Insomnia, joint pain, heart palpitations, panic attacks, anxiety, depression, brain fog: These are some of the lesser-known initial signs of perimenopause, a phase of hormonal change that can begin as early as 35 years old and last 10 years until, and sometimes into, menopause, when a woman’s period ends. Even while many local gynecologists list “menopause” on their websites, most women in their 30s aren’t looking for menopause treatments, even if they have symptoms that signal hormonal shifts.

As a result, some women white-knuckle their way through 10 years of depleting symptoms due to a lack of information or a wariness of hormone replacement therapy. The primary cause of that fear is a study that showed increased cancer and stroke risks with certain types of hormone treatments, a limited study that has since been debunked. But discomfort isn’t the only issue at hand, says Dr. Mary Haver, a gynecologist in Texas who is outspoken about menopause.

“During the menopause transition, we are at a greater risk of developing cardiovascular disease, osteoporosis and some cancers,” she says. The key, according to Haver, is “identifying perimenopause symptoms sooner to proactively prevent menopause-related conditions.”

Haver has discussed menopause extensively online after experiencing it herself
and realizing that, even as a doctor, she was unprepared to address her own symptoms. “A survey of U.S. obstetrics and gynecology residents found that only one in five received formal training in menopause medicine,” she says. Even Oprah had a hard time finding a doctor to identify the underlying hormone changes that were causing her heart palpitations, something she revealed in her recent special The Menopause Talk.

Amanda Hoelscher is a nurse practitioner at St. Petersburg’s Uplift Wellness Center who specializes in hormone therapy. She says she focuses on optimizing health to stave off crisis. Even while newer online platforms that prescribe medications for symptom relief directly to patients represent a breakthrough
for access, Hoelscher says one-on-one practitioners play a vital role. “Everything I do is individual,” she says. “I don’t follow an algorithm. That’s where online programs may not offer the rest of the benefits of bioidentical hormone replacement therapy, because they may be underdosing.”

Finding the right provider can be daunting, however. Start with the North American Menopause Society’s provider database. Hoelscher studied bioidentical hormone replacement therapy (known as BHRT) with Worldlink Medical, which also offers a provider database on its website.

“There are several ways to get BHRT certification,” says Hoelscher. “Find a provider who invested in their training and care.”

Considering Hormone Replacement Therapy? Here Are Some Tips from Dr. Mary Haver

Bring research to your health care provider.

Haver refers to studies from the American Heart Association and the North American Menopause Society and says, “The consensus is that for healthy people
born female younger than 60, and within 10 years of menopause onset, the benefits of hormone therapy outweigh the risks.”

Prepare for your first appointment.

See your provider in the morning, fast so you are ready for tests, write down your
family history (this could qualify you for better insurance coverage), keep a symptom journal and consider your preferences for treatment and your
provider’s opinion based on your medical history.

Get a second opinion.

Don’t simply accept the opinion of a provider who suggests your symptoms are your “new normal” or who refuses to offer hormone replacement therapy (that should depend on your medical history) or suggests a time limit on therapeutic approaches.