You book the appointment. You wait three months. You finally sit on the crinkly paper, wearing the paper gown. You tell your doctor: “I’m exhausted, I can’t sleep, my joints hurt, and I’m raging at my husband.” The doctor looks at you and says: “That’s just aging. Try to exercise more. Here is a prescription for an antidepressant.”
You leave the office in tears, holding a script for Zoloft you didn’t want. This scenario plays out thousands of times a day. The reality is that most General Practitioners (and even many OBGYNs) receive less than 10 hours of menopause education in medical school. They are operating on outdated data from 2002.
If you want help, you have to stop acting like a passive patient and start acting like a CEO hiring a consultant. You need a strategy.
Step 1: Speak Their Language (Data, Not Emotion)
Doctors are trained to look for pathology. If you cry and say “I’m sad,” they hear “Depression.” You need to translate your suffering into medical metrics.
- Don’t say: “I feel crazy.”
- Say: “I am experiencing Vasomotor Symptoms (hot flashes) that are disrupting my sleep 5 times a night. This sleep deprivation is affecting my cognitive performance at work.”
- The difference: You have presented a physiological symptom (Vasomotor) with a functional impact (Cognitive/Work). This triggers a different algorithm in their brain.
Step 2: Bring the evidence
Do not go in empty-handed. Download the “MenoPro” App (created by the North American Menopause Society). It has a diagnostic tool. Or, simply track your cycle and symptoms for 3 months. Hand them a sheet that says:
- Last Period: Nov 12
- Hot Flashes: Average 6 per day
- Migraines: 3 per month (cyclical)
It is hard to dismiss hard data.
Step 3: The “HRT” Conversation
If you want hormones, ask for them specifically. Do not wait for them to offer.
- The Script: “I have read the NAMS 2022 guidelines. I understand that for a healthy woman under 60, the benefits of transdermal HRT outweigh the risks. I would like to discuss starting an Estradiol patch and micronized progesterone.”
- Why this works: You signaled that you know the guidelines (“Under 60,” “Transdermal”). You signaled you know the drug names. You have done the homework.
Step 4: Handling the “No”
If the doctor says, “We don’t prescribe hormones, they cause cancer,” do not argue. You cannot educate a doctor in a 15-minute visit. Ask this question: “Is there a medical reason specific to MY history (like breast cancer) that makes HRT unsafe? Or is this your general policy?” If it is their general policy, say: “I understand. Could you please document in my chart that I requested treatment for perimenopausal symptoms and was denied?” Then, find a new mechanic.
Step 5: Find a Specialist
Stop going to the doctor who delivered your baby. Obstetrics is not Menopause care. Go to the North American Menopause Society (menopause.org) website and use their “Find a Practitioner” tool. These are doctors who have taken the extra exams to be certified in midlife health. They will not tell you it’s “just aging.” They will tell you it’s a treatable endocrine deficiency.