A Guide to Finding a Menopause Clinician That’s Not Clueless

An “MD” after the name is no assurance that the person to whom you are about to bare your soul—and your vagina—is an expert when it comes to menopause.

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This is the transcript of my podcast episode, Finding a Menopause Clinician Who is Not Clueless. If you prefer to listen- here’s the link.

And be sure to check out “Is Your Doctor a Menopause Expert? for a list of specific questions to ask (and potential answers you might get ) that indicate if the person you are seeing is an expert.

WHO DO YOU TRUST?

A recurrent theme in many of my podcasts over the last few months has been who to believe when a popular social media menopause influencer gives the opposite advice from a personal physician. A few weeks ago, my friend, Dr. Rachel Rubin, posted a thoughtful Instagram reel along those lines and stated that women who are confused, or getting conflicting information need to “Educate themselves to decide what’s right for you, do your own research.” Well-meaning, but, unrealistic and unfair. Should a woman who is trying to get pregnant trust the fertility specialist she was referred to? Or as a savvy patient, is she expected to devour the medical literature to decide which protocol would give her the best chance of conceiving?

It has taken me four years of med school, four years of residency, and over three decades of clinical practice and research to become the menopausal expert I am. And I’m still learning. And when I am reading research in a scientific journal, I evaluate and understand that research in the context of what I already know. To expect a woman, no matter how educated, no matter how bright, to decide if hormone therapy is right for her, and if so, which of over thirty protocols would be best, is just not reasonable.

I am not saying that women should blindly trust whatever a physician tells her, but from my point of view, if she is going to figure out the best course, doing “research” is not going to necessarily point her in the right direction. Far more valuable is to find someone who truly has expertise in menopause to guide decisions and help wade through all of the information and misinformation out there.

I am going to walk you through the steps to find someone you can trust to fix your flashes, foggy brain, and failing sex life.

Why Most Doctors Know Nothing About Menopause

One would think that having an “MD” is an indication that this person knows enough about menopause to tell you what to do about your sandpaper sex and personal hot flash hell. But, that’s not the case.

This is why I hear every day from women who went to their doctor with their dry giney woes and were told, “Buy a lube” Hot flashes? “Dress in layers. Tough it out.” End of story.

The obvious question is, why most gynecologists, even good gynecologists from great medical schools and great training programs, are not experts when it comes to menopause? It’s simple. 70% of programs do not include menopause in their curriculum. If it is included, it may be one lecture or one article.

I ran one of the few academic menopause centers in the country staffed by knowledgeable, experienced experts. Yet, the doctors in that OBGYN residency program spent no time in our clinic. It’s not they didn’t want to- many express an interest. But their required time in labor and delivery, surgery, oncology, fertility, and high-risk obstetrics left no time for learning about menopause.

Once someone finishes their training and starts to practice, most patients in general ob-gyn practice are pregnant, wanting to get pregnant, or wanting to NOT get pregnant. For the typical ob-gyn, the first time they see any volume of patients going through menopause is 20 years into their practice, when the moms they delivered are now trading in their birth control pills for hormone therapy pills.

That doesn’t mean your gynecologist isn’t a menopause expert so before you cross the person who delivered your babies off the list, it is worth having a conversation to see if that person has interest and expertise.

What if Your Doctor Doesn’t Have a Vagina?

Every so often I hear, “I’ve had the same ob-gyn for 20 years, and I love him, but he’s a man, so of course there was no way I could talk to him about this! I want a woman doctor who will understand.”

As a physician, I can tell you that I don’t need to personally experience vaginal atrophy to help my patient with vaginal atrophy, any more than I need to experience a urinary tract infection to know how to treat it. The gender of your clinician doesn’t matter. Some of the best menopause experts in this country are men that you have heard on my podcasts. If you aren’t comfortable being examined by a man or talking to a man about intimate issues you will be better off with a woman doctor.

Don’t assume a woman doctor is an expert, just because she is a woman.

