Menopause is a natural transition that most women experience between the ages of 45-55 when menstrual cycles stop permanently due to decreasing estrogen and progesterone production by the ovaries. The years leading up to menopause are called perimenopause when most women begin experiencing signs and symptoms of hormone changes like hot flashes, night sweats, vaginal dryness, mood changes, trouble sleeping, etc.
Seeing a doctor during this transition is important to monitor for any concerning symptoms, get advice on managing bothersome symptoms, ensure bone health with aging, and discuss the pros and cons of hormone therapy. The type of doctor a woman chooses to see can vary based on her individual needs and preferences. The most common options are:
- Primary care provider (PCP): A general practitioner or internist who provides routine screening and preventative care can be very helpful to monitor a woman's overall health during perimenopause and menopause. PCPs can order basic lab tests related to hormones, cholesterol, thyroid etc. Most PCPs feel comfortable providing basic education and advice on common menopausal concerns.
- Gynecologist: Obstetrician-gynecologists receive specialized training in female reproductive health and can provide the same screening, testing, education and advice as a PCP, in addition to specialized care related to the female reproductive system. For concerns like heavy/irregular periods, uterine fibroids/polyps or other gynecological issues, seeing a gynecologist may be preferred.
- Endocrinologist: These are medical doctors who specialize in glands and hormones. Endocrinologists receive advanced training in complex hormone conditions and imbalance. They can provide more detailed testing and analysis of female and male hormones implicated during perimenopause and menopause. Typically endocrinologists would be consulted for:
- Women with premature ovarian failure/early menopause
- Surgical menopause after ovary removal
- Complex hormonal conditions like PCOS, thyroid dysfunction
- Severe menopause symptoms not relieved by initial therapies
- Continuing use of hormone therapy beyond age 60
At HormoneHarmony, our specialized endocrinologists and nurse practitioners have advanced expertise in hormonal changes across the lifespan from puberty through adulthood and aging. We help patients navigate the unique challenges of perimenopause and menopause through evidence-based testing, education and treatments to optimize wellbeing during this transition. Contact us today to see how our individualized care plans can help you feel your best!
When to see an endocrinologist
Many healthy women transitioning through natural menopause can have their basic health needs managed by their gynecologist or PCP without needing to see a specialist like an endocrinologist.
Consultation with an endocrinologist may be recommended if a woman experiences:
- Premature ovarian insufficiency or early menopause (before age 40)
- Surgical menopause after bilateral oophorectomy
- Unusually severe symptoms - frequent hot flashes interrupting sleep, severe mood changes impacting relationships/work
- Symptoms lasting longer than average - persistent regular cycles after age 52, vasomotor symptoms lasting over 10 years
- Need for continuing hormone therapy past age 60
- Complex medical conditions like thyroid disorders, an autoimmune disorder, pituitary tumor, uncontrolled diabetes, or adrenal disorders
- High risk factors for osteoporosis or heart disease in which hormone therapy risks/benefits would need careful evaluation
When to see a endocrinologist - key points:
- Premature or early menopause
- Surgical/medically induced menopause
- High risk for health complications
- Severe, prolonged or abnormal symptoms
- Need for extended hormone therapy
- Other hormonal or endocrine disorders
What to expect at the first visit
The first endocrinology consultation for perimenopausal or menopausal concerns will be very thorough and typically last 60-90 minutes. It will start with a detailed health and symptom history. The endocrinologist will ask questions about:
- General health, medical conditions, surgeries
- Reproductive history - first period, pregnancies, prior contraception use
- Menstrual cycle patterns - frequency, regularity, flow, pain
- Onset of perimenopause symptoms
- Symptom frequency/severity - hot flashes, mood changes, insomnia, etc
- Impact on quality of life - personal, professional, sexual
- Family history of health conditions possibly relating to hormones - early heart attacks, osteoporosis, blood clots, cancers, etc
Then a
physical exam will be done checking height, weight, BMI, blood pressure, breast exam, and a pelvic exam if needed. Blood and sometimes urine or salivary tests for hormone levels will usually be ordered and often additional tests for cholesterol, anemia, thyroid etc.
Based on the full assessment, an individualized
treatment plan will be suggested which may include:
- Lifestyle changes - stress reduction, exercise, sleep hygiene
- Safe symptom relief options - cooling techniques, black cohosh, SSRIs/SNRIs, cognitive behavioral therapy
- Hormone therapy if appropriate - oral tablets, transdermal patches/gels, intrauterine devices
- Follow up testing and appointment schedule