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How do you know when to go to an endocrinologist? Ever since my last baby, my periods have been extremely irregular, heavy, and painful (despite being on the same birth control I was on pre-pregnancy). In addition, I’ve really struggled with losing weight and severe mood swings. My gynecologist did a blood hormone test and told me everything was “normal” and that my only option would be to switch to the Mirena IUD. I wanted to talk about what was really causing these problems, whether I’m a candidate for Wegovy, and/or whatever other options were available, but have generally been dismissed because I won’t make the IUD insertion appointment. I’ve never had an IUD and am not sure I want one, but don’t really know where to go from here.
—Maggie
That sounds frustrating. To move forward, I think you will have more success if you separate the two problems you mention. Many doctors wouldn’t feel confident that they have the expertise to manage both issues.
First, the heavy painful uterine bleeding. You deserve to have your questions answered prior to having an IUD placed. You will likely need to schedule an appointment with your doctor to have those questions answered, but it is completely legitimate to make that appointment. Come prepared with your questions. I would also push back on the idea that there is only one solution to your heavy painful uterine bleeding. An IUD may be the best solution, but it is unlikely to be the only solution.
If your current doctor refuses to see you to discuss these issues or doesn’t answer your questions in a helpful way, it is time to seek a second opinion. A gynecologist will likely be more helpful here and easier to get into. Many causes of heavy painful uterine bleeding are structural, not hormonal, and as such fall into a gynecologist’s area of expertise. Plus, many of the various treatments for heavy uterine bleeding beyond prescribing birth control pills are procedures performed by a gynecologist.
When it comes to considering taking an anti-obesity medication like Wegovy, you should seek out a doctor who practices medical weight management. These doctors are often endocrinologists, but not always. If you live near an academic medical center, they will typically have a specialty clinic set up specifically for medical weight management. I would caution you to be very wary of online weight loss programs that offer miraculous results with compounded versions of semaglutide (Ozempic/Wegovy) or tirzepatide (Mounjaro/Zepbound). The goal of these businesses is to make a profit selling you the drugs directly. They often prescribe the medications indiscriminately and inappropriately, and they often do not provide appropriate oversight and support.
Ultimately, I think you will get better results addressing your two concerns separately with a gynecologist and a medical weight loss specialist. And consider seeking a second opinion if your current provider doesn’t address your concerns.
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I’m experiencing the same postpartum hormonal issues, which have changed my cycles and periods terribly. My GP and gynecologist don’t seem interested to determine the cause and only want to treat with hormonal birth control, which destroys my mental health. I’ve made an appointment with a functional medicine practitioner to try to find answers. At the very least it’s a path not yet explored.