Do you need a menopause specialist?

I gave birth vaginally to two bruisers—a 9.9½-lb. boy and a 9.5-lb girl—so it’s no wonder my pelvic floor took a beating. Did I leak a little urine when I had a bad cough? You bet! But that was pretty much the worst of it, until about 15 years ago when, closing in on 50, it seemed I could barely walk around the block without wetting my pants. Just when I thought I was getting rid of feminine hygiene products for good, I had to switch out tampons for panty liners.

When I told my gyno about it, she kinda gave me a deadpan stare and implied it was par for the course. In other words, “Live with it, lady!” 

Unfortunately, my midlife experience is not unusual. Certified menopause specialist Kathleen Jordan, MD, Chief Medical Officer of Midi Health, a virtual clinic that provides customized care for women in perimenopause and menopause, says, “seventy-five percent of menopausal women actively ask their gyno or PCPs for help, and they’re too often met with a shrug.” An internist by training, Jordan herself admits that “when I was first out of my medicine residency, I probably shrugged at someone, too. As I wasn’t sure how to help and hadn’t yet been trained.”  

The fact is while we may think of gynos as “vagina doctors,” they don’t get much education in treating a vagina once its use as a birth canal has, er, dried up. 

“Most ob/gyn programs have no training in menopause—if they have it, it’s one hour to one week,” says Jordan. 

Consider: A 2017 survey of 20 U.S. residency programs in family medicine, internal medicine and ob/gyn showed that only 6.8% of residents felt they were sufficiently prepared to manage menopause. So it’s no wonder women in the throes of menopause have been told everything from “get more naps” and “find a hobby” to “there’s nothing we can do.”

Fortunately, there is something you can do: Seek out a menopause specialist, a provider who helps women navigate the transition from perimenopause to menopause and beyond.  Although there is no formal menopause residency training program, the Menopause Society has created a self directed program and certification process that affirms certified providers have a standard knowledge base equipping  them to treat everything from hot flashes and night sweats to anxiety and hair loss. 

Indeed, if it seems as if just about every part of your body is under siege during menopause, it’s not your imagination. “Estrogen levels plummet from as much as  500 pg/m to under 10.  It’s a big change,” Jordan said. “You have estrogen receptors in your skin, in your hair, in your liver, and really all over. This estrogen depletion makes your insulin sensitivity get worse, your blood sugars go up, your skin gets dry, and you start to gain weight in the belly.”

The good news, stresses Jordan, is we don’t need to accept those and other hormone-related problems: “We have a lot of tools.”

And a menopause specialist knows how to wield those tools wisely, weighing your concerns and treating you holistically. In fact, one of the most common comments Jordan hears is: “I finally feel heard…. Thank you so much!” During a visit with a menopause specialist, you will likely discuss the symptoms that are bothering you—and not just physically. If thinning hair is sapping your confidence, if vaginal dryness is throwing a wrench in your relationship, if brain fog is making work challenging—a menopause specialist can help you address those issues, too. Together, you’ll work on a personalized treatment plan that feels right.

And about that leaking? Just last March, I sought out a urologist who took care of it with a simple sling procedure. Too bad I hadn’t met with a menopause specialist all those years ago. Think how much I could have saved on panty liners.

To find a menopause specialist, check out Menopause Society’s Find a Menopause Practitioner search tool. Because there are currently only about 1,000 menopause specialists nationwide, you may also want to consider a virtual provider, such as Midi Health.