When choosing your gynecologist, you are looking for someone who has the skills you need and whose judgment you trust. Sometimes that person is a woman, and sometimes it’s a man. In any case, regardless of gender, if your gynecologist is clearly clueless when it comes to perimenopause, hot flashes, and hormone therapy, it’s time to branch out.

Starting the Search

But where to start? It’s confusing. A menopause expert might be a gynecologist, an internist, a urologist or a family practice doctor. It’s also possible that the best person to help you may not be a doctor, but rather a non-physician clinician such as an advanced practice nurse, or a physician’s assistant. An advanced practice clinician often has more menopause training and is likely to spend more time with you than most physicians. I know this firsthand because I utilized advanced practice nurses and physician assistants in the Northwestern Medicine Center for Sexual Medicine and Menopause.

Midi Health, where I am the medical director of community education and outreach, has an amazing staff of advanced practice nurses who have far more menopause training and expertise than 90% of physicians.

Do the Letters After a Name Indicate Expertise?

Not necessarily. The person with the most degrees, or the most letters after their name, is not necessarily the most knowledgeable. Sometimes, those titles and letters don’t mean a whole lot or can be misleading.

Doctor” in front of a name might be a physician, but might also be a dentist, podiatrist, psychologist, or English professor. If you are looking for a physician, look for an “MD” or a “DO.”

MD stands for “Medical Doctor.” Anyone who has graduated from medical school is allowed to put “MD” after their name. DO stands for “Doctor of Osteopathy.” An osteopath’s training is essentially identical to an MD’s and should be considered equivalent.

BOARD CERTIFICATION is the gold standard that assures you that a physician is an expert in a specialty or subspecialty. Licensure is not the same thing as board certification and does not guarantee expertise in a specific field. Having a medical license just tells you that someone graduated from medical school and hasn’t committed any felonies. Although committing multiple felonies is apparently no longer a disqualification for important trustworthy positions. But I digress.

The American Board of Medical Specialties, ABMS, is the medical organization that oversees physician certification by developing standards for the evaluation and certification of physician specialists. To be board-certified, a doctor must complete a post-medical school residency in his or her specialty that has been recognized by The American Board of Medical Specialties, followed by written and oral examinations.

If a doctor wants to subspecialize, he or she must then complete fellowship training after finishing residency. For example, a board-certified gynecologic oncologist went to four years of medical school, then completed a four-year residency in obstetrics-gynecology, followed by a three-four year fellowship in the subspecialty of gynecologic oncology.

Menopause is Not a Subspecialty like Fertility or Gynecologic Oncology.

There are no fellowships in menopause and there is no such thing as being board-certified in menopause. Strictly speaking, reproductive endocrinology and infertility, commonly known as fertility specialists, get menopause as part of their fellowship training, but with rare exceptions, the only menopause patients most fertility specialists see are women who want to get pregnant post-menopause, not women who want to get rid of their hot flashes.

All specialists and subspecialists must maintain board certification by taking medical courses and passing tests to prove that he or she kept up to date. A board-certified gynecologist with the letters FACOG after his or her name is a Fellow in the American College of Obstetricians and Gynecologists. I am board certified, but I rarely put FACOG after my name since no one what it means. I have to read a set number of medical literature articles and answer questions about them, along with taking a recertification exam every few years to maintain my certification.

The only way to verify that a doctor is board-certified is to go to the American Board of Medical Specialties, ABMS, website. Just search, “Is my doctor board certified” and The American Board of Medical Specialties site comes right up.

“Anti-aging” is NOT a Specialty Recognized by The American Board of Medical Specialties.

Certification in Anti-Aging does not require a residency. There are no residencies in anti-aging. All that is required for certification from the American Board of Anti-Aging and Regenerative Medicine is to complete an online self-learning course and pass a written test and a 1-hour oral exam where they are presented with one, yes one, case to discuss.

