Social media is really taking us all for a ride. Lately, that ride means I have more patients who are disappointed when what I say doesn't match up with what this year's social media darling is saying. And weirdly, that social media darling is the one who told them to go to menopause.org and find a Certified Menopause Practitioner (me) in the first place! It's a little bonkers, and my waiting list being long, I feel compelled to write a little post so that the people waiting on that list have reasonable expectations. So without further ado, here's some things you should know about my perspective and the care I offer:
I trust your body
My perspective is that menopause is a normal life stage, not an evolutionary mistake. You are not broken or deficient because your hormonal state is different than it was when you were younger. Distress at this change in your life is quite normal (and fine and welcome!), but ultimately, you’ll have to face this distress. I can’t make you younger. I can’t protect you from heart disease or dementia. And I won’t pretend that I can. If you are feeling fearful and distressed by the bare fact of your menopause (as opposed to specific disruptive bodily experiences), get curious about where the fear is coming from. Could we help you get better at untangling that fear so it affects you less? You are getting older and you’ve got some great years ahead and we don’t want ageism and misogyny stealing your power and joy.
Perimenopause is a change
If you need help with a problem during this change, I am here for you. But the change itself is not a problem. Perimenopause is a time of uncertainty and shift. It can make us doubt ourselves in myriad ways. It can also bring us into greater alignment with our life goals and help us grow in honoring our needs. Many perimenopausal people are getting the message on social media that they need hormone therapy, just because they’re in perimenopause. This is scientifically unfounded and not supported by guidelines. Please follow up if you are dealing with insomnia, mood problems, abnormal bleeding, or any other health concerns at this time of your life. And when you see someone, remember that the best treatment might be something other than hormone therapy, especially if you're in early perimenopause. If you’re overall well and just feeling worried about perimenopause, you might start by limiting social media.
Hormone therapy is just medication
I am not afraid of prescribing menopausal hormone therapy (MHT), and I also understand it is just medication, not magic. My practice generally follows commonly accepted guidelines for menopause care as established by the Menopause Society. If you are curious about whether I would consider hormone therapy a safe option for you, you can review the guidelines before our visit. Because social media is (big surprise) getting this wrong, you should know that hormone therapy is not currently recommended to prevent or treat heart disease or dementia. If your hope is to start hormone therapy for this reason, I might not be a good fit for you, and you may wish to seek out providers who work in “anti-aging medicine”. I am very much in support of low dose vaginal hormonal therapy, and there is a position statement on the use of this therapy as well.
Testosterone is just medication
I am unlikely to prescribe testosterone therapy for patients until post-menopause, and for only limited reasons. My practice closely follows these joint recommendations for the use of testosterone therapy in women. Social media (big surprise) is getting this one wrong as well. What if your body was wise, and doing everything fine, and the real problem was the messages you are getting about women and aging? Again, if you’re feeling really motivated to start testosterone and you're still in perimenopause, you probably want to check out people who work in the area known as “anti-aging medicine”.
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 coming to me for 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.
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