Healthcare

How To Approach Your Healthcare Provider About Hormone Therapy (HT)

According to a Yale University study, 60% of women with significant menopausal symptoms sought medical assistance, yet more than 75% of them were left untreated.

If you’re feeling frustrated trying to find relief from your menopausal symptoms, you’re certainly not alone. Despite the discomfort experienced throughout their menopausal journey, and the readily available safe and efficacious therapeutic options that could improve quality of life and possibly prevent a number of chronic illnesses, only a small fraction of people are offered treatment. According to a Yale University study¹ that examined insurance claims from over 500,000 people born female in various stages of menopause, 60% with significant menopausal symptoms sought medical assistance, yet more than 75% of them were left untreated.

You Deserve Better.

Following are my top tips to make the most of the time you have with your provider – who, hopefully, is committed to helping you – so that you can advocate for yourself, your health and your wellbeing.

How To Prepare For Your HT Appointment

Try to schedule the first appointment of the morning to ensure a fresh physician. Tell the staff you have issues you would like to discuss, so the scheduler knows to block off additional time.
Consider showing up to the appointment fasted (no food/drink other than water after midnight). This will avoid any delay in testing requiring a fasted state.
Write down your family history of diseases and illnesses, which relative had them, and at what age. This information could qualify you for certain medical tests you may not otherwise be qualified for. For example, if you have fatigue and a family history of hypothyroidism, your physician can utilize that diagnostic code and increase your chances of insurance covering the test. Your family history can also determine if you are a good candidate for certain hormone therapies.
Keep a symptom journal, noting any changes to your health since your last visit, including new aches and pains, increased fatigue, hair loss, weight gain or loss, constipation, forgetfulness, depression, etc.
Consider your preferences for managing your symptoms and long term health, e.g. hormone therapy (HT), an herbal approach, changes in your lifestyle. It’s your choice and you’ll want to ask your provider their opinion based on your medical history.

Arm Yourself With HT Information & Share It

A survey of U.S. obstetrics and gynecology residents found that only one in five received formal training in menopause medicine, and that seven in 10 would have liked to receive it. Sharing information from credible sources will show your provider that you have done your due diligence and will help the two of you work together to determine the most appropriate course of treatment.

After years of research, the renowned menopause organization, the North American Menopause Society (NAMS), gives us fresh hope with its updated position on hormone therapy. The consensus is that for healthy people born female younger than 60, and within 10 years of menopause onset, the benefits of hormone therapy outweigh the risks. The full report²is an extensive 28 pages, but I have summarized the highlights in this article that you can print and bring to your appointment.
Hormone therapy is not one size fits all and there are many options available. This is a helpful summary of FDA Approved Guidelines Options.
Those who are treated with hormone therapy along with a comprehensive nutrition and lifestyle approach have less cardiovascular risks and negative disease outcomes. This statement by the American Heart Association published in Circulation magazine³ is a great resource to give to your provider as well.

What You Should NOT Accept When Approaching Your Healthcare Provider About HT

Your healthcare provider should not tell you that this is just that time of your life and that this is your “new normal”. Yes, menopause is a natural stage, but please don’t feel that means you should have to put up with every symptom without help.
It is unacceptable for your healthcare provider to tell you that they don’t prescribe HRT. It’s up to you and what you want to try and for them to say whether it could be right for you, depending on your medical history. If they continue to refuse, check out our Recommended Physicians Database to find a new provider, or you can reference the Menopause Society Certified Practitioners database to find a provider in your area.
Do not allow your provider to impose unnecessary time restrictions e.g. they’ll only prescribe this once or for a year or two. This is an ongoing conversation and if your symptoms persist, you’ll still need help to manage them.

What to Say and How to Say It

When we are nervous or overwhelmed, it's easy to get tongue tied or wish you were a turtle that could retreat inside your shell, however, your health and wellbeing is too important and your feelings should not be dismissed! Following are some tips, tricks and phrases you can practice prior to your appointment that may help you feel more confident so you can advocate for yourself and the care you deserve.

