Your Doctor May Not Have the Full Picture

PLUS: Anger is a symptom, too

Estimated reading time: 3 minutes

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👋 Hello friends!

Welcome to the July 21st edition of Menopaussible—bringing you the news you can use and the ⚡ energy ⚡ you need to support your menopause journey. I'm Maria Caracci Ciccolella—mindset coach and menopause advocate. (Connect with me on IG or LinkedIn!)

Just a few short weeks ago, The New York Times published an article that reminded me that for all the progress that’s been made—there is always work to be done. The feature, titled Millions of Women Are Left Out of Menopause’s Moment, highlighted how much of the menopause renaissance has been built around one answer: hormone therapy. As a result, women who can't take hormone therapy, or choose not to, are finding themselves on the fringes of a movement that was supposed to be for them.

The clear takeaway: education—specifically among providers as well as women—is greatly needed, especially when it comes to knowing about hormone therapy alternatives.

So in this issue, we’re here to help close the gap.

Menopause Hormone Therapy (MHT) Isn’t a Solution for Everyone and Everything

Despite much of the mainstream discussion around menopause hormone therapy, it is not a panacea for all that menopause ails you in midlife. In fact, some women find that they cannot tolerate hormone therapy once started, while for others, personal histories of estrogen-sensitive cancers, blood clots, cardiovascular disease, endometriosis and some liver conditions create more nuanced and limited use cases.

That said, for many of these women, the conversation often ends with: “menopause hormone therapy is just not an option for you”—full stop.

At the root of the problem is knowledge within the provider landscape. A study of OBGYN residency programs in 2023 found that less than one-third of those programs offered any training on menopause, and in most instances, it amounted to nothing more than a few hours of lecture. And that’s just one subset of the medical profession. If doctors aren’t presented with the information, how can patients then be?

What Exists Beyond MHT

It is first important to establish that when one often hears about menopause hormone therapy, the reference is generally to systemic hormone therapy: the pills, the creams, the patches, the sprays, or vaginal rings that are designed to introduce estradiol (estrogen) into the bloodstream at a minimum effective dose to address symptoms such as vasomotor symptoms (hot flashes, night sweats), genitourinary symptoms, and osteoporosis.

The toolbox for addressing menopause symptoms, however, is not solely reliant on systemic hormone therapy. Among the options, are:

• Low-dose vaginal estrogen (also known as local estrogen), used specifically to treat genitourinary symptoms, including recurrent UTIs, vaginal dryness, vulvar itching, pain with sex, and urinary urgency. Low-dose estrogen has a distinct risk profile from systemic MHT—given that it is minimally absorbed into the bloodstream and does not raise systemic levels to the range seen with oral or patch hormone therapy. As such it is often appropriate even for women who can't take systemic estrogen.
• Non-hormonal prescription drugs
  • Fezolinetant (Veozah) and Elinzanetant (Lynkuet)—two FDA-approved non-hormonal options designed specifically for hot flashes; in trial studies, elinzanetant was also observed to help improve sleep among study participants
  • SSRIs (Paxil, Celexa) or SNRIs (Effexor, Pristiq)—which have been used to effectively manage hot flashes, anxiety, and/or depression
  • Gabapentin and Clonidine—also have been used to treat hot flashes and anxiety
  • Flibanserin (Addyi) and Bremelanotide (Vyleesi)—the only two FDA-approved medications for hypoactive sexual desire disorder (aka, low libido), with varying approvals depending on menopausal status.
• Cognitive Behavioral Therapy (CBT)—underutilized despite a body of evidence, CBT has shown to be highly effective in managing the intensity and impact of hot flashes
• Lifestyle interventions, including adjustments to nutrition, movement, sleep, and stress management have been shown to improve symptom experience
• Masturbation—yes, recent clinical research from the Kinsey Institute indicates that a little self-pleasure is a highly effective and cost-free way to manage an array of symptoms—with the biggest improvements cited as feeling more rested and having fewer mood swings.

Don’t Just Take “No” for An Answer
​As you can see above, when it comes to treating menopause symptoms, one is not without options—just, perhaps, without a fully-informed or knowledgeable physician. If you find yourself feeling less than satisfied with symptom management or minimal explanation, it may be time to seek out a new provider, specifically one trained in menopause and hormone management. The Menopause Society offers a searchable provider database based on zip code.

All the Paussibilities

Information changes what's possible: for your health, for your life, for everything that comes next. Menopaussible exists because informed women make better decisions.

The signal that something needs to change often lives in a feeling—dissatisfaction, frustration, a quiet sense that something's off. Acting on that feeling is what leads you to the information. And the information is what leads you to what's next.

This issue was about knowing your options. Imagine what that same clarity could do for the rest of your life. Book a free clarity consult here.​

Plus: News Items

Even Rage Has Been Left Out of the Menopause Conversation

Hot flashes. Brain fog. Sleep disruption. These are the symptoms that have finally started getting serious clinical attention—but a recent TIME piece makes the case that anger deserves a seat at the same table. Women experiencing menopause-related rage have largely been told to manage it quietly, rather than being asked whether it's a symptom worth treating. It's a sharp extension of this issue's premise: the gaps in the menopause conversation aren't only about which drugs get discussed. They're about which experiences get taken seriously at all.