Perimenopause: When Your Doctor Just Doesn't Get It

Health & Wellness

Nov 26

[Estimated reading time: 4 minutes, 58 seconds.]

In the midst of everything else going on with women in mid-life, there’s this “little thing” called perimenopause. To say this is a time of great change and upheaval for women is the understatement of the century. It’s more like everything is going batshit crazy.

Illustration by Marta Monteiro.

Perimenopause symptoms can be wide-ranging and debilitating, and often go undiagnosed or dismissed by doctors. Let’s talk numbers:

By 45 yo, about 80% of women are experiencing symptoms. This increases to about 90% by 50 yo.
It is estimated around 20 to 30 million women in the US are currently in perimenopause. This represents approximately 10% to 15% of the female population in the US.
It typically begins around 40 yo and can last for several years, with the average being around 4 to 5 years. The range of symptoms can vary from as few as 6 months or as long as 10+ years.

Many women going through perimenopause feel they are not being taken seriously by their doctors. It feels very frustrating and isolating. Strength training helps with symptoms, but being able to advocate for yourself is key.

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The stats back this up. A 2021 study by the North American Menopause Society (NAMS) found 61% of women reported their doctors had dismissed or downplayed their menopause symptoms. The study also found 46% of women said they had not been given any information or treatment for their symptoms.

It gets worse for marginalized populations

Other studies have shown women of color and members of the LGBTQ+ community are even more likely to have their menopause symptoms dismissed by their doctors. Or people are just not being taken seriously. This leads to many not getting the care they need for their symptoms. This can leads to more problems, including:

Worsening of existing symptoms
Decreased quality of life
Increased risk of mental and chronic health problems

I’m going to get into some of the specifics of the why (or what little we know about the ‘why’) in the next week.

What if I told you……

Some statistics about menopause education in the US:

Only 31.3% of OB-GYN residency programs in the US have a dedicated menopause curriculum
On average, students in OB-GYN programs with dedicated menopause curriculums receive only 5 hours of formal instruction on menopause

This lack of standardized menopause education in medical school is a major concern for many healthcare providers. They argue the lack of adequate training is leading to underdiagnosis and undertreatment of menopause symptoms. Ya think?

When you throw in the lack of studies on women in general, add in age, sexual orientation, race and ethnicity, it doesn’t give much cause for optimism for getting help from the medical community. What happens is:

Misdiagnosis
Dismissive responses to symptoms such as “it’s in your head” and “you must be crazy”
Being told your symptoms are "just part of getting older" and you should "learn to live with it”, which feels frustrating and dismissive

Then you always have the “women are considered small men” mindset by the medical community. Not helpful.

Let’s talk about what YOU CAN DO

Here are a few tips on where you can take control:

Educate yourself about perimenopause: The more you know about the condition, the better equipped you will be to advocate for yourself with your doctor. My go to source is Dr. Jen Gunter, who writes the Vajenda and is a best-selling author on the topic.
Keep a symptom journal: This will help you to track your symptoms and identify patterns. This will be helpful in discussing symptoms with your doctor. Be as specific as possible when journaling - frequency, severity and impact on life all matter.
Initiate the conversation with your doctor: Don't hesitate to bring up menopause with your doctor, even if you're unsure whether you're experiencing symptoms. Early discussions allow for timely assessment and preventive measures.
Don't minimize your symptoms: Even if you think your symptoms are mild or manageable, share them with your doctor. Menopause symptoms can affect your overall health and well-being, and treatment can improve your quality of life.
Ask about treatment options: Once your doctor has diagnosed menopause, inquire about the treatment options available. Understand what studies have been properly peer-reviewed vs. which ones have been debunked.
Get a second opinion: If you feel like your doctor is not listening to you, don't hesitate afraid to obtain a second opinion from another doctor.

Strength training helps with reducing symptoms of perimenopause

Go Long has covered on numerous occasions the value of resistance training when going through perimenopause (start earlier!). It is especially true as it relates to loss of bone density and muscle mass, which lead to osteoporosis and sarcopenia.

Here are some other positives for how strength training can minimize symptoms:

Boosts energy levels: This is the #1 complaint I hear from clients. Resistance training can help to boost energy levels by increasing muscle mass and improving cardiovascular health. It also helps to improve circulation, which reduces inflammation and fatigue.
Improves self-image: Ah, the belly fat problem. It’s a thing. Resistance training can help improve self-image by building muscle mass and toning your body. The chances of you getting bulky from lifting at this stage of your life are slim to none.
Reduces hot flashes: Hot flashes are caused by a sudden drop in estrogen levels, which can trigger a surge in body temperature. Resistance training can help to reduce hot flashes by increasing levels of endorphins, which have mood-boosting and pain-relieving effects. It can also help to improve blood circulation, which can help to regulate body temperature.
Improves mood: When you engage in resistance training, it improves your mood by increasing levels of serotonin, which helps in regulating mood. It also helps to reduce stress and improve sleep quality, both of which contribute to an improved mood.
Improves sleep quality: Resistance training can help to improve sleep quality by promoting relaxation and reducing stress. It also helps to regulate your body's natural sleep-wake cycle.