My provider search began this past spring when I was informed that my PCP was leaving the practice and I had to find a new one. She had not done any menopause care, which seems typical. All the doctors I had seen for anything would ask all sorts of probing questions about depression, anxiety, alcohol use. Nothing about menopause symptoms, never recommending HRT/MHT. "Oh, more than a year after your last period and you're fine? Good. See you next year!" I wanted to be a good patient so I would be upbeat about everything. I did not know the symptoms.
This sub really opened my eyes. I was shocked to see that all my weird issues for the past 20+ years were standard for perimenopause and menopause. A lot of them I had asked doctors about, but none of them had ever suggested hormones. True this was after the WHI estrogen scare, but you would think they would still have menopause screening questions so women wouldn't think they were going crazy.
I found this sub after seeing a comment about vaginal estradiol creme on another sub that was enlightening! I mean, WHAT??? I had been so miserable about those GSM issues. Since I was between PCPs, I remember thinking that I'd better get some of that before I had to get what would have been a very painful pelvic exam. I spent an absurd amount of money for an online provider to rush it to me, but it was worth it to have immediate relief. Then I picked up some phytoestrogen pills and also felt better. They worked so well that I started eating soy and every other natural phytoestrogen I could find. Hey, I was on to something!
But I kept reading that estradiol was the gold standard. So I booked a visit with an online provider and started on the 2x/week patch. Again, the improvement was almost overnight and definitely life changing. When I finally got to see my new PCP (younger and more aware than the other one), I asked if I could have a higher dose. It was only about a month, so she prescribed me the same low dose in the weekly patch. Better!
However, my libido was still non existent, so I wanted to try testosterone. PCP said I would need to see a gynecologist for that, so off I went to find one. I found one who was recommended by the Menopause Society not too far from me. I had to wait a few more weeks for an appointment, but it was only with the Nurse Practitioner, since "Dr. Wonderful" was booked into next year. I figured this meant she was really that awesome. When I saw the NP and she asked why I was there, I said I wanted to get my MHT dialed in and start on testosterone. I was surprised she had to ask, since I told them this when I scheduled the visit. "Oh, the doctor has to see you for that. I don't know why they had you see me."
Okayyy... mistakes happen. They managed to get me in to see Dr. Wonderful a few weeks after that. She was really not so "wonderful" in person. She seemed really annoyed, standing there with her arms crossed, telling me that the telehealth provider I used started off great but now all they do is sell supplements. I realized that not all doctors have pleasant personalities, so I brushed it off. She did prescribe me the estradiol gel packs (so much better for me than the patch while I could get them). She also let me know that while the GSM vaginal cream treatment for life, that the vasomotor symptoms treatment would have to stop in a few years. (WHAT?) I asked about the libido issues and testosterone. She said I would need a follow up appointment to discuss that after getting blood work that day. "Often libido returns after your estrogen levels stabilize."
I got the lab results and my T levels were low, liver function fine. Nurse called me to say "good news! your lab results are normal and the doctor will discuss testosterone in TWO MONTHS." I wanted to ask her if she realized that I could access the labs and wtf, but again, I try to be a good patient and not cause trouble.
BUT, guess who just blew off our telehealth testosterone talk? I sat there for an hour waiting for her to join the call. Finally got through to the office after several attempts. The admin said she was probably with another patient. "That's why I booked the first visit of the day. What's going on? Is she going to be able to do this at all today?" Nope, I would have to wait another month.
I was annoyed, angry, frustrated. I felt ignored and belittled. The way she stood there with her arms crossed while I sat, then blew off our telehealth visit: hierarchical. The gatekeeper. And I thought, no wonder she was so dismissive of the telehealth provider I used, since they (and all the telehealth providers) are her competition and she is is not even trying to keep up.
I am not shilling for any particular telehealth provider. I am just glad I was able to make a follow up appointment with them and the provider actually showed up. The bar is that F*n low. (She upped my estradiol dose and scheduled a follow up with a testosterone specialist too.) If you have an actual real life menopause specialist, you are so lucky! I'm in a major metropolitan area, but they are still all booked out weeks in advance. I have seen other posts and comments here about providers doing this weird gatekeeping thing. The official position of the Menopause Society is to continue MHT for vasomotor symptoms as long as the patient has the symptoms, in discussion with the doctor. I read the long version to make sure I understood it, but here is the handout: https://menopause.org/wp-content/uploads/default-document-library/MenoNote-Deciding-About-HT-2025.pdf
Honestly, these doctors who talk down to us (literally, in my case) really need to wake up to reality. We have agency.