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

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

1. 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.  
2. 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. 
3. 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.
4. 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. 
5. 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.

1. After years of research, the renowned menopause organization, The Menopause Society (TMS), 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 report² is an extensive 28 pages, but I have summarized the highlights in this article that you can print and bring to your appointment.
2. Hormone therapy is not one size fits all and there are many options available.  This is a helpful summary of FDA Approved Guidelines Options.
3. 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

1. 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.
2. 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.
3. 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.

I know that finding a healthcare provider to work with can be challenging. Luckily, now, more than ever, there are telemedicine options, like Midi Health, that offer insurance-covered telehealth care for perimenopause and menopause with expert clinicians. It's a great option if you cannot find adequate in-person care.

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!  Download my Menopause Empowerment Guide for additional information and resources.

You are your best advocate for the healthcare you need and deserve to achieve your best health!

Sources:

1. https://medicine.yale.edu/news-article/the-high-cost-of-hot-flashes-in-menopause/
2. https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

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