Ask Barbie! Barbara Taylor MD's Q&A addressing your burning questions about Menopause

Ask Barbie: How Do I Find the Right Doctor to Prescribe HRT?

Q: Introducing Speed-Doctoring and Doctor Shopping!

Welcome to ‘Ask Barbie’, where I answer your most burning questions.

Today’s question—”How do I find the right doctor to prescribe HRT”— is a real sizzler. In fact, it’s my favorite question. And that’s because it gets to the root of all the problems in today’s world of successful menopause management.

Finding the right doctor to prescribe HRT is the most difficult part of managing your menopause your way. BUT, it is only half the challenge. The whole challenge entails two things:

Getting HRT
Managing HRT

You need both!

Getting HRT and Managing HRT

While getting HRT is easier than managing HRT, you need to find a doctor who can and will do both. It would be a waste to find a doctor who will prescribe HRT, but who cannot manage HRT. You need to pursue this as finding a menopause manager who will help you manage your menopause your way from start to finish.

That brings us to the reasons that “How to find the right doctor to prescribe HRT” is such a great question, as well as such a difficult challenge:

Reason #1: No Menopause Education in Medical School

It all starts with the fact that there is no education on menopause in medical school. This means that doctors do not know how to manage menopause. They know as much about it as you did before you got this education from me. Obstetrics and Gynecology residency programs devote only one percent of the time to menopause. The result is that the system is not in place for you to find a doctor to prescribe or manage HRT.

Getting HRT for estrogen deficiency at menopause should be as simple as getting thyroid hormone for hypothyroidism. But it isn’t.

Instead, both menopause and home replacement therapy for menopause are shrouded in neglect and fear. Fear is the most powerful emotion on Earth. And fear is very difficult to reverse or erase. So finding a doctor who will even prescribe HRT for menopause entails overcoming fear of menopause, fear of HRT, and fear of lawsuits.

Reason #2: Marketers and Management of Your Menopause Someone Else’s Way

Rather than having a medical system that is rife with educated menopause providers, we have a free market that is rife with marketers. The difference is that menopause education empowers you and your doctor to manage your menopause successfully. But marketing merely empowers marketers to make loads of money.

So one of the first things you have to do is separate medicine from marketing. And that’s not as easy as it sounds.

An educated menopause manager does not offer just a single way of managing menopause. Nor do they sell a product. There is no pushing anything on you. They tailor everything specifically to you and your needs.

But a marketer is different. A marketer does offer just a single way of managing menopause. And they do sell a product. Their goal is to push that product on you, regardless of whether or not it is right for you.

So avoid anyone with a single way of managing menopause or a product for managing menopause.

There is no “right,” “wrong,” “good,” “bad,” “better,” “worse,” or “best” way to manage menopause. Those are all marketing words. Women are not robots. Every woman has to find what is right for her. And every woman has to find the right menopause manager for her.

Reason #3: Legal Snafus

Unfortunately, most medical providers who can prescribe HRT refuse to do so. And the reasons for this are completely illogical, but legal.

Historically, doctors gave HRT to all women at the time of menopause. They did so because menopause is estrogen deficiency. Therefore, the logic was to replace estrogen, just as one would replace insulin or thyroid hormone if you were deficient in one of those hormones. And the dosages for HRT were always adequate for preventing the three diseases of estrogen deficiency (which are heart attack, osteoporosis, and Alzheimer’s disease). Additionally, HRT was something that women took for the rest of their lives, just like other hormone replacements that people take for the rest of their lives. The science was simple, and prescribing HRT for menopause was simple.

But in 2002, the Women’s Health Initiative (WHI) scared everybody. Despite the fact that it was a completely flawed study that was severely distorted and dramatized by the media, it became the only thing women and doctors knew about menopause. And that meant that the world of menopause became rife with neglect and fear.

Since 2002, that one defective and distorted study has governed everything in the world of menopause. And because it incited fear, doctors became afraid to prescribe HRT. So now we have a situation in which doctors are doing what is in their legal best interest … rather than what is in your medical best interest. And that is why this question about how to find the right doctor to prescribe HRT is such an apropos question.

