Menopause Confessions: Not all medical advisors are built the same!

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26 February, 2024.

Dear Mia,

I hope this letter finds you well and navigating life with grace.

I've been reflecting on our recent conversations about menopause, and I completely understand why you might be feeling overwhelmed with so much conflicting information out there.

It's a huge maze, and finding the right path can be challenging and a little intimidating.

What’s in a name?

The very first thing to be clear about when looking for a primary health care provider is - what is their expertise?

Gynaecologist:

A gynaecologist, according to WebMD, ‘…give reproductive and sexual health services that include pelvic exams, Pap tests, cancer screenings, and testing and treatment for vaginal infections. They diagnose and treat reproductive system disorders such as endometriosis, infertility, ovarian cysts, and pelvic pain…’

If you read the whole article there is one mention of menopause.

This is a clue!

Moving onto Obstetrics, WebMD states:

‘…take care of you throughout your pregnancy, and give you follow-up care such as annual Pap tests for years to come. OB/GYNs have graduated from medical school and completed a four-year residency program in obstetrics and gynecology…’

So What?

While a title and degrees and training are important, helpful and reassuring. The main element, in my experience and opinion, that really makes a great primary health care provider for my menopause journey, is beyond the title and the degress and the training (these are entry level requirements), what really matters to me is experience in menopause and openness to listen.

Questions I was asking each time I met with an expert - Have they heard what I am saying and have experience in understanding likely menopause symptoms? Do they have patience? Are they also going through menopause? Do they know what it feels like. What pshycology may be invovled. What physical symptoms might be involved?

TIP - go where you are treated best when it comes to menopause. This may require some searching on your part. It’s worth your time.

Where to go next?

Let me share a personal experience that might shed some light on the importance of choosing the right expert to guide you. A few years ago, I was facing issues with hormonal imbalances during menopause.

My decision to go onto HRT, when I was at my wits end (as you know), meant I had to go on 2 hormone replacement therapies – estrogen (oestradiol) and progesterone.

After I started on HRT, I wanted to explore alternatives to taking progesterone orally – I found I was lethargic, put on some weight (I was hoping to lose excess belly fat on HRT!) and I was not keen for more pills that my kidneys and liver then needed to process.

BTW - You are told you only need to take progesterone when you start hormone replacement therapy (estrogen), if you have a uterus. The reason you then take progesterone is to supposedly stop the lining of the uterus from becoming too thick – to stop the wrong environment appearing and for diseases to then grow in that environment.

What I find out (much later) through my own formal studies in functional nutrition, is that progesterone drops more than estrogen in the menopause journey.

And….

…Progesterone is important in menopause for staying calm (low anxiety), brain functioning and according to an interesting menopause medical practionery, Dr John Lee, progesterone helps reduce/eliminate hot flashes and night sweats - not what my medical experts told me at the time of starting hormone replacement!

What about Progesterone?

So originally, exploring progesterone options led me back to a general medical practitioner who claimed expertise in menopause and who first prescribed both estradiol bio identical patches and progesterone tablets.

I asked if there were alternatives to progesterone tablets - especially when being told at the time, taking progesterone was to keep the lining in my uterus thin and thus minimise chances of serious disease.

As said, I was not keen to take more pills, so I asked at the time, whether my Mirena (which was supposed to release progesterone in low doses - but see below ‘Postscript’) was enough instead of having to take the additional oral progesterone pills.

Unfortunately, she basically said "not possible" to me using a progesterone-releasing Mirena instead of oral pills.

I always felt like this doctor was a bit unsure of herself , especially when I asked questions that didn't quite fit into her usual routine. Instead of addressing them, she would just brush me off.

Trust your gut is the moral here! Move on and ask another expert.

Turns out experts differ on quite alot about menopause and the journey of symptoms and implications.

Later, I found out that she had recently finished training in menopause after becoming a general practitioner.

That explained why she seemed to prefer a more structured, checklist-style approach when dealing with me—maybe it made her feel more comfortable.

I was obviously disappointed. Still I wasn’t convinced. Don’t ask me why. I just had a doubt.

I decided to get a second opinion from fully trained ‘women’s doctor’ an obstetrician-gynaecologist (Obgyn), about alternatives and about the Mirena doing the job needed while I was on HRT, instead of me taking oral progesterone tablets?

PS - I chose an Obyn before fully appreciating the training and differences in experts!

I received the same blunt response.

A flat no. No way.

As I left the second doctor’s office, I couldn’t help feeling I had been brushed aside yet again. Postscript: it turns out this doctor specialized in all things babies and had very little experience in menopause, despite coming highly recommended.

Wow!

TIP: Always ask what your expert is training in. Training dictates your expert’s ‘world view’ on how to work with you and treat your symptoms and work with you. Always ask how many years experience your expert has in menopause work.

This is IMPORTANT!

Because your adviser will only be as good for your menopause needs, as the training and experience and world view on menopause they have and obtained through practice.

Choose your experts wisely and carefully.

Reference check them by looking at websites and speaking to their receptionist to find out their years of experience, the specialisms and training.

I left one Obgyn specialist’s office at the time and I still just wasn’t convinced about her advice. It felt as if she was speaking off a script and was not comfortable with my questions.

So I decided on a third opinion!

I know stubborn, right?!

Finally, after persistent research and a bit of luck, I found a second Obgyn who not only understood my concerns but confirmed that a Mirena was a good idea and a good option for my progesterone needs. Again, no mention (at the time) that this Mirena product was not progesterone but rather a pure synthetic product that, at a molecule level, resembles testosterone more than it does progesterone.