When I see doctors who advertise that they are double-boarded, or triple-boarded, it sounds impressive, but often, that person did one residency and then did some additional online course work that awarded a board certification…a board certification like Anti-Aging that is not recognized by The American Board of Medical Specialties or any academic institution.

What’s also bizarre, and scary is that in the compounded hormone world, many doctors who are legitimately boarded did their training in specialties that have NOTHING to do with gynecology, women, or vaginas. This is particularly rampant in doctors who prescribe pellets and compounded hormone therapy and are board-certified not in gynecology or endocrinology but, inexplicably, in emergency medicine. I have spent enough time in ERs to tell you that even women with the worst cases of hot flashes and vaginal dryness do not go to the Emergency Department, so it is a mystery to me how these doctors are such experts.

Before you decide to trust a doctor, who claims to be an expert in hormone therapy and brags on their website about multiple board certifications, it is worth a minute of your time to go to the ABMS.org page and see exactly what that person is boarded in.

Once You Determine that Someone is Licensed, and Boarded, What’s Next?

It’s generally a good sign if a physician has an academic appointment at a medical school. Faculty ranks such as instructor, assistant professor, associate professor, and professor depend on physicians’ level of involvement in teaching medical students, their research, and the number and stature of their publications. I am a full professor, and it took me years to get there. University affiliation means it is more likely that that person does research and teaches other doctors.

If a doctor has no university affiliation, does this mean he or she isn’t an expert? No. Many physicians who have no university affiliation are excellent doctors who keep up with advancements in their fields and give very good menopause care.

I’ve already established that there are no formal training programs in menopause. So, how does someone become a menopause expert?

My story is pretty typical. I graduated from my residency program (where to my recollection we had no lectures on menopause) and joined a general practice where I delivered over a thousand babies, and routinely treated menstrual cramps, irregular periods, sexually transmitted infections, and vaginitis. I also did a lot of surgery. In fact, after about 15 years of doing general OB-GYN, I stopped delivering babies and limited my practice to gynecology with an interest in minimally invasive surgery, hysterectomy, and alternatives to hysterectomy. That’s when I wrote my first book, The Essential Guide to Hysterectomy, which is a guide for women who had been advised to have surgery.

During that time, I was one of the busiest gynecologic surgeons in Chicago. Because I was doing so many hysterectomies and ovary removals, I saw a lot of menopausal women. So, while I knew more than most gynecologists about hormone therapy, and thought I knew a lot about menopause, in retrospect, I wasn’t really a menopause expert.

It was only when I started writing Sex Rx: Hormones, Health and Your Best Sex Ever, that I realized I had a lot to learn. So, I did. I went to a ton of conferences, I exhaustively read journal articles, and I became active in the North American Menopause Society, now known as The Menopause Society, where I hung out with other menopause experts. Soon I was one of the go-to experts who was asked to lecture at medical conferences, review articles in scientific journals, and participate in research. By the time I was asked to start the Menopause Center at Northwestern Medicine in Chicago, I was ready to give up my general practice and devote all my time to menopause.

You don’t need to find someone who only does menopause to find someone who knows a lot about menopause, but you are likely going to have to do some legwork to find a clinician who is a real expert when it comes to hot flashes, hormones, and other consequences of low or no estrogen.

The Menopause Society

The Menopause Society, a nonprofit scientific organization that promotes menopause education for clinicians, is a good place to start your search. If someone is a Menopause Society Certified Practitioner of The Menopause Society it means they passed a written exam about menopause, hormone therapy, and mid-life health. To keep up and maintain that certification, a clinician needs to take a certain number of continuing medical education courses every single year. Advanced practice nurses and physician’s assistants are also eligible to take the test and be designated as a TMS Certified Practitioner.

I wish I could say that all TMS Certified Practitioners are trusted experts. There are plenty of clinicians on their site who passed the test but do not practice according to science-backed recommendations. Many pellet pushers use the credibility of the certification to get patients. But it’s a good place to start, and most clinicians on their site, practice scientifically based menopause care.

