Hot flashes. Vaginal dryness. Moodiness. Brain fog. Night sweats. Now that you’ve consulted Dr. Google, you’re ready to get real answers to your questions about these common menopause symptoms. But let’s face it: Having a one-way consultation with an online health site is a whole lot easier than talking about unpleasant, often embarrassing, symptoms with an actual health care provider.
Menopause, which occurs when a woman has had 12 straight months without a period, is looked upon as a taboo subject, says Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine. “We live in a puritanical society and menopause involves things that have to do with female sexuality,” she explains. “Another issue is we tend to go through menopause as we get older, so it’s a sign you’re getting older, and we’re a society that worships youth. It’s a loaded discussion.”
Making matters worse, research suggests doctors don’t always have a full understanding of menopause and the hormonal upheaval that happens to women when they quit having their period, which usually happens at age 51, on average. According to a seminal study published in the journal Menopause, only 20 percent of medical residents in the U.S. who responded to a survey said their program in obstetrics and gynecology (ob/gyn) included a formal menopause curriculum.
But that doesn’t mean you should be left to navigate the menopause experience—or, for that matter, the perimenopausal years that precede it—on your own. Here are five ways to make sure you get the information you need from your healthcare provider.
1. Pick the right doctor.
You may have a long, healthy relationship with your ob/gyn and an even longer one with your primary care doctor. But if neither is up to speed on all things menopause—meaning not just the best treatments, but also the other conditions that can kick in when you go through menopause—then ask for a referral to a specialist.
“Start with your primary care doctor and say, ‘I understand that going through menopause puts me at greater risk for cardiovascular disease and osteoporosis. Can you tell me how to protect myself?’” suggests Dr. Minkin. “If you get a good solid answer, fabulous. If not, ask if there’s a menopause specialist they could recommend.” You can also go to the North American Menopause Society (NAMS) website, and plug in your ZIP code to find a local licensed healthcare provider who’s also a NAMS certified menopause practitioner.
2. Arrive for your doctor’s appointment prepared.
The average doctor’s visit lasts 18 minutes, according to a recent study published in Medical Care. To make the most of a one-on-one with your doctor, bring a list of medications (including both Rx and over-the-counter), notes on your symptoms, and an understanding of your medical history and your family’s. Especially important to know: How old the women in your family were when they went through menopause. “Let’s say you’re 41, but you’re having hot flashes and irregular periods”—classic signs of menopause, says Dr. Minkin. “But your mom, sisters, and aunts went through menopause at 55. Your doctor may want to look for other causes. It may not be menopause that’s giving you funky periods.”
Family history is very relevant, particularly bone health and cardiovascular history, adds Dr. Minkin. That’s because your risk for things like osteoporosis and heart attack goes up after menopause. “Did your mom fracture her hip at age 60? Did she have a heart attack at 60? That’s helpful for your doctor to know,” says Dr. Minkin.
3. Bring a list of questions.
It’s easy to forget everything on your to-discuss list once you’re in the exam room, so be sure to write them down in advance, and in order of importance. “Write down everything you’re experiencing, whether you think it’s related to menopause or not,” says Barbara Dehn, RN, NP, a nurse practitioner with El Camino Women’s Medical Group in Mountainview, California. “So often we think menopause is hot flashes and only hot flashes, but it can also be sleep disturbances, weight gain, vaginal dryness. We might be like, ‘I’m having trouble sleeping, but that can’t possibly be menopause,’ but it definitely can be. ”
4. Be open and honest with your doctor.
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Whatever you have to say about your health habits, know this: Doctors have heard it before. No matter what “it” is. Say, for instance, you’re a smoker. Here’s why you shouldn’t keep it a secret from your care provider: Although fertility falls during perimenopause, you still need to use birth control because you aren’t fully protected from an unplanned pregnancy until you’ve reached menopause. For women who don’t smoke, a doctor might recommend low-dose birth control pills, which can also help reduce hot flashes, maintain bone health, and improve the acne that can flare up around menopause. “But if I have someone who is 45 and in otherwise good health, but she smokes, she can’t take a low-dose birth control pill,” says Dr. Minkin. The combination raises your risk for stroke and heart attack.
For smokers or any women who would prefer a hormone-free option, your MD might recommend a hormone-free, nonprescription option that can help with symptoms. “For example, one thing that’s been shown to work is soy,” whether it’s found in supplements or in foods such as tofu, edamame, and soy milk, says Dehn, citing a recent study published in the journal Menopause. The research found that a plant-based diet rich in soy reduces moderate to severe hot flashes by 84 percent, from nearly five per day to fewer than one per day.
5. Ask how you can relieve symptoms.
During perimenopause and menopause, the ovaries make less and less estrogen, leading to a variety of symptoms and changes in your body, including hot flashes, mood swings, and sleep disturbances. You may also experience vaginal changes, including dryness, irritation, soreness, and itching.
“Vaginal irritation has to be addressed for a whole bunch of reasons,” says Dr. Minkin. “Since bothersome vaginal symptoms often goes along with bladder issues, menopausal women are at an increased risk of urinary tract infections (UTI). One of the most common causes of death among older women is urosepsis,” or sepsis caused by a UTI. Ask your doctor about vaginal estrogen tablets, creams, or capsules, as well as hormone-free options, including supplements.
One thing to note: Since no two women experience menopause exactly alike, be specific with your healthcare provider about the symptoms you’re looking to target. And be sure to ask about the science behind any therapy, whether it’s available by prescription or over-the-counter. “Ask your provider: ‘What’s the data? Does the data support the claim?’ ” suggests Dehn. “Go for something that has actual evidence and not magical thinking.”
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