I would have liked to have been told so that I could make a more informed decision at the time.

Lessons?

I was right to trust my gut originally and push for what I wanted - unless I was told no way. That is, to go with a Mirena to supplement hormone therapy, without having to take progesterone tablets.

But be prepared to revisit your decisions. As I did some years later - deciding to remove the Mirena when discovering it was not a progesterone replacement therapy nor was it bio identical. Rather synthetic. It was after I decided to roll of hormone therapy, too.

At the time, I was almost 100% satisfied the Mirena was enough. I did always feel relief when my annual gynaecological check up confirmed the lining of my uterus had not thickened.

TIP- what might work for you in the beginning may need to be reviewed in the future (like for me with a Mirena to replace progesterone when it turns out it doesn’t).

ALWAYS be on the look out for more information. Ask questions. Do your research. Don’t hound yourself but always be alert to asking questions.

Don’t just rely on someone who is medically trained. They don’t, as it turns out, know everything about menopause yet.

Don’t get me wrong, a primary health care practitioner is very helpful. They should be part of a team. But for me, they are not the only people I surround myself with in my own menopause journey.

I lead. I am in the driver’s seat.

I now do my own testing so I can keep track of what’s going on in my body.

What about Testing?

Many tests out there are about the average (can you imagine who is included in the average - smokers, unhealthy people, people with co morbidities. We don’t want to be compared to the average in a test. We want optimal!)

How do you achieve optimal results from Testing?

If you would like me to do a blog or YouTube video on testing reach out to me HERE

Hope all this is making sense?

So fast forward several years, loads of research, formal training and conversations with experts and women clients and I'm happy to report that after moving off hormone replacement therapy (HRT), the lining of my uterus is healthy and the thickness is where it should be.

So it was worth it, right!

Same job title, different expert!

This episode with the doctor and various gynecologists really was a pivotal point for me, it’s when I started to realize not all primary health care practitioners, including specialists like Obgyns are cut from the same cloth – some may specialize and have more experience in delivering babies rather than helping women navigate hormones and menopause.

It also taught me that although people may call themselves specialists in a particular field of study – like Obgyns – they don’t all practice medicine in the same way or with the same views.

So what does that mean for us as a patients?

You should always enter a general doctor’s or specialist’s consulting rooms – armed with your own knowledge and information so that you can have a conversation as equals.

You bring your expertise about what you are feeling, experiencing nd your doctor or obgyn brings their technical expertise about medicine.

However, if your gut tells you something is off with the conversation – trust it. My experience is that my gut is not what is off or sometimes wrong – it’s my interpretation later on that may be a bit off, but my gut is always right. And so is yours! So is everyone’s.

If you find the attitude is off. Walk away!

I promise you the sky will not fall in.

Nothing happens.

Just a temporary set back. Maybe you lose a week or two while finding another appointment.

Maybe you pay a fee without proper service.

So what!?

You need to be heard, your needs need to be understood and how you are treated are paramount.

Trust your gut and keep looking!

You just move onto finding someone more suited to your style and more respectful of you.

Getting that third opinion taught me a valuable lesson – to trust my gut feelings, to trust those nagging doubts.

To basically back myself!

So make sure you back yourself.

And, you realize that not every doctor or Obgyn are not built the same or will provide the same level of expertise or specialisation we need and desperately seek in our menopause journey.

So I would say the biggest lesson is to be a guardian for yourself.

Be mindful of who you allow into your life and grant the privilege of advising you. Realize that health care professionals while useful are not the be all and end all of what you need.

I would think about building your own advisory team. A health care professional may be a part of Menopause Team You - but shouldnt necessarily leading the team.

Not drive that team. That’s your role for you.

They are not necessarily impartial or unbiased even if they do have your best interests. That certainly has been my experience on several occasions with medically trained health care professionals along my menopause journey.

PS - I finally found a wonderful, warm, empathetic, compassionate and experienced gynaecologist who gets me and listens. I respect her immensely because she respects the patient’s views and listens.

Her menopause experience is sound and practical. Something I appreciate greatly.

Always remember, you're an expert in yourself, so surround yourself with a team of advisors (if I had my time in perimenopause this is definitely what I would do) and you have the right to choose who best serves your preferences and concerns.

This doesn't mean you'll always be right or know what to diagnose – that's not the point.

In the story above about progesterone, what bothered me about the first two healthcare professionals was their dismissive attitude, maybe because I took them out of their training and comfort zone, or perhaps because they felt they knew best, seeing me as 'just' a patient.

So learn to stand up for yourself and surround yourself with capable, impartial, unbiased advice. And remember to always be open to reviewing that advice, years later, when new information comes into your world.

You deserve it!

So, Mia, until next time

Hugs,

Gra

PS - Like this blog?

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POSTCRIPT: When asking my expert at the time whether a Mirena could replace progesterone tablets while on hormone replacement (ie estrodiol) which is an internal coil that releases supposedly progesterone. She said a flat no.

I later found out the Mirena coil release Progestin. Progestin is synthetic chemical and its’ chemical structure is closer to testosterone not progesterone. Again my ‘expert’ did not tell me any of this. She just flatly efused to discuss the pros / cons of a MIrena. Research and my own formal qualificatons revealed this information about the usefulness (or not) of a Mirena in hormone replacement therapy.

DISCLAIMER: This blog is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this blog is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health-related diagnosis or treatment. No information in this blog should ever be considered as a substitute for advice from a healthcare professional. The author of this blog shall bear no liability for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.