To find a certified menopause practitioner

Make sure that on their profile it says The Menopause Society Certified Practitioner

If they do not have a Menopause Society Certified Practitioner designation, it means that they joined The Menopause Society and paid their dues. They did not take the qualifying test. It designates an interest in menopause, but not necessarily expertise.

Check Out Publications

It’s always interesting to see if a doctor has published any scientific papers related to menopause. Go to Pub Med put in your doctor’s last name and first initial and see what pops up. It won’t show you consumer publications, only articles in peer-reviewed science journals.

Many excellent clinicians have never published a thing, but if someone has published, it is a pretty good bet that they have some level of expertise.

Get a Referral?

Asking one of your doctors for a referral is hit or miss. They may know who the experts are, but they may also just be giving you the name of their favorite OB-GYN who delivered their kids, so you still need to check it out. A better approach is to see if there is a major medical center near you that has a designated menopause clinic.

Most hospitals have a physician referral service that will help you find a doctor. Keep in mind that the people who work in hospital referrals are obligated to make referrals to all the physicians on staff, so if you just call up and say, “Hi, I have a dry vagina. Which ob-gyn is good?” you’ll most likely be given the name of whoever is next on the list.

You need to ask specific questions that will lead you to the doctor who is most appropriate for you. For example, instead of saying, “I need a gynecologist because sex hurts like hell,” you might try, “I’m looking for a board-certified gynecologist who has been in practice for at least five years. I would like someone who takes care of a lot of menopausal problems, no longer does obstetrics, and has identified themselves as having an interest or expertise in menopause and sexual issues.”

Hospital referral services are not the same as the commercial referral agencies that operate independently of hospitals. Referral agencies that advertise in magazines, or on TV are not reliable sources. Participating physicians pay to be part of the service and tell the service what to say. As with any paid advertisement, healthy skepticism is appropriate.

While there are exceptions, if you show up and everyone in the waiting room looks like they are about to go into labor any minute, it is generally not a good sign.

And then there’s the savvy friend. That friend. The one who you can rely on to tell you who has the best cappuccino, the freshest sushi, and where to get a decent massage. And she often is the one to tell you she has the BEST doctor who helped her when she was flashing all night and had a vagina like a Venus fly trap. And she may be right. Or she may be wrong. So, sure, hear what she has to say and then do your due diligence. It also helps if “that friend” is a medical professional who has some inside information on who’s who.

Searching Online

What about Yelp or one of the other online consumer search sites? This seems like a reasonable approach. After all, wouldn’t someone who has already been to that doctor be the best judge of how approachable or knowledgeable he or she is? Actually, no. While it’s reasonable to use Yelp to see if people liked a certain nail salon, it’s probably not the best strategy to find a menopause expert.

Keep in mind that consumer ratings are no better than asking strangers on the street what they think. Typically, there are no more than a handful of “reviewers” who are rating the doctors. The typical doctor sees thousands of patients a year, and the experience of two or three people is hardly reflective of a typical experience. People who have a bad experience are more likely to fill out a review than people who had a good experience. You have no idea who is writing these reviews or what their agenda is. A glowing review may be from the mother of the doctor. A scathing review may be from a disgruntled patient or employee, or the spouse of the competing doctor in town. It has become common for “online profile management” companies to post positive reviews for businesses and get rid of the bad ones.

Even if reviewers’ comments accurately reflect their experience, their comments are usually more about how they were treated at the office than about the skills of the doctor. More than one five-star review has been posted because the doctor was “really friendly,” had a “great staff,” and offered free estrogen samples. A one-star review may be because they were kept waiting or had a run-in with the receptionist.

Checking out a doctor’s website can be helpful and often will give insights into their education, professional organizations, and research. A website is also where you will find red flags that tell you this person is more interested in making money than in practicing science-based menopause care.

Red Flag #1 is if the doctor promotes hormone pellets instead of FDA-approved commercial products. Check my Substack post next week for an article explaining the problem with pellets and pellet pushers.

