The (peri-)menopausal transition can be life-altering for women and their families. Yet with the “HMO-ing” of medical care, clinicians —most poorly educated in the art of menopausal medicine— have only 10-15 minutes to spend with patients, often “cookbooking” their therapy to coincide with the insurance company’s “cheapest meds” formulary. As a result, women’s individual needs are often left in the dust.
Additionally, many practitioners are in the “Middle Ages” when it comes to the propriety of hormonal therapy (“HT”). They remember only the headlines from the Women’s Health Initiative 12 years ago damning HT and are unaware of all the subsequent data proving the true benefits of HT. (It turns out the WHI’s findings, as originally presented, had it all wrong.)
Unfortunately, another group of cookbookers has risen to fill the gap between what women need from their practitioners and what they are actually receiving. And these new “experts” are not a welcome addition to women’s options.
Enter what’s known as bioidentical hormone replacement therapy (BHRT).
These “franchisees” and poseurs —individuals of dubious training and skill— have seized this gap as merely an opportunity to make money. And although they come at the situation from a different angle than traditional practitioners, they offer little more integration or individualization than the “company docs” —yet they make much more money at it.
While individual practitioners and their practices certainly differ, and many are well-trained, most so-called “BHRT practitioners” are little more than general docs or midlevel non-MD practitioners looking to make a quick buck. Many are franchisees, following their company’s cookbook policies and frequently using the company’s products or labs, for which they receive a kickback. (See Body Logic and other such franchises.)
So, to cut to the chase, how can you tell who to stay away from, and who to see?
Who NOT to See
Stay away from anyone who:
- Seems to have an agenda
- Is “part of a network”
- Promises to “test you monthly to get you balanced” (especially if this is saliva testing!)
- Is not an MD, DO, or NP specializing in menopausal medicine
The use of “bioidentical hormones” or BHRT does make sense, but understand that many unscrupulous practitioners advertise themselves as “BHRT specialists.” This is an advertising gimmick; there is no such legitimate thing as a “BHRT specialist” or “BHRT practitioner.” Also stay away from anyone who equates BHRT with compounding.
Don’t get me wrong; there are many legitimate uses for compounded hormonal products, and real compounders are intelligent pharmacists, but BHRT does not specifically refer to compounding. You can get both FDA-approved and compounded hormonal products. Stay away from anyone who steers you to a specific compounding pharmacy; that person probably gets a kickback. Choose a pharmacy in your area, or a legitimate mail-order pharmacy such as WIP. And definitely stay away from anyone who does frequent hormone testing to “get you balanced.”
One does not “balance” their patient based on lab tests —especially not salivary, which has a built-in error factor approaching 25%. Not only do women’s hormonal levels differ day by day (whatever you are today, you were quite different a few days ago, and may be very different in a couple of weeks), but there are no established “ideal ranges.” Every woman has her own “normal.” An experienced clinician relies on her or his expertise, not a cookbook or on predetermined “levels.” (Remember: If all you have is a hammer, everything looks like a nail…)
Who TO See
An experienced practitioner who:
- Does not have their office filled with pregnant women
- Practices Gynecology only (rather than an “OB/GYN”)
- Treats you as a whole person, not just “between the knees and the navel”
- Takes their time with you
- Is experienced in many avenues of therapy
- Knows about herbs and botanicals in addition to hormones
- Is savvy in “integration” and takes the time to discuss lifestyle changes, stress reduction, your family and your life
How Do You Identify This Ideal Practitioner?
For starters, go to the website of the North American Menopause Society, the premier organization for all practitioners savvy about and interested in menopausal medicine. If the practitioner you’re considering is not listed as a member, stay away.
Even better, your ideal practitioner should be listed on the site as a “Certified Menopause Practitioner.” This assures you that this provider has taken the time to study for and pass a rigorous exam assuring you that they really know what they’re doing.
Once you see this person, use your gut to tell you if they are on your “wavelength.” Are they flexible? Do they understand your needs? Are they ready to be your guide rather than your “boss”? Never underestimate the power of your intuition! Call their office and see if you are put through a phone tree or are able to speak with a responsive, real person. You should expect a callback within 24 hours.
(Peri-)menopausal women are often vulnerable. Because they feel so poorly, they can fall prey to unscrupulous and poorly-trained/minimally experienced practitioners.
Beware of anyone who charges you a monthly or annual fee. Beware of anyone who makes a grand list of all of these supplements you should take (which, of course, you must purchase from their office at great cost). Shop around. Be an informed consumer. Look at Google Reviews, Yelp, Vitals.com, and HealthGrades.com. Look at the provider’s website—it should be educational rather than strictly trying to sell you something.
You have many alternatives. Beware of marketers and scammers. Take your time and find the practitioner that works for YOU. They are out there!