Your guidance often mentions “talk to your doctor” (which I get), but which doctor do you recommend? Do I bring up perimenopausal issues with my gynecologist once a year, or with my general primary care doctor once a year? (Presumably not with my pulmonologist, orthopedist, or dentist.) What about someone like you — do we get a referral from a gyn or pcp?
—A patient with many doctors
My goal in writing Hot Flash is to arm you with data about your health in the post-reproductive years. My patients often apologize for reading about their concerns online before they come into the office, but I find I can have more helpful and nuanced conversations with my patients when they arrive at their appointment with some baseline knowledge of the topic at hand. Armed with reliable data, you can have better conversations about your health concerns with your doctors — especially since in most doctors’ offices, we only have 15 minutes for those conversations.
You are also right that you need to be talking to the right doctor. But which doctor is the “right” one for a given problem is not always as straightforward as it would seem. And sometimes there might be more than one right doctor.
There is so much overlap among specialists. Take obstetrician/gynecologist and endocrinologist. Endocrinologists are experts in all types of hormones, not just reproductive hormones, but we know reproductive hormones well. We aren’t surgeons, and we don’t monitor pregnancies or deliver babies. Obstetrician/gynecologists are surgeons and manage pregnancies and deliver babies, and they often have a great working knowledge of reproductive hormones but are not experts on all the other hormones.
One study suggests that obstetrician/gynecologists feel most comfortable prescribing hormone replacement therapy, followed by primary care doctors. But the authors didn’t include members of my speciality, endocrinology, at all.
So what is a patient to do? I would recommend starting with your gynecologist for many of the issues we discuss in Hot Flash. Most women have an ongoing relationship with their gynecologist, which facilitates open conversation. You don’t have to wait for your annual appointment if you aren’t feeling well. You can schedule a visit to discuss a specific complaint anytime! If your gynecologist can’t provide the care you need, he or she can always refer you to a specialist.
You can also ask when you call to make the appointment if the doctor you are scheduling with treats women for symptoms of perimenopause, for example. My office staff have a general understanding of the types of things I treat, and if they don’t know, they ask me. Then no one is wasting their time with an unhelpful visit.
In short, I would usually start with your gynecologist or primary care doctor, but don’t be afraid to ask if the doctor you are scheduling with treats the issue you want to discuss.
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