Red Flag #2- Any mention of “balancing your hormones” “comprehensive hormone testing” or the Dutch Test is a bad sign, a really bad sign. Let me be clear: there is no such thing as “hormone balancing”. “Hormone balancing” is not a medical term, there are no scientific studies that address “hormone balancing”, and there are no classes in medical school on the topic of “hormone balancing”. It is a made-up term. The concept of hormone balancing is nothing more than a strategy to justify useless hormone levels and sell worthless products and concoctions.

Red Flag #3 is pushing procedures and products that are not covered by insurance. Some desire enthusiastic testimonials, that have not been proven to be effective. The Emsella™ chair for incontinence goes in that category. Some procedures are, in my opinion, inappropriate for a gynecologist to offer. Facial Botox, fillers, lip augmentation, and liposuction are big money makers but are not part of gynecologic training and not something a menopause specialist should be offering. There are exceptions to this rule, and I know some physicians who offer these procedures who are excellent clinicians. But those are exceptions.

Lots more, red flags, but you get the idea.

No Luck

You have done your homework and still haven’t come up with a clinician who is menopause savvy takes your insurance, and has an appointment in the next five years. Now what?

Should you try and educate your doctor who does not appear to be a menopause expert? Maybe bring them articles to read so that he or she will be more comfortable prescribing hormone therapy? Or suggest to them that they listen to my podcast? The short answer is no. Even if your doctor was receptive to you educating them, which they won’t be, reading an article or two is not suddenly going to make them a hormone expert.

If you are seeing someone who is knowledgeable but for example, is not on board with prescribing estrogen since you had a blood clot during pregnancy, it’s not unreasonable to show them an article about the safety of transdermal estrogen. But it’s all in how you present it. If you say,” You are clueless, - please read this article”, I guarantee that conversation will not go well. If you say, “I’m sure you have already read this article, but I’m interested in your take on it”, they are more likely to take a look ..and either tell you why they still think you are not a candidate, or even change their position.

What About Springing for a High-Profile Concierge Doctor?

The short answer is, maybe. Just because someone is concierge and charges a lot doesn’t mean they are an expert. They may just be popular, very entrepreneurial, and selling everything but expertise.

You still must do your due diligence. But sometimes someone is concierge because they have a high level of expertise and choose to limit their practice so they can deliver a different level of care.

If you can afford it, it may be well worth an additional fee to have an expert’s undivided attention for a full hour for a consultation along with direct access when you have questions. Before you blast greedy doctors who only treat those who can afford it, let me give you, my perspective.

Why I Went Concierge

For most of my professional career, I provided care to all comers. As my expertise grew, so did my frustration. I was incredibly stressed seeing a patient every 15 minutes. I talk fast- but there was no way I could provide enough education to have a shared decision-making consultation with a discussion of all their options.

So, I started a hospital-based concierge menopause practice. I took insurance, but my patients paid an annual fee. It allowed me to spend a full hour at every visit and I was able to give much better care. I initially had a hard time justifying only seeing women who were well-to-do enough to afford it.

But I then considered that between my podcasts, online articles, and social media, I was giving information and education to far more women than I could see even if I saw patients 7 days a week. My books are all under 10 dollars. My podcasts are free. Free.

To that point, recently the New York Times published an article on Dr. Mary Claire Haver, a gynecologist and author of The New Menopause. Without getting into the details of the article, there was a mention that she charged $1500 an hour for a consultation. Many of the comments blasted her for charging that amount instead of just taking what insurance offered. Let’s think about this. Dr. Haver’s book costs $17. Anyone can buy it for less than the cost of lunch. You can borrow it for free from your local library. She has millions of followers on social media and 7 days a week doles out the same information she gives patients in her office, which anyone can access … for free. She appears on other people’s podcasts, which anyone can listen to… for free.

Does your physician (who takes your insurance) spend 20-plus hours a week giving out free education? Did your physician write a book on menopause that anyone can purchase? With rare exceptions, I know the answer to that question is no. Whether you agree with her advice or not, is beside the point. Dr. Haver does more pro bono menopause education than anyone on the planet right now. And reaches far more people than if she were to run a traditional office that took everyone’s insurance.

