The Difficulty in Finding an OB/GYN Who Treats Menopause and Post Menopause ...

So I have ... or had (? see below)  ... uterine fibroids, which were discovered 6 years ago on ultrasound.  

At the time, I was transcribing for a hospital in Canada that had a progesterone-based drug for women who were sensitive to estrogen that was doing wonders versus the estrogen-progesterone combo.

But of course, it's not approved here.

In fact, my provider hadn't even heard of using progesterone-only-based hormones for estrogen-sensitive women with fibroids/going through menopause, but she was open to trying it - and it worked! 

She prescribed the next best thing to the Canadian version, norethindrone (brand name "Heather"), and it was like a wonder drug.  

Suddenly, all of the heavy bleeding, the hot flashes, night sweats, bloating, wild hunger cravings,  sleep problems,  fog brain, sudden overwhelming tired spells, irritability  - all of that just ... disappeared -  and it was marvelous!

I'm not kidding, it was like a wonder drug  - and the most important thing - the fibroids were shrinking!

Shame that I had to ask about it myself and that I only knew about progesterone-based hormones because of my transcription in Canada, though, right?  

How many other women - and even US doctors - don't know a better way?

Now - what we DO know is that long-term usage of hormones in women, any hormone, can increase your risk of breast cancer, so after a few years of being on them, noting that my fibroids had shrunk and being asymptomatic, my provider took me off of them, saying I could go back on them at any time I became symptomatic again.

HOWEVER, we also know that with lesser hormone levels in women post-menopause, you lose your previous cardioprotection and higher immunity, as well as skin/viscera elasticity and moisture, and lack of certain hormone production can even cause cancer, so it's a toss-up ... or more accurately, there's a need to find a balance in supplementation.

So life was still great for about 2 years after going off of them.  

Then about a month ago, I started developing what I thought was fibroid pain, though I completed menopause about a year ago. I also had a return of hot flashes, sleep disturbance, bloating, fog brain - all of it just came back - so I called to schedule an appointment, just to get my hormones again.

*I forgot to mention this, when I originally wrote this, but they would NOT see me without an ultrasound first, simply because I mentioned the word "fibroids" among my list of returning symptoms.

Now, whether or not I still had fibroids, hormones are the antidote for all of it, and I was told that I had to do was call and set up a quick med visit to get them again.

But no, they wouldn't do that, I had to pay $250 out of my pocket (because I haven't met my $1,500 deductible yet) for an ultrasound or they won't see me. 

This is the state of healthcare in America - what is most profitable  for them, not what is best for the patient. 

Now, to be fair, they had to squeeze me in, they were booked up until June for ultrasound visits (this is private-insurance/out-of-pocket healthcare, mind you, who still only sees you for 10-15 minutes), but the lack of knowledge and new dismissive attitude after I told them I'd completed menopause a year ago really surprised me. 

They gave me the quickest transvaginal ultrasound I've ever had for fibroids, though I hadn't been back in two years.

I promise you, it lasted no longer than 3 minutes - and I saw my provider for 5.

They told me the fibroids had "disappeared"  - and that they were unable to visualize my left ovary due to bowel gas pattern/constipation.

Okay, so first of all, I'm thinking the constipation is a problem in and of itself, because I usually have the opposite problem, and the only other time I was ever constipated since childhood was when the fibroids appeared.

AND I was told that women complain of bowel changes with hormone fluctuations, but there's no science to support that.

Erm - that's not exactly true.

Though they haven't pinpointed the exact link between hormones and GI issues, there are plenty of studies proving hormone fluctuations do affect the GI tract and even the gut-biome immunity, including THIS STUDY, among many others.

*Also THIS STUDY done in 2023 about estrogen spikes leading to constipation.

And we also know that "morning after" pills are mostly estrogen- bombs that can not only end a pregnancy, but cause profuse vomiting, and we also know now that morning sickness is related to estrogen spikes in the morning!

Not to mention, literally every woman I have ever known complains of either diarrhea or constipation (or both) just before, during, or just after their period - and they all were told the same thing for years,  that it's "unrelated" to hormone shifts  - until some providers actually did (or read) the studies!

