How Do I Find The Right Doctor For Menopause?

How do I find the right doctor? ? That is one of the most frequently asked questions after the programs. It's a good question, but one for which we each have to do our own soul-searching before we begin our quest. Often we bring to the doctor's office a list of unrealistic expectations. We want our physicians to fix whatever is wrong, we want them to fix it fast, and some of us feel that unless we leave with a prescription in hand, nothing was done to help us.

Now that we know the expectations, let's examine the realities.

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First of all, we need to put more time into finding the physician who is right for us and in working with him or her to achieve a sense of trust and easy communication. Getting to that point, however, is not a matter of luck. It involves work on our part.

When I examined the thousands of questionnaires turned in at the programs, I learned that most of the women who attended were the patients of gynecologists (78. 2 percent). First runner-up were general family practitioners (14. 6 percent), followed by specialists in internal medicine (5. 6 percent). The other few percent fell into a category labeled other. ? No questionnaire response indicated that any woman did not have a physician, unless, perhaps, that information was thrown into the other category.

According to the questionnaires, a few women expected menopause to be a nightmare (2. 4 percent), while others felt it to be unpleasant (15. 2 percent), or to be sometimes good and sometimes bad (20. 4 percent). Most women (two thirds), however, indicated that they didn't know what to expect.

The questionnaires indicated other vast gaps in the women's knowledge about menopause an interesting finding, given the large percentage of women under the care of a gynecologist, who (one might think) would be the logical provider of information. For example, responding to the question What was most unexpected concerning the symptoms of menopause,  31. 8 percent of the women were surprised by the severity of their symptoms; 35. 1 percent were not expecting the symptoms to occur so frequently; 21. 3 percent were delighted by the mildness of their symptoms; and 15. 5 percent did not expect that they would experience any symptoms at all.

From the questionnaires, I found that women had learned about menopause from friends, physicians, and blogs in about equal percentages and secondarily from magazines, other media, and family. I also wondered whether other women, like me, had subconsciously chosen to ignore what they knew.

Large numbers of women indicate that they attend the educational programs because they still are not sure how to deal with their symptoms and whether to take ERT or HRT. That's not surprising, as there is some confusion on the part of physicians as well, inasmuch as research concerning hormone therapy and women is still in its infancy when compared with research done on other major physiological changes and medical conditions (such as heart disease), which has focused primarily on men. Some say that this is because scientific research has been held in the hands of men throughout history. Perhaps that's one of the reasons. Whatever the case, research into women's menopausal changes began haltingly only about thirty years ago. Now, fortunately for us and even more fortunately for our daughters there is a research race to catch us up.

That lack of concrete research results is part of the problem in finding the right physician to care for us at this important rite of passage. If the pathway to appropriate care is not clearly marked, how can we know if the right route has been chosen? The other part of the problem is that we as women still must embrace the challenge of taking control of our own care. Many women indeed are taking steps to learn more about menopause and those who will probably have the most useful in- formation are the women who are learning what to expect of this interesting rite of passage while they are still many years premenopausal. They are the first generation of women to approach menopause with the information they need to help them fashion for themselves a first-rate second half of life.

In order to achieve that end, you need to work in concert with your own physician. At the end of this chapter there are twelve tips for you to consider each time you go to the doctor. I hope that they help you maximize the quality of your visits. But before we consider the office visit, let's talk about the patient/physician partnership.

I received a telephone call recently from a woman in a small town in western Illinois. I read your story in Managing Your Menopause and I had to call and tell you that you have saved my life! ? she told me.

The woman, whom I'll call Laura, was fifty-four years old, a successful artist, and a twin. She was having such constant and debilitating hot flashes and night sweats that she believed that every facet of her life and artistic career were in jeopardy. She had an important exhibit coming up and could not prepare for it.

Laura said that after she read of my eight weeks of menopausal hell, learned that I had gotten help and had gone on to write and lecture about it, she felt reassured. She knew that for her, too, this bad time would pass.

Laura felt that she was having a difficult time obtaining interested medical care. She explained that she blogs in about equal percentages and secondarily from magazines, other media, and family. I also wondered whether other women, like me, had subconsciously chosen to ignore what they knew.