I appreciate that this seems like a huge and unfair barrier to the average patient. But let’s be honest if high-profile docs did run a traditional office that accepted all forms of insurance, the wait would be years to get in, so the average consumer would never get to see them anyway.

You Don’t Need a Concierge Doctor to Get Good Care.

I promise, if you follow the guidelines, I have just given you, you will know how to find amazing experts that you will have access to and take your insurance, even if they are not household names.

1. Start with The Menopause Society Clinician Finder

2. Check out academic medical centers

3. Spend some time on the websites of promising possibilities.

OK, so you have looked high and low, and you simply do not have access to a menopause expert. You may live in a small town, or your insurance may keep you locked into a particular group of physicians. The only doctor you have access to is clueless or just dismissive. And that is where telehealth comes in.

Telehealth?

I used to be dead set against telehealth, but I have completely changed. In a perfect world, every peri or post-menopause woman would have access to a menopause expert, in the neighborhood who takes insurance.

But let’s be real. For over 90% of the population, that doesn’t exist. And telehealth has filled that gap. But not all telehealth companies are equal, so you want to know what you are signing up for.

There are two general categories of menopause telehealth.

Category 1 are telehealth companies that require a monthly membership fee, are not covered by insurance, and offer a limited menu of products. They may claim to provide health care, and some do give very good information, but others are essentially an online pharmacy that sells a limited number of products. If you want a transdermal estrogen, and the only option you are offered is a patch and you are not offered a spray or gel, that’s a red flag.

Category 2 are telehealth companies that provide health care and take insurance. These companies are no different than going to a doctor’s office, but you can have a virtual appointment and meet on Zoom with your clinician from your home, office, or car. You usually will meet with an advanced practice nurse or physician who has extensive training and expertise in menopause and will walk through all of the different options for your symptoms. If you need a prescription, it will be sent to your pharmacy just as a traditional doctor’s office would.

Full disclosure- I am the medical director of community education and outreach for Midi Health, so obviously I think they do a really good job.

Telehealth companies get an A+ for convenience and many also get an A+ for expertise that you would not have access to. The downside of telehealth is there are times when you are going to need an exam. For example, if you are having persistent pain with sex despite treatment, or if you are experiencing bleeding, telehealth is no longer an option. Persistent vulvar itch? A crotch selfie is not going to cut it. The good telehealth companies will collaborate with your doctor or facilitate a referral. The bad ones just say, you’re on your own “Make an appointment with a gynecologist”.

Finally, and most importantly, if you are not given solutions for your dryness, pain, and insomnia, it doesn’t mean there are no solutions, It just means you need to see someone else.

There are many outstanding menopause experts out there- and you only need to find one.

Check out, “Is Your Doctor a Menopause Expert? for a list of specific questions to ask (and potential answers you might get ) that indicate if the person you are seeing has expertise.

Links

· To verify that a physician is licensed

Federation of State Medical Boards website

fsmb.org

· To verify that a physician is board certified

ABMS.org is the site where you can check out whether a physician is board-certified and find out what he or she is certified in.

· To find a certified menopause practitioner

www.menopause.org.

· To see if your physician has published any scientific articles

NIH National Library of Science- Pubmed

https://pubmed.ncbi.nlm.nih.gov/

· Midi Health www.Joinmidi.com

Midi Health is a telehealth company that provides high-level menopause care and takes insurance in all 50 states. Dr. Streicher is Midi’s Medical Director of Education and Community Outreach and is familiar with their medical protocols, which are all regularly updated and set by the top academic menopause experts in the country.

· Major Medical Centers

It also may be helpful to check with major medical centers in your area. Many have menopause clinics or lists of doctors who have an interest and expertise in menopause.

The Northwestern Medicine Center for Sexual Medicine and Menopause Sexmedmenopause.nm.org