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. 

Now that you’ve decided to finally get that long-delayed annual physical and have gathered an understanding of what to look for in a good doctor, it’s time to take things up a notch. Finding a quality physician and getting a yearly checkup provides a solid baseline for the fuller continuum of your personal healthcare portfolio.

And that broader picture requires building your total healthcare team. As you get older, having a complete medical squad ready to deploy in the backdrop of your ongoing wellness is vital. Sure, you’ll still see your core primary care physician (PCP) for routine office visits and once-a-year follow-ups to monitor your baseline health and get meds for things like sinus infections or UTIs. But creating a comprehensive care team goes beyond these minimums.

In some cases, it can be challenging to construct your healthcare team due to insurance red tape. For example, your internal medicine doctor may be the gatekeeper – the one you through which you must funnel most specialized medical requests. In such cases, the PCP largely holds the cards in determining whether, or when, you get that prized referral to see a specialist who focuses on a particular area of the body (e.g. a cardiologist for heart concerns, a neurologist for nerve-related issues). However, even if this is true for you, you can still build a go-to care team by doing the legwork now to determine precisely which doctors in what areas you want to see if or when circumstances dictate.

For those who have a primary care physician but who also have the autonomy to see other doctors without going through PCPs for a referral, you’re probably wondering, “What is a healthcare team? What kind of doctors need to be on it?”

A care team is akin to a team in sports: Everyone has a role, a position to play, with expectations of what that title conveys. Similarly, it is understood that most people who are 40+ years old currently need, or will need, more than the garden variety family medicine doctor to deal with all the medical concerns they face. Your PCP cannot be all things to all of your problems. So let’s call the other care providers “reinforcements,” though this is not intended to belittle the critical role they play.

Your body is unique, and the needs you have from a medical standpoint are, too. So these are simply recommendations, or considerations, of the various provider types who you’ll need to recruit as part of your total healthcare team.

Dentist. Oral health is important. People should visit their dentist twice a year for cleanings. Assuming no other issues are discovered, such as early stage periodontal disease or failing teeth, these two outings will be the only times you see your dentist annually. Though this may seem “low level” when it comes to overall health, it’s not: oral health is connected to diabetes, heart disease, oral cancer and stroke, according to many reputable health sources.

Dermatologist. Skin changes at midlife. You may start to see more moles, new wrinkles, a return of acne and changes in skin texture. Yes, in most cases these are more superficial, aesthetic considerations rather than medical needs. But feeling good about how you look is an important aspect of well-being. Dermatologists provide treatments and medications that can help women feel better about their changing selves at middle age without going under the knife.

Endocrinologist. With hormonal havoc happening during perimenopause, some women in the 40-and-over camp may find themselves visiting an endocrinologist for the first time. Most endocrinologists don’t treat perimenopause, but instead focus on diabetes, cholesterol issues, thyroid problems, adrenal disorders and hypoglycemia. The caveat to note is that reproductive endocrinologists are trained to deal with hormonal problems and can be well suited to manage hormone replacement therapy (HRT).

Gynecologist. This is perhaps the most obvious recommendation to have on your personal care team as a woman. Though we may not be entertaining the idea of reproduction at this stage, there are other elements of your reproductive health to maintain. It is now recommended to get Pap smears every three years (often along with HPV testing). Some women still opt to visit their GYN annually for an exam. It is important to find a doctor or practice skilled in, and attentive to, treating patients who are not obstetrical cases (in other words, women who are neither pregnant nor interested in being so).

Optometrist / Ophthalmologist. Most people’s vision changes around the age of 40, even for those who’ve never needed glasses before. Getting your eyes checked every year or two should be pretty customary for the 40+ set. This evaluates any changes to your vision and ensures you get the right prescription to see clearly, and also checks for any underlying eye diseases, like the beginnings of glaucoma.
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Orthopedist. The aches and pains of advancing stage start to hit many people going into their 40s or 50s. In many cases, the discomforts are short-lived and benign; other times, there is actually a structural and functional problem involving the musculoskeletal system. These problems could be degenerative in nature (think arthritis), acute (think runners knee) or require surgery (like bone spurs impinging on nerves). Achy necks, back pain, knee stiffness and the like are common symptoms that lead to orthopedic care.

Psychiatrist. A perimenopausal woman, or one going through the menopausal transition, has at least double the risk of first-time anxiety or depression than a pre-menopausal woman. The risk ratio is higher for women who’ve previously experienced postpartum depression or who’ve had prior depressive episodes. For many women, this will be the first time in their lives that they are offered or prescribed an antidepressant or anti-anxiety medication. Sometimes these medications have other benefits, such as treating hot flashes or reducing hormonal headaches. In any event, it’s probably better to have a professional trained in this pharmacology to manage this than a general medicine doctor. And this type of physician just happens to be a psychiatrist.

Your situation is as unique as your biology, and you may need other types of providers in your wheelhouse as you navigate the changes of age and time. Coming up soon in this series will be a list of the specialists and providers that are “nice to haves” in enhancing your total well-being and health.