The reason it’s so difficult to find a doctor to prescribe HRT is because doctors will use any reason to avoid giving it to you. They will terrorize you with possible complications. They will tell you that you are not a good candidate. They will say you aren’t eligible because of a disease some family member had. They will plainly state that they do not believe in it (as if it were a religious preference rather than a hormone replacement).

The extrapolations and explanations are shocking.

Reason#4: Guidelines

After publication of the WHI study, all the guidelines for menopause management were changed. They were literally flipped upside down.

Instead of prescribing HRT

routinely for all women, the guidelines designated HRT only for women with severe symptoms of menopause.

for the primary purpose of preventing the three fatal diseases of estrogen deficiency, the guidelines designated prescribing HRT only for alleviation of severe symptoms of estrogen deficiency.

at a dosage capable of preventing the three fatal diseases of estrogen deficiency, the guidelines designated prescribing the absolute lowest dosage possible, which is incapable of preventing the diseases.

for the rest of your life, the guidelines designated prescribing HRT for the shortest time possible.

These are the guidelines that doctors are still following today. And with no menopause education whatsoever to make them aware of how ridiculous these guidelines are, this is what makes it such a challenge to find a doctor who will prescribe HRT or manage it in a way that accomplishes your goals.

My Menopause Education for You

The very reason I give this menopause education directly to you is because medical professionals do not have this education at all. It’s really difficult for you to find someone who will help you manage your menopause your way … when they don’t know how to manage menopause any way.

So I teach you everything you need to know in order to decide how you want to manage your menopause. And you can use what you learn in this education to find the right doctor to prescribe HRT for you.

This means that the education comes first. You can’t find someone to help you manage your menopause your way if you have no education with which to designate your way.

I teach you that you need to listen to your body. And your doctor needs to listen to you.

A Menopause Management Consultation

Women who have consultations with me know 90% more about menopause than doctors do. Therefore, they have a much easier time finding the right doctor to prescribe HRT for them. And that’s because I provide the entire menopause education and tailor it all specifically to each and every individual woman. Then, I coach them in precisely how to have the conversation in order to get what they want from a menopause manager.

Because the world of menopause is shouted with neglect and fear, you have to be careful not to burn your bridges. Having the wrong conversation with a doctor can definitely burn your bridges. But getting my education and tailoring everything to you avoids the pitfalls that make it impossible to find the right doctor for prescribing and managing HRT.

If you have a consultation with me, your options for a menopause manager change drastically. Without the education and tailoring that I provide, you need to look for someone who says they know something about menopause … even if it’s not true. =

But with my education and tailoring from a consultation, you can use any kind of provider for managing your menopause. They don’t have to know a thing about menopause. They just have to work with you and for you. In essence, after a consultation with me, all you need is a scribe. You will be empowered to decide what you want, and you will know how to get it.

Defining Your Goals

The first step in deciding how you prefer to manage your menopause is defining your goals. Once you’ve defined your goals, finding doctors who are potential menopause managers for you becomes very easy. You only want to consider the ones who will help you accomplish your goals.

Designating your goals entails choosing among several considerations. They include:

Alleviation of symptoms versus prevention of diseases
Non-pharmaceutical options versus pharmaceutical options
Menopause HRT versus birth control containing both estrogen and progestogen
Transitioning from birth control to menopause HRT
Short term versus long term hormone replacement

I’ll go through each of these briefly.

If your goal is alleviation of diseases that are caused by estrogen deficiency, you must use pharmaceutical HRT and take a dosage that is high enough to prevent the diseases. Non-pharmaceutical HRT cannot prevent the diseases.

If your goal is both birth control and menopause hormone replacement therapy, then you need to use birth control containing both estrogen and progestogen. And you need to find a provider who will prescribe it.

If your goal is to smoothly transition from birth-control containing estrogen and progestogen to HRT for menopause, you need to find a provider who will do so gradually.

If your goal is to take HRT over the long term, you need to find a practitioner who will give it to you for as long as you want it.

Your Way

Your goal is to find a doctor who will help you manage your menopause your way. Mere access to HRT is not equivalent to success with HRT. So you have to know what’s included in your way of managing menopause. You do not want to manage your menopause someone else’s way. And if you use a doctor who follows the guidelines, your menopause management will merely be a matter of taking the lowest dosage for the shortest time … and forfeiting any long-term goals.

