Menopause marks the end of regular menstrual cycles for people with uteruses. This part of life is preceded by a transitional phase called perimenopause, during which a person’s period becomes sporadic before stopping altogether. That’s typically when people begin experiencing telltale symptoms like hot flashes or vaginal dryness. In the United States, the average age of onset for cisgender women is 51 years old.
Although menopause is a natural biological process, it is still often shrouded in cultural stigmas. This can lead to shame or discomfort around talking about menopause, which may discourage women from seeking help to alleviate their discomfort. And even among obstetrician-gynecologists, who specialize in women’s reproductive healthcare, menopause is rarely an area of focus or expertise. Even when patients do consult with their OB-GYN, the average provider may not have the most up-to-date information about treatment options.
One survey found that only about 20 percent of OB-GYNs receive formal education about menopause care during residency. Another indicated that just 7 percent of resident physicians across specialties felt “adequately prepared” to manage menopausal patients. And a recent survey found that over 80 percent of obstetrics and gynecology program directors believed more menopause education resources were needed.
It’s a “double taboo,” says Flow Advisory Council member Dr. Maria Sophocles, an OB-GYN, menopause expert, and medical director of Women’s Healthcare of Princeton. “Standard OB-GYNs are busy focused on obstetrics and don’t always have the time to listen to a patient. The medical education system that trains clinicians in this county is late to the game and behind the times, and patients are frustrated with the lack of resources.”
But times are changing. In recent years, Dr. Sophocles has observed an increase in the prevalence of menopause specialists, who offer compassionate, targeted care for any physiological issues that arise during perimenopause or menopause. As our