But no, let's keep gaslighting women about this based on your refusal to look at the science, rather than actual science, because it's easier, shall we?

Secondly - and perhaps most importantly - I'm told my fibroids just "magically disappeared," despite not being on hormones for two years, though I'm symptomatic again with the exact same symptoms?  

Okay, so - fibroids can shrink after menopause, but actually completely disappear?  

Hmmm, not sure about that.

But I didn't say any of that. I just said ...

Me:   "Oh, fibroids can just disappear like that? Wow, I didn't know that!  I knew they could shrink, but-" 

Provider:  "Yes, it happens all the time." 

Me:  "So they couldn't see my left ovary - so is it possible the fibroids were obscured too?" 

"Because I feel exactly the same as 6 years ago, and that was the only other time in my life I was constipated." 

"And is it a problem that they couldn't see my left ovary to rule out an ovarian cyst as the cause of the pain?"  

Provider:  "No." 

Me:  "Okay, well, then I guess I AM crazy lol." 

Provider: "Lol, no, it doesn't mean you're crazy.  You're just constipated, and though we don't have evidence to support GI changes due to hormones, many women do complain of that, plus you're also experiencing hot flashes again, so I can prescribe you some hormones if it makes you feel better." 

Me:  "Okay, yep, let's try that."

Now, I realized she was rushed, but her entire demeanor was different.  She used to really listen, explain things thoroughly, give choices, and thoughtfully made her decisions. 

Now, I hadn't visited or called in two years, but I tell her I completed menopause a year ago, and  I'm suddenly like a fly buzzing around her - why?  

I hadn't changed, in fact, I was less anxious/annoying now than before  - so was she just stressed that day, or is it because she erroneously thinks there shouldn't be hormonal problems ever again after menopause?

So I left feeling stupid and also like because I wasn't of child-bearing age anymore, my OB/GYN health wasn't as important and I shouldn't have even come in the first place!

So I go to the pharmacy, and lo and behold, there's a national shortage on progesterone and there has been for almost a year, and no one knows why.  It's a simple molecule to process and derived from natural sources.

But my OB/GYN didn't even know about that?

So I called to let them know - they had no clue they had been out all year, which means they rarely prescribed it. 

Then they told me that the only strength that was in was the most potent, so they prescribed that.

Me:  "Should I halve it because it's double-strength? You know, the risk of breast cancer and all?" 

Med Asst:  "No, it's fine.  And you should be celebrating, your fibroids are gone, yay!"

 

Now, I felt like saying "Bitch, I don't feel like celebrating. Just wait until you go through menopause and some 30-year old says that to YOU -  you'll want to punch them in the uterus 😂 --- AND -- I'm not sure that's true that fibroids can "disappear" completely, and that was the fastest ultrasound I've ever had in my life and you didn't even see my left ovary!" 

But of course, I didn't say any of that.  

I just said "Oh, okay, thank you!"

You see, most of us non-Karen women live in fear of being perceived as a Karen, so we just STFU.

(In fact, I think only actual Karens never worry about being perceived as a Karen - the rest of us now fear it and have to wear that stigma if we ever speak up.)

So then I started thinking, if this one was double the dose at 200, what was the original prescription for , pure progesterone rather than my norethindrone 0.35?

I called the pharmacy and they said "Yes, pure progesterone."

So NOW, I'm thinking  "Okay, I was on norethindrone 0.35 mg previously, a derivative of progesterone, and was given a drug holiday from that due to being asymptomatic and also the risk of breast cancer - but now y'all want to hit with a hammer what may only need a flyswatter?  Especially when they believe the fibroids are gone? "

But again, I didn't say any of that.

Now, in the meantime, I've been changing things for the constipation, going with that - and yet the pain is clearly in my low pelvis, exactly where it was before, sharp.

So I started looking for OB/GYNs who specialize in menopause and post menopause.

I came across the NAMS website, which gives you a list of menopause-certified providers - and would you believe there's only 5 in my city? 

I also read this AARP article - among others - that admitted medical schools - even OB/GYN fellowships - do not offer training in menopause treatment!

I then read thread after thread on Reddit about the difficulty in finding an OB/GYN that knows much about menopause and the scarcity of certified providers, even in larger cities!

