-were-happy-to-destroy-me-the-women-forced-out-of-work-by-menopause

My Hormone Replacement Therapy Journey So Far – Elle is For Living, Jan. 23, 2014 – https://www.youtube.com/watch?v=fauPe6ChxMQ (Also see “An Update on My Hormone Replacement Journey” – https://www.youtube.com/watch?v=sw9Iry6yx1I

My Menopause Journey – Dawn’s Life, Over 40, Jan. 15, 2018 – https://www.youtube.com/watch?v=ki8CMD-qbiI

We Need to Talk about Perimenopause – Alyssa Schwartz, Elle, Nov. 2, 2021 – https://www.elle.com/beauty/health-fitness/a37922110/we-need-to-talk-about-perimenopause-november-2021/