I know it can seem like ob/gyn offices are full of pregnant women! And while general practitioners can be extremely helpful, sometimes you want the extra training and focus of a menopause care specialist.
I recommend finding a menopause provider in your area by going to the North American Menopause Society (NAMS) website, where you can enter your zip code and specify a mile radius to find a practitioner near you. Note that you can also check the box (NCMP) to limit the search results to NAMS-certified providers, who have completed additional focused training and receive ongoing updates on research and recommendations from the society.
Your primary care provider will continue to be your health resource for the spectrum of things that can happen at any age and especially at midlife: hypertension, sinus infections, asthma, joint injuries, and so on. A menopause care provider is a specialist; gynecology is typically also supported through health insurance (but individual plans vary). Some insurance plans require that your primary care provider provide a referral for "menopause care," which I recommend begin as soon as women are aware of symptoms of perimenopause.
When you're reviewing options for menopause care, look for certification by The North American Menopause Society (and get help from the NAMS website to find a practitioner with the NCMP credential). Certification means a health care provider has completed extra training to gain competency in menopause. (Those who are "members" of NAMS have access to the specialized information the organization provides but are not certified.)
An older couple walked into the therapist’s office. The marriage had been a bit rocky from the get-go, but now the woman had completely lost interest in sex. The therapist recommended that the woman seek sexual counseling.
Now, that might have been all right except that the therapist had no understanding of the very normal changes to libido brought on by menopause and thus wasn’t able to address that possibility or access resources to either reassure or help the woman.
The couple never came back.
Sue Brayne, a British therapist and author of Sex, Meaning, and the Menopause, commented in her blog on a recent workshop she conducted: “…it continues to amaze me that in a room full of therapists on their way to fifty, or who are well into their fifties and even sixties, this workshop was the first time most of them had ever spoken about the menopause in any depth, or admitted to how it is affecting their lives.”
So, while many healthcare professionals have personally experienced menopause, very few have actually received professional training or information to help others.
In a survey of 900 women conducted by womentowomen.com, 80 percent visited their doctors for help with menopausal symptoms and 60 percent came away feeling as though they hadn’t had a “supportive, honest discussion about menopause options.”
Therapists in Brayne’s workshop complained that, “their GPs [general practitioners] had no interest in the menopause, and they were often ‘fobbed off’ with unwanted prescriptions for HRT [hormone replacement therapy].”
As patients, we are often shy about discussing sexual issues to begin with, and as we’ve mentioned before, doctors rarely initiate that conversation. Throw menopause into the mix, and you may be met with discomfort, avoidance, or the “fobbing off” that Brayne mentions.
Many doctors and therapists simply aren’t equipped to understand the array of menopausal symptoms. Menopause isn’t a disease or a medical condition. A doctor can’t “fix” it. Menopause is complex in that it affects a whole bunch of physical and emotional systems, and there’s no one-size-fits-all remedy.
That said, you have every right to expect your medical practitioner to knowledgeably address your menopausal symptoms during this transitional time. And you should be able to talk openly about them. Yes, that includes sex.
So, how do you get the ball rolling with your practitioner?
If you’re frustrated in your attempts to communicate with your regular provider, or you feel you’d benefit from a specialist with targeted knowledge about menopause, the North American Menopause Society has a menopause certification program as a way of assuring basic competency and assuring high-quality care. You can find a NAMS-certified practitioner in your area by searching here.
Medical professionals may sometimes struggle to find the information they need to support and treat their menopausal patients, but as patients communicate (nicely) that they expect support and knowledgeable treatment from their doctors, everyone is nudged along the road toward greater awareness.
And that can only help us all.
The MiddlesexMD team and I have just come back from representing what we do at two conferences in Orlando. The first was the gathering of the North American Menopause Society; the second was the Nurse Practitioners in Women’s Health.
These events are both exhausting and exhilarating. It’s great, as a medical professional, to learn from the presentations by my colleagues on topics I’m dealing with every day, whether in my office or by responding to questions on or researching products for MiddlesexMD. Both physicians and nurse practitioners are enthusiastic about what we offer—a safe place for both solid, reliable information about sex after 40 and private purchases of products that can help address changes many of us face. We met other people who share our mission of making sure women know that they can continue (or start!) to have comfortable, satisfying sex, no matter what their age.
We’ve been doing these events for a couple of years now, in a variety of places. We’re reminded—as I certainly know, investing in my continuing education—that medical professionals always have things to learn—and are eager to do so. They’re surprisingly up front about wanting information for themselves as well as for their patients. We love the women who come back to our booth on day two of a conference, having discussed their sex lives over dinner the night before! And we’re also touched by the woman who steps away to call her husband before she chooses a vibrator. We love to see all that conversation about our sexuality!
There are, of course, a lot of professionals at these conferences—people who talk about body parts and processes all day long. But we’re especially happy to talk to hotel employees who happen by, who may have fewer opportunities to have their questions about sexuality answered. We met Linda, who picked up information for her friend who’s just recovering from a hysterectomy, and Tony, who was deputized to pick up information for his coworkers to share with their midlife wives. Our fellow exhibitors are also welcoming; we exchange information about how we support women and are often able to share resources.
