Menopause officially begins when you have gone 12 months without a period, but it can creep in long before that in a slow accumulation of physical and emotional changes. Good medical care is crucial to understanding what is going on, getting relief, and feeling well.
Knowing that I’m around the average age at which menopause begins (early 50s), I often wonder if a subtle change or new experience I’m having is the result of hormonal changes. Did I wake up sweating last night because I’m perimenopausal or was the heat too high? Are hormones making it harder to maintain my goal weight or am I eating more than I realize (looking at you, snack drawer)?
According to Dr. Claudia Levine, an internal medicine specialist and co-founder of the menopause educational resource Pausology, it may not be obvious at first glance that you are in perimenopause, the phase leading up to menopause that can begin in your late 30s Early 40s. If you’ve had regular periods (which isn’t the case for everyone), changes to your cycle can help you identify what’s happening.
“[Perimenopause] “This is probably starting sooner than expected, and it’s taking a long time,” Levine said.
Watch: The 3 phases of menopause >>
Receive good menopause care
Once you reach menopause, you stay there for the rest of your life. But not every health care provider (HCP) has experience with or is comfortable with menopause. If this is not the case for you, you may not be up to date on treatment recommendations and you may miss out on treatment that could relieve menopause symptoms.
Hormone therapy receives much attention, but other approaches include non-hormonal medications, antidepressants, dietary 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 treat night sweats.
“There are a lot of tools out there, but you need someone to help you navigate,” said Dr. Shannon Cothran, board-certified OB/GYN and founder of Meno-Start, a menopause clinic and membership wellness provider.
How can you be sure your healthcare professional is equipped to provide good menopause care? Cothran recommends seeing a licensed physician and not visiting a medical spa, gym, or online pharmacy without medical guidance.
Levine suggests looking for signs that your HCP is attuned to menopause, such as: B. asking what your period looks like or if you are aware of any changes that you think may be related to hormonal changes.
“Menopause-informed care is everyone being aware of this phase of life that may impact how you feel,” she said.
As with any relationship, you should feel like your HCP is really listening to you and taking you seriously.
“If you feel like you’re not being listened to or that you’re just being heard [the runaround]“That’s the biggest danger sign,” Cothran said
If you feel like you’re being laid off, she recommends making a separate appointment to discuss menopause.
“[Menopause] is really a whole body problem and it takes more time [address] that,” she said.
HCPs don’t always have this time for an annual checkup or contraceptive refill visit. A separate visit allows your HCP to prepare and gives you the space to address your concerns.
“If the office doesn’t plan for that, that’s a red flag,” Cothran said.
Another bad sign: If your HCP oversimplifies the solutions or suggests that medication alone will make everything better.
“Someone who does this type of work and understands hormone care and menopause and perimenopause care [is] “I’m not just going to say, ‘Do one thing.’ They’re going to really look holistically at how to help you feel your best,” Levine said. “You really have to look at the bigger picture of your life.”
Levine says you should also be wary of healthcare professionals who are uncomfortable prescribing hormone therapy.
“If you feel like hormones aren’t safe, that’s definitely a red flag,” she said.
Trust your gut if you suspect your doctor isn’t an expert on menopause. According to Levine, it’s okay to ask, “Do you do a lot of menopause care in your practice? Is it something you’re 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 be lucky if you call your health insurance provider and say, “I’m really not happy with my care. Is there anyone you can call more knowledgeable?”
Both Levine and Cothran recommend checking the Menopause Society website to find menopause-certified HCPs 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 HCP and don’t have the luxury of switching, Levine suggests advocating for it yourself by saying, “This really affects me and I need to talk about it more.” I need to think of a better plan.”
Is menopause care covered by insurance?
The Affordable Care Act (also known as “Obamacare”) requires insurers to cover preventive services. However, menopausal care can include several categories, all of which may not be covered: hormonal and non-hormonal therapy, physical and mental health care, and other therapies or services for symptom management.
Insurance coverage depends on, among other things, what treatment you are seeking, where you live, whether the HCP is in the network, and what type of insurance coverage you have.
Levine said some of her patients who are insured through California’s Medicaid are better covered for certain treatments than others who have job-based insurance.
To improve your chances of coverage, reach out to in-network HCPs whenever possible. If not, request an exception to coverage if you can demonstrate that their expertise is not available in-network. You may be able to get at least some reimbursement for bills that you pay yourself. However, check with your health insurance provider before incurring any costs.
If your insurance does not cover the medications you need, your doctor can help you apply for coverage or appeal a denial based on his or her medical judgment.
Some menopause-focused telemedicine providers now accept insurance, which may 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 give to people. I think that’s one of the reasons we pushed ourselves [menopause] under the rug,” she said. “Now there is a lot of hope and you don’t have to feel terrible. There are options regardless of your history. So keep looking if you’re not feeling well. You know you can feel better.”
This educational resource was created with support from Astellas, a member of the HealthyWomen Corporate Advisory Council.
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