Menopause officially begins when you’ve gone 12 months without your period, but it can slowly appear in a series of physical and emotional changes long before that. Good medical care is essential to understanding what is happening, getting relief, and feeling your best.
knowing that I am close to average age of onset of menopause (In my early 50s), I often wonder if some subtle change or new experience I’m having is the result of hormonal changes. Did I wake up last night sweating because I’m perimenopause or was it too hot? Are hormones making it harder to maintain my ideal weight or am I eating more than I think (looking at you, snack drawer)?
According to Claudia Levine, MD, board-certified internal medicine physician and co-founder of the menopause educational resource. PausologyIt may not be obvious at first that you are in perimenopause, the phase leading up to menopause and which can begin between the ages of 30 and 40. If you’ve had regular periods (which not everyone has), changes in your cycle can help you recognize what’s happening.
“[Perimenopause] It probably starts earlier than expected and takes a long time,” Levine said.
See: The 3 stages of menopause >>
Receive good menopause care
Once you are in menopause, you stay there for the rest of your life. But not all health care providers (HCPs) are experienced or comfortable with menopause. If yours doesn’t, they may not be up to date with the latest treatment guidelines and you may miss out on care that could relieve menopause symptoms.
Hormone therapy gets a lot of attention, but other approaches include nonhormonal medications, antidepressants, supplements, diet and exercise, services such as cognitive behavioral therapy and clinical hypnosis, and products such as quick-drying fabrics and special sheets or pajamas to control night sweats.
“There are a lot of tools, but that’s where you need someone who can help you navigate,” said Shannon Cothran, MD, board-certified OB-GYN and founder of Meno-Homea membership model menopause clinic and wellness provider.
How can you be sure your doctor is prepared to provide you with good menopause care? Cothran recommends going to a licensed health professional rather than a medical spa, gym, or online pharmacy without medical guidance.
Levine suggests looking for signs that your doctor is in tune with menopause, such as asking what your periods are like or if you’re aware of changes that you think might be related to hormonal changes.
“Menopause-informed care is anyone who is aware that this is a stage of life that will potentially affect how they feel,” she said.
As with any relationship, you should also feel that your healthcare professional really listens to you and takes you seriously.
“If you feel like they’re not listening to you or that they’re just getting you [the runaround]”That’s the biggest danger sign,” Cothran said.
If you feel like you’re being dismissed, she recommends scheduling a separate appointment to talk about menopause.
“[Menopause] It is really a whole body problem and needs more time to [address] that,” he said.
Health professionals do not always have that time for an annual check-up or a contraceptive refill visit. A separate visit allows your doctor to prepare and gives you the space to address your concerns.
“If the office doesn’t schedule that, that’s a red flag,” Cothran said.
Another bad sign: if your doctor oversimplifies solutions or suggests that medications alone will make everything better.
“Someone who does this type of work and knows about hormonal care and menopausal and perimenopausal care. [is] I’m not just going to say, “Do one thing.” They’re really going to look more holistically at how to help you feel better,” Levine said. “It really requires looking at the big picture of your life.”
According to Levine, care should also be taken with healthcare professionals who are not comfortable prescribing hormone therapy.
“If you get the sense that they think hormones aren’t safe, that’s definitely a red flag,” she said.
Trust your gut if you suspect your doctor may not be an expert on menopause. According to Levine, it’s okay to ask, “Is there a lot of attention paid to menopause in your practice?” Is it something you are comfortable with and knowledgeable about?
If they tell you it’s not their area of expertise, ask if the health system has menopause experts they can refer you to. Levine said you might have luck by calling your health plan and saying, “I’m really not happy with my care. Is there anyone you can identify as more knowledgeable?
Both Levine and Cothran recommend searching Menopause Society website for certified menopause healthcare professionals in your area who accept your insurance and are accepting new patients. People in your community may also have recommendations.
If you’re not getting what you need from your healthcare provider and can’t afford to change, Levine suggests standing up for yourself by saying, “This is really impacting me and I need to talk about it more. I need to come up with a better plan.”
Does insurance cover menopause care?
The Affordable Care Act (also known as “Obamacare”) requires insurers to cover preventive services, but menopause care can encompass categories that may not all be covered: hormonal and non-hormonal therapy, physical health care and mental health, and other therapies or services for symptoms. management.
Coverage depends on factors including the treatment you seek, where you live, whether the HCP is in-network, and the type of coverage you have.
Levine said some of his patients covered by California Medicaid have better coverage for certain treatments than others with insurance through a job.
To improve your chances of coverage, see in-network healthcare professionals, if possible. Otherwise, request a coverage exception if you can demonstrate that your experience is not available in-network. You may be able to get at least partial reimbursement for bills you pay yourself, but check with your health plan before incurring costs.
If your plan doesn’t cover the drugs you need, your healthcare provider can help you apply for coverage or appeal a denial based on your medical judgment.
Some menopause-focused telemedicine providers now accept insurance, which can be a cost-effective way to access specialized care.
Overall, Cothran sees reason for optimism.
“Even five years ago we didn’t have many options to offer people. I think that’s part of why we push each other [menopause] under the rug,” he said. “Now there is a lot of hope and there is no need to feel terrible. There are options, no matter what your history is. So keep looking if you’re not feeling well. You know you can feel better.”
This educational resource was created with the support of Astellas, a member of HealthyWomen’s Corporate Advisory Board.
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