As some of our new relationships develop over the next few months, I’ll share details here. For now, just know there’s a whole community of people out there who are ready to help you maintain your sexual health. And we at MiddlesexMD are pleased to be a part!
I often recommend that people try the North American Menopause Society's (NAMS) website. NAMS has a rigorous process for certification, so the health care providers who are a part of it are likely to be committed to continuing sexual health for women like us. The website has a practitioner finder, too, so you can see whether there's a member in your area.
If that option isn't fruitful, we recently published a longer blog post with some other suggestions to explore.
Good luck, and keep looking! It's important to have a health care provider you're able to communicate and work with as you navigate the years ahead.
We’ve discussed when you might want to look for a new health care provider. MiddlesexMD advisor Dr. Sheryl Kingsberg minces no words on that point: If your health care provider isn’t addressing your sexual health concerns, find a new one. If your current physician isn’t listening or is talking down to you, find a new one. If you are uncomfortable and can’t communicate with your provider—you guessed it—find another.
Changing physicians is a daunting task. The process is fuzzy, and credible information is hard to come by. Maybe that’s why we put up with less-than-ideal situations for so long.
But the relationship with your doctor is too important to settle for an uneasy status quo. Trisha Torrey, who writes extensively about the issue, says it’s like choosing a spouse, except that you may be more intimate with your provider.
If you’ve been dissatisfied with your provider or are just putting up with a situation because you’ve been avoiding the task of finding a new one, here’s a plan of attack.
If possible, out of fairness to your current physician, try to address with him or her the reason for your dissatisfaction. If you aren’t a good “fit” with her personality or style of practice, a heart-to-heart might not be very productive. It’s unlikely that he can change such basic traits. But if you have a problem with her staff or have health care issues (such as sexual complaints) that haven’t been addressed, you should give your doctor an opportunity to discuss the causes of your dissatisfaction.
Also, as Torrey points out, “nice” doesn’t necessarily equal “competent.” A good bedside manner is pleasant and soothing, but for my money, I’d rather have competency.
If you’re convinced that you need a different provider, don’t leave your old provider until you’re sure you have a new one. You don’t want to come down with a cough or find a lump without a regular physician. According to a 2008 article in the New York Times, “Studies have found that it is hard to get an appointment at short notice when cold-calling, and that patients with a regular source of care get better care, even when they are uninsured.”
Then, as you begin your search, consider these issues:
Once you’ve mulled over these parameters, your next challenge is to find solid, trustworthy information about the providers on your short list. The bad news is that it may be easier to get information about a washing machine you want to buy than about a doctor you’re considering. Websites that provide information and ratings on physicians are in their infancy, and sites that feature patient reviews have to be carefully vetted for objectivity.
“The truth of the matter is that people are hard pressed to make well-informed decisions when they choose a doctor, and they’re doing it blind,” said Joyce Dubow, a senior adviser in the office of policy and strategy at AARP in an article in the New York Times.
When you call your insurance company for participating providers, ask if they have a review system or an “honor roll” of providers. Some companies are starting to do this.
Some online sites rate physicians, but they vary in quality and credibility. You wouldn’t trust a review of a washing machine from the company that sells it; neither should you find a doctor on a site hosted by a pharmaceutical company. Pay attention to who created the website, who funds it, who makes money from it, how complete it is, and how current it is. Check out healthgrades.com for basic information; reviews are often available if you Google the doctor or practice name (just use your judgment on what's a credible review source).
Doctors must be licensed to practice in a state, but board certification indicates a higher level of competency. Most providers are board-certified, and yours should be as well, either with the American Board of Medical Specialties for MDs, the American Osteopathic Organization for DOs, or the American Board of Physician Specialties, which accepts both disciplines. A doctor may be certified with other boards as well, but these three are widely recognized and demand a certain level of competency and achievement. To find a health care provider with specific menopause-care knowledge, you might start with the North American Menopause Society's website at menopause.org; there's a practitioner search you might find helpful.
Word of mouth is still a common and effective way to get information about local providers, especially if the word comes from someone in health care. I found a terrific dentist from a hygienist who taught at a dental school. Another woman found her internist from a trusted pharmacist. Ask family and friends who they see and how they like the person.
Check social media sites and search engines like Google. It’s easy and worth a shot, just make sure you’re getting information about the right person.
Finally, schedule consultations with the providers on your short list. You’ll probably have to pay for the appointment, but you’ll be able to assess the provider’s attitude and personality, the office environment, and, very importantly, the attitude of the staff.
Bring a list of questions, such as whether she schedules same-day appointments for illness, how he handles emergencies, whether you’ll see the doctor or members of the staff (physician’s assistants or nurse practitioners), how she handles prescriptions, where he went to medical school, how long she’s been in practice (if you haven’t ferreted this out already). Ask about board certification and any special training. And tell him or her you want to feel free to discuss matters of sexual health.
Finding a provider is a challenge, but it’s a critical and long-term relationship, so it’s worth putting in the effort upfront in order to avoid ongoing dissatisfaction down the road. And take heart from Dr. Sheryl: “If a women is smart enough to have found the MiddlesexMD website, she’s savvy enough to ask friends and other health care providers and to do some basic research to find someone she’s comfortable with.”