Large numbers of women indicate that they attend the educational programs because they still are not sure how to deal with their symptoms and whether to take ERT or HRT. That's not surprising, as there is some confusion on the part of physicians as well, inasmuch as research concerning hormone therapy and women is still in its infancy when compared with research done on other major physiological changes and medical conditions (such as heart disease), which has focused primarily on men. Some say that this is because scientific research has been held in the hands of men throughout history. Perhaps that's one of the reasons. Whatever the case, research into women's menopausal changes began haltingly only about thirty years ago. Now, fortunately for us and even more fortunately for our daughters there is a research race to catch us up.

That lack of concrete research results is part of the problem in finding the right physician to care for us at this important rite of passage. If the pathway to appropriate care is not clearly marked, how can we know if the right route has been chosen? The other part of the problem is that we as women still must embrace the challenge of taking control of our own care. Many women indeed are taking steps to learn more about menopause and those who will probably have the most useful information are the women who are learning what to expect of this interesting rite of passage while they are still many years premenopausal. They are the first generation of women to approach menopause with the information they need to help them fashion for themselves a first-rate second half of life.

In order to achieve that end, you need to work in concert with your own physician. At the end of this chapter there are twelve tips for you to consider each time you go to the doctor. I hope that they help you maximize the quality of your visits. But before we consider the office visit, let's talk about the patient/physician partnership.

I received a telephone call recently from a woman in a small town in western Illinois. I read your story in Managing Your Menopause and I had to call and tell you that you have saved my life! ? she told me.

The woman, whom I'll call Laura, was fifty-four years old, a successful artist, and a twin. She was having such constant and debilitating hot flashes and night sweats that she believed that every facet of her life and artistic career were in jeopardy. She had an important exhibit coming up and could not prepare for it.

Laura said that after she read of my eight weeks of menopausal hell, learned that I had gotten help and had gone on to write and lecture about it, she felt reassured. She knew that for her, too, this bad time would pass.

Laura felt that she was having a difficult time obtaining interested medical care. She explained that she had a large estrogen-fed uterine fibroid tumor that she and her physician had agreed to wait for menopause to shrink, because she refused to undergo a hysterectomy to have it removed. In the face of her refusal, the physician's logical thinking was this: The fibroid was nourished by Laura's natural estrogen. Once the ovary ceased its production of estrogen, the fibroid would shrink. That was true, but Laura discovered that she couldn't bear the estrogen-deficiency symptoms.

When she took her symptoms to the doctor, he said if Laura couldn't live with the hot flashes, they could try hormone replacement therapy. But the fibroid will grow,  she protested. Then we'll do a hysterectomy and get rid of all your problems,  he said. Laura felt as if she were back at square one. She still did not want to undergo surgery. She felt out of control.

I asked Laura about her mother's menopause. She said that when she went to her mother for advice and information, her mother, who is in her eighties, told her we just don't talk about that. ? When Laura explained to her mother that she felt at the end of her rope and out of control, her mother said patiently, It's because you're too involved in your work and your civic and social activities. You should rest more. You're simply doing too much! ? I recognized her mother's comment as fairly typical of that generation, and I laughed inwardly. My own mother couldn't have said it better!

Interestingly, Laura told me that her identical twin sister was having no problem with menopause. We talked about that. Laura is thin, a healthy eater, and a regular exerciser. Lana, her twin, began to gain weight about ten years before menopause, and Laura thinks that Lana must now be at least forty pounds heavier than she is. Laura had read about estrogen being converted and stored in fat cells and had begun to wonder whether that was the cause of the difference in their menopausal experience. Laura also learned from her reading that in selected individual cases, carefully monitored hormone replacement therapy can be given for a short time even when a fibroid is present. That was another piece of information that she felt saved her life. ? So Laura is making an appointment with a well-known menopause specialist in the large metropolitan area where her next exhibit will be held, and she's going to see him knowing exactly what she wants to ask him about. That's 90 percent of solving the medical puzzle: knowing what you want to know before you go.

Laura promised to let me know what happens. In the meantime, I know she is again taking control of her life. That's what is important. That's why you have to find the right doctor for you.

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