So at this point, I stopped feeling stupid, crazy OR that I wasn't as important as child-bearing age women - because it IS irresponsible to brush off women with difficulties during and after menopause because if they could end up with some form of cancer or heart disease!

Also, I remember first going on birth control years ago and being given the basic Ortho Novum and became super sick, it felt like food poisoning, I vomited up everything I tried. 

I ended up in the ER with an IV and the ER doc diagnosed "virus."

I politely asked if it could possibly be related to the birth control I'd just started three days before. 

The doc literally yelled at me the following:  "Can't be the birth control, it's estrogen and all women have estrogen!"

But guess what?  

I stopped the full-on estrogen birth control and the vomiting stopped within 24 hours.

And now we know not only what I said above, above too much estrogen ending pregnancies (thus the main ingredient in the "morning after" pills) and cause vomiting/nausea, but women vary in estrogen production in general, and even that some women - like me, and my little sister - are very sensitive to estrogen, and can cause migraines for folks like us.

So I really that hope that dumb-ass doc knows that now and is now yelling at himself, as well as is not gaslighting women for their OB/GYN concerns anymore.

So Ladies of a certain age?

No, it's not you.

You are not crazy, a bother, or less valuable or important because you can't have children anymore (despite the fact that America does tend to still value women only for their ability to produce children.)

It's the fact that no one cares enough to learn, though the studies and information ARE out there at their disposal, they just don't care enough to find out, get trained, or certified in it.

Thus, Most OB/GYN care is focused on child-bearing AND cancer, and the rest of us can just eff off and suffer through it, I guess, even though as I said, it's the same hormones as pregnancy, going haywire.

And providers?

You are making big bucks compared to other countries, both from private insurance and out of our pockets, but spending less time with  your patients and have less training requirements in certain disciplines.

So FFS, use your CE requirements to go get certified in menopause treatment, it just takes a couple of months?

And if you're not, at least read the latest studies on it or go to your conferences because - damn.

If I can read these journal articles and studies quickly, then you can - and if you haven't and don't know, then say that and find out - stop gaslighting women about shit you didn't bother to train in!

At the very least, we know that hormones can both cause and treat reproductive cancers, as well as that the lack of them can increase heart disease - so you should think carefully about what to prescribe, at what strength and for how long, before you do - and be aware of national shortages!

As for me, I'm going to see the NAMS provider soon, plus treating the sudden constipation (and if that doesn't resolve, then it's colonoscopy time), so I'm sure I'll be fine, but it's the money I've spent, that my private insurance has spent, on something that should be simple to treat!

All of this money we spend on private insurance and out of our own pockets on healthcare in America, only to see our doctors for 10 to 15 minutes, who may or may not be trained in what you need and aren't required to be like other countries!

Again, I'm moving to Spain. Or Canada 😂

For more on the prevalence of medical gaslighting of women, by both male and female providers, read read HERE.

The short synopsis is, studies have shown that women are more likely to be misdiagnosed than men and have longer wait periods before being diagnosed correctly with  heart disease and cancer.  

This can also include the converse of my situation -  attributing symptoms to your hormones that actually aren't related - that's a form of gaslighting, too.  

Now, in my situation, she never said, nor implied, that thinking my fibroids flaring were to blame, and specifically said my thinking that didn't mean I was crazy

 - BUT - 

She ALSO ... 

1)  Said that fibroids regularly "disappear" with menopause (not true, they mostly just shrink and they CAN re-flare if your hormones still spike, which they can, even up into your 60s). 

2)  Said that there is no connection between hormone fluctuations and the GI tract  (definitely not true, countless studies on this). 

3)  Thoughtlessly and carelessly prescribed an overly powerful hormone just because I said I also had hot flashes again, without considering the long-term repercussions of doing so.

4)  Had no idea there had been a national shortage of this medication for the last year, despite being an OB/GYN provider.

.... all of these things making me feel dismissed and that my concerns were trivial and a bother, despite being in quite a bit of discomfort, - all of which are more subtle forms of medical gaslighting.

But as I said, rather than raise a fuss, I just scheduled with a new provider, an NAMS-certified one.