Now that our new site has been up for a while, we've met and made friends with others in online communities serving midlife women and sharing information about sexual health. We'd love for you to meet some of our new friends:
The amazing women at Vibrant Nation invited me to participate in their -- really very vibrant -- community. It's a great place to explore and share life with others our age. Four of our posts made the top 10 in August and September!
Liz from Flashfree (Not Your Mamas Menopause) asked for a guest post on her blog, where she writes about the physical, emotional, and societal issues that surround midlife and menopause. I was happy to oblige.
I had a great time discussing sex at menopause on the Voice of the Nation show "Sex with Jaiya", who was very interested in hearing about how we can adjust our ideas about sexuality to meet the changes we experience as we age.
Melinda Blau's MotherU was a marvelous blog she keeps with her daughter, Jennifer Blau Martin. Melinda is a bestselling author, and a brilliant blogger who does a great job of including as many voices as she can on her comforting and informative blog. She asked to run our recent contemplation of new grandmotherhood.
And we love Owning Pink, an online community that endorses and celebrates living full and authentic lives. I've joined the Pink Posse to talk about Owning Sexuality. I swear it's not just so that I can say that I've joined the Pink Posse, though that's a pretty good reason to join up.
In the off-line community, we've just come back from participating at The North American Menopause Society Annual Meeting in Chicago and the Nurse Practitioners in Women's Health Women's HealthCare Conference in California. We made lots of new friends--and were exhilarated by the response! Whew! Now to catch our collective breath...
It's a personal question, I know, but one I'm trying to be sure to ask my midlife and older patients who are newly single and sexually active.
Among women our age, sexually transmitted infections (STIs, sometimes called STDs for sexually transmitted diseases) are up and condom use is down. There's a direct correlation.
Those of us who have spent the last 30 to 40 years in long-term monogamous relationships may not have even seen a condom in that time, let alone bought and used one. When contraception was the goal and a steady partner was the norm, we tended to choose less intrusive methods of protection--like the pill or IUDs.
Now, though, if you're single and entertaining the possibility of a new sexual relationship, it's time to get acquainted or reacquainted with the most effective means of preventing transmission of STIs like gonorrhea, HPV, herpes, chlamydia, and HIV: the venerable condom. Because it's an actual physical barrier, and because it's the easiest barrier to use, it's the most effective option we've seen.
Of course you can buy condoms at your local drugstore or grocery store, but if you don't want your kid's best friend waiting on you, you may want to consider an online source. And if you've never bought or used latex protection before, don't worry. We've sought out the right combination of function, fun, and discreet packaging so you can purchase from the comfort (and privacy) of your laptop, and our website offers basic instructions for using condoms.
(A parenthetical note: We know there are female condoms, which work just fine as a barrier for protection. But when we actually tested them as part of our product selection, we found them too clunky for us to be comfortable. We wouldn't recommend them to our friends. But we'll keep an eye on the options and let you know when something better comes along--or let us know if you've found a brand or a method that makes them your preference.)
A few more tips to help build your condom confidence:
-- Keep a ready supply on hand--in a zippered pocket of your purse, in a drawer of your nightstand, or in nifty bedside storage like this tissue box we found with a private drawer. Scrambling around for that little packet in the heat of passion can cool things down in a hurry.
-- Talk with your partner about condom use as soon as it seems clear that sexual intimacy is a definite possibility for the two of you. Agreeing that protection is essential--and deciding who's in charge of making sure it's there when the time is right--will ease anxiety and embarrassment for both of you.
-- Incorporate condoms into your sex play and lovemaking. Application can be quite exciting in itself!
Finally, remember that not even your friendly condom offers 100-percent protection. In addition to insisting on a latex condom, NAMS (North American Menopause Society) guidelines for safer sex include choosing partners wisely and discussing sexual histories, getting an annual exam that includes testing for STIs, and making sure that your Hepatitis B vaccine is up to date.
While we are on the subject of finding medications and supplements that can help us… a quick note about using herbal remedies to help alleviate the symptoms of menopause and/or to boost your flagging libido and support your vaginal tissues...
Herbal supplements, for the most part, are developed and marketed in the U.S. as food stuffs. For this reason they do not require clinical studies to test their efficacy or to measure their side effects. They are also not subject to manufacturing rigor that would guarantee their potency. So I can't promise or deny their effectiveness or safety.
At the same time, there is no doubt some of my patients have experienced some relief of their symptoms by using various supplements. Very few of the herbal products designed for menopause support are known to be harmful, and trying them yourself may be the best way to learn of any benefit. It's your body. How these supplements work for you is really the question.
A good way to test their efficacy and safety for you is to keep a symptom journal for a week or so before starting a new supplement, and then for 12 weeks after starting it, tracking the type and severity of your symptoms, and how they change over time. The accepted wisdom for herbal supplements is that 12 weeks is an adequate time to determine whether a supplement will help your symptoms or not.
There are so many supplements out there thought to support us as our hormones are changing. What has been your experience of supportive supplements? Any that have helped you? Any cautionary tales?