Set the tone at the start of your appointment by communicating any previously disappointing experiences where you feel your concerns were not addressed. Consider saying something like "In the past, my concerns have been dismissed by other clinicians. I want to be sure that doesn't happen today".
Sometimes, even with the best of intentions on your part, your clinician may continue to dismiss your symptoms. It is absolutely your right to ask for clarification or an explanation. "Please help me to understand why (symptoms x, y, z) aren't notable. They are really disrupting (my life, sleep, relationships) and that feels really notable to me".
When or if labs indicate (and your clinician agrees as a result) that "nothing is wrong", don't gaslight yourself! Instead stand your ground with something along the lines of "I'm relieved that my lab work looks good, but I know my body best. Can we think more broadly about what might be causing my symptoms and how they might be addressed?".
If you just don't seem to be getting anywhere with your clinician and you're not satisfied, ask to be referred to a specialist, for additional testing to be conducted or suggest that you reschedule your appointment for when your clinician may have more time to devote to the conversation.

If after all of your efforts, you are unable to get the care you deserve, please don’t give up! Following are online providers that are in no way sponsored by me, The 'Pause Life or the Galveston Diet, but could be a resource to help you manage your symptoms.

	Evernow www.evernow.com	Alloy www.myalloy.com	Midi www.joinmidi.com
Membership Required	Yes	No	Yes
Insurance	Yes. Offers options to use insurance and HSA/FSA. Accepts most HSA/FSA payment options for membership, and members can receive prescriptions at their local pharmacy where insurance coverage can be applied.	No. Accepts HSA/FSA payment options.	Yes. Telemedicine visits and prescriptions covered by most major insurance plans. Clinicians work with patients to identify prescription solutions covered by their plan. HSA/FSA payment options available (for prescriptions, supplements and botanicals).
Cost	$35 per month with an annual plan, includes unlimited access to a personal menopause medical provider, outcomes-focused behavioral programs, educational content, symptoms tracker, and video visits (in most states). HSA/FSA payment options available. All 3 month and 12 month memberships now include complimentary Vaginal Estradiol (received at your door for no extra cost, if you medically qualify).	Varies by treatment prescribed.	Insurance coverage subject to deductible and copay. Patients fill prescriptions at the local pharmacy to receive insurance-covered medications. Self-pay varies from $250 for initial visit and $120 to $250 for subsequent visits.
RX Cost	Covered by insurance, or available at Evernow’s below market negotiated prices.	Varies by prescribed treatment, ranging from $24.99 – $74.99 per month.	Based on individual insurance coverage. Supplements and botanicals can be purchased using HSA/FSA funds.
Intake	1. Complete online health profile. 2. Virtual consultation to collect details to determine if a good candidate for HT. 3. Sign up and get connected with clinician who will review health profile and answers to create a detailed treatment plan. 4. RX delivered to patient’s home or available through local pharmacy of choice.	1. Complete online health profile. 2. Choose personalized treatment plan to be reviewed by a menopause medical provider. 3. If desired, register to discuss with a provider within 24 hours. 3. Once treatment plan is created, patient can purchase 3 months of RX for home delivery.	1. Create an account and review insurance eligibility. 2. Schedule a telephone visit with a clinician. 3. Complete an online health profile. 4. Meet with clinician via telemedicine for an in-depth discussion and receive a care plan based on symptoms, health history and goals. 5. Blood tests or imaging may be ordered depending on health history and/or symptomatology. 6. Care plan includes prescribed medications, personalized lifestyle coaching, supplements and botanicals (can be delivered to patient’s home).
Treatment Available	Estrogen patch, pill, cream, progesterone, estradiol, venlafaxine, paroxetine, SSRIs. Members can now consult directly with their Evernow medical provider to see if they qualify for hair loss treatments (such as oral minoxidil). Health profile incorporates guidelines from ACOG & NAMS.	Estradiol pill, patch, cream, paroxetine, Alloy Synbiotic, birth control pills, restorative skincare, O-mazing cream. Board-certified physicians prescribe only FDA-approved, generic medications for the treatment of menopausal symptoms.	Clinicians personalize treatment for each patient, recommending evidence-based solutions that may include bioidentical estrogen, progesterone, topical estrogen, non-hormonal prescriptions, supplements and botanicals. Custom prescription solutions available to improve skin, hair and sexual wellness.
Availability	Available in 35 states and continuing to expand! (check your state here).	Available in all states and Washington DC.	Available in all states and Washington DC.

You Are Your Best Healthcare Advocate!

There is nothing more important than understanding the options available to you in managing the symptoms you’re experiencing and I hope that this information helps you to feel more confident and more empowered! You are your best advocate for the healthcare you need and deserve to achieve your best health!