So knowing how to find a doctor who will listen to you and help you manage your menopause your way is the absolute most critically important part of menopause management.

Speed Doctoring

Doctor-shopping is a lot like Speed Dating. Speed Dating is a process in which you spend only five minutes with each potential dating candidate to determine whether or not you ever want to see them again. And in those five minutes, you pose just two or three short, hypothetical, open-ended, dealbreaker questions that determine whether or not you ever want to see that person again.

Doctor-shopping is just the same. You can call it “speed-doctoring,” or more accurately, “speed doctor-shopping.” You might even be able to do speed doctor-shopping online. Here are the steps:

Get my education so that you know 90% more than most doctors about menopause.
If you need more guidance than just my education, schedule a consultation with me so that I can tailor everything specifically to you.
Using my menopause education (with or without a consultation), designate your goals.
Arrange five-minute interviews with multiple doctors. Pose the same two or three short, hypothetical, open-ended dealbreaker questions to each. Their answers to those dealbreaker questions will determine whether or not they are potential menopause managers for you.
Run from any provider who has only a single way of managing menopause or who sells a product.
Choose the doctor who will prescribe HRT in accordance with your goals and help you manage your menopause your way.

Here are some examples:

Example 1:

If you’ve decided that you want to take HRT for the rest of your life, one of the questions you’ll post to every potential speed-doctor candidate is: “What if I want to take HRT for the rest of my life?” You’ll get two kinds of answers:

Some will answer with, “Well that’s fine. That’s what you do with all hormone replacements for all hormone deficiencies.”
Others will answer with, “Oh no! I stop everybody at age 60.”
Which one do you want to see again?

Example 2:

If you’ve decided that you want estrogen plus progestogen birth control for peri-menopause and to switch to menopause HRT later in post-menopause, one of the questions you’ll pose to every potential speed-doctor candidate is: “How and when will I transition from birth control to menopause HRT?” You’ll get two kinds of answers:

• Some will answer with, “Well, we will listen to your body and transition when the time is right for you, personally … based on your personal benefits and risks.”
• Others will answer with “Oh I just take everyone off birth control at age 55, and put them on the lowest dosage of HRT.”

Which one do you want to see again?

For every question you can possibly pose, there will be answers that correspond with how you want to manage your menopause, and answers that conflict with how you want to manage your menopause. Do not waste any time trying to work with any of the doctors who provide answers that conflict with how you want to manage your menopause.

Remember that you are interviewing them. Create a spreadsheet to compare their answers. Take your time choosing a doctor. Hire slowly; fire quickly.

Do not engage with any doctor who does not help you manage your menopause your way.

Nobody Can Choose a Doctor for You

Be sure you understand that nobody else can choose a doctor for you. The entire goal is to manage your menopause your way. Well, nobody else knows what your way entails. Do not ask other people who they recommend for managing your menopause your way. Nobody knows.

Unfortunately, we live in a quick-fix marketing world. Everybody asks everybody else what to do these days. This will not work with finding a doctor to prescribe or manage HRT. You cannot shoot in the dark, start with just anybody, and expect success.

You have to do this in an orderly, methodical manner. That’s what speed doctor-shopping is.

No girlfriend, nurse, or doctor can recommend the right menopause manager for you. You have to find them yourself. And the speed doctor-shopping method makes it easy to do so.

How to Win at Menopause eBook

Recently, I published an e-book called “How to Win at Menopause”, which is all about finding the right doctor to prescribe and manage HRT.

Finding a doctor who will prescribe and manage HRT is such a huge problem that I felt the need to write an entire book on it! The great thing is that the book is very short, and it’s a guide that provides all the responses you need in any kind of conversation with your doctor, and tips and strategies for finding the right one.

So between this menopause education, my consultations, and my e-book, you should have no problem whatsoever finding the right doctor who will prescribe and manage your HRT. Just don’t expect shortcuts. There are none.

Because I wanted nobody to miss out, I priced my book at under $5. So order your copy of “How to Win at Menopause“, and get speed-doctoring!

I hope this, and my Ask Barbie segment, sets you on the path to success!

Watch the video version on YouTube

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