Before you schedule

I am a midwife with a special interest in menopause. I feel I occupy a point of balance regarding this life transition – understanding that it is both a normal event, and a potential cause of suffering. I do not see menopause itself as a tragedy or a cause for alarm, just a reproductive life event like puberty or pregnancy. On its own, menopause is not a problem that needs correcting.

My perspective, unfortunately, is in conflict with some popular messaging on social media. As social media coverage of menopause has increased, I observed that more of the patients who came to me were scared, or distressed about the changes in their physical appearance, and often they had developed a sense of urgency about wanting to be prescribed hormone therapy as soon as possible to protect them from age related chronic disease.

Hormones can help or they can harm, and to use them well we must keep both those facts in mind. I am not afraid of hormone therapy – and I find it can be used safely for a majority of people with menopausal concerns. Sometimes it makes a big difference in someone’s wellbeing. Still, hormones are only an option and not a requirement - and healthy aging does not require hormone therapy. I have many options for those who need or prefer non-hormonal approaches.

I read research nearly every day in an effort to further refine my practice of menopause care. I also utilize guidelines from professional societies to help keep my practice in line with other experts in the field. When a particular individual’s situation is not addressed with guidelines or research, I use my best judgement, and give options where I feel reasonable and safe options exist. However, that doesn’t mean that all hormones, all forms, or all doses are an option for you. Please read that last sentence again, particularly if you are expecting to be prescribed testosterone, wanting hormone therapy to prevent dementia or heart disease, thinking you need high doses of hormone therapy, or if you are hoping I can help you with weight loss*. I want you to consider now that I may not be able to meet your expectations.

The final thing I like to share with potential patients is that mine is a small healthcare practice. There are a lot of benefits to this, particularly longer visit times – but, it means this practice might operate differently than other larger healthcare practices you’ve seen. Here, patients are responsible for scheduling their own appointments, and are asked to complete questionnaires online before the visit. All communication between visits happens through the patient portal. Responses to patient messages may take up to 5 business days.

I hope that I can help you on your menopause journey. Or, maybe you’ve learned from reading this that we’re not a good fit. Either way, thank you for taking the time to read this, so that I can continue to bring in the patients I am most likely to help.

Christina Cameli, CNM

*Weight neutrality matters

I do not routinely weigh or recommend weight loss to my patients. I do not prescribe weight loss medications. I am happy to investigate whether a medical problem is causing weight change for you. I’m also happy to discuss diet and physical activity in reasonable and flexible terms, however my primary goal is for you to be in a place of trust and care with your body, as opposed to one of judgment and dominance. Diet culture causes undue harm to people in the menopause transition, and I do not wish to participate in its destructive patterns. If you are seeking weight loss help, I may not be able to provide the outcomes you are looking for. If, however, you are looking for a provider who will listen to your concerns without blaming them on your weight, you’re in the right place.