Managing Menopause: When to Seek a Specialist

Even though it’s a natural process, the transition to menopause can be challenging for some women. But that doesn’t mean you have to face it alone. Whether you’re experiencing early symptoms or post menopause, your first stop for support is your OB-GYN or your primary care provider. 

Common Menopause Symptoms 

In the United States, approximately 6,000 women each day reach menopause. Menopause is reached when menstrual periods have stopped for one full year. The transition phase before menopause is called perimenopause. During this time, hormone levels fluctuate, and the supply of mature eggs in the ovaries is reduced. Ovulation becomes irregular. The making of estrogen and progesterone declines. 

Then there is a permanent decline in hormones. It’s the big drop in estrogen levels that causes most of the symptoms of menopause. Understanding these common symptoms can help you seek the right support and treatment from your OB-GYN or primary care provider.

• Hot flashes and night sweats 
• Vaginal dryness and discomfort 
• Pain during intercourse 
• Sleep disruption 
• Mood swings 
• Anxiety 
• Low libido 
• Bone loss (osteopenia/osteoporosis) 
• Thinning hair 
• Brain fog or memory issues
• Change in weight and body composition

Treatment of Menopause Symptoms

Treatment options may include lifestyle changes, nonhormonal prescription medications, systemic hormonal treatment through pills and patches, and local hormonal and nonhormonal treatment like vaginal moisturizers or estrogen.

Hormone Therapy (HT)

This involves taking the female hormones estrogen and progesterone during perimenopause and menopause. HT comes in pill, skin patch, vaginal or topical forms. It’s important to talk with your doctor about the risks and benefits of HT for your individual situation.

Estrogen Therapy (ET)

ET is the use of estrogen alone and is typically prescribed for people who had a hysterectomy. Estrogen is available as pills, skin patches, vaginal rings or creams. As with HT, discuss the risks and benefits of ET with your doctor.

Nonhormonal Treatment
Nonhormonal options use other types of medicines to relieve some menopause symptoms. These may be suitable for those who can't or prefer not to use hormones.

Estrogen/Progestin Alternatives

These are nonhormonal prescription medications called SERMs (selective estrogen receptor modulators) that can improve menopausal symptoms without increasing the risk of endometrial cancer.

Alternative Therapies

Homeopathy and herbal treatments may offer some relief from menopause symptoms. These treatments include plant-based phytoestrogens. Food sources rich in phytoestrogens include nuts, oil-containing seeds, legumes and soy-containing products. However, there are concerns about their potency, safety, purity and effectiveness, so it’s important to approach these options with caution and speak with your doctor.

What You Need to Know About Bioidentical Hormones

Bioidentical is a term not recognized by FDA and is often misused by compounding pharmacies who inaccurately market as “natural” and “safer” when there is no evidence to support these claims. Bioidentical means it's chemically the same as what your body produces, not that it is derived from plants.

Hormones that are chemically identical to hormones produced by ovaries during reproductive years include estrone, estradiol, estriol, progesterone, testosterone, dehydroepiandrosterone (DHEA) and cortisol.

The Menopause Society and American College of Obstetricians and Gynecologists have each released position statements against the use of compounded bioidentical hormones. It doesn’t endorse serum, saliva or urine hormone testing to determine dosing. 

There are FDA-approved, extremely effective, bioidentical hormones that are monitored and regulated for purity and safety. 

When To Consider Seeing a Reproductive Endocrinologist 

If your symptoms are severe or aren’t responding to treatment, it may be helpful to seek care from a reproductive endocrinologist. A reproductive endocrinologist is a physician with advanced training in hormonal and reproductive conditions. They can help with conditions, such as: 

• Premature ovarian insufficiency (POI) or early menopause 
• Complex menstrual histories 
• Hormonal disorders, including thyroid-related issues 
• Endocrine causes of bone loss or metabolic changes 
• Other disorders of glucose metabolism 

If you think you could benefit from a specialist, talk to your OB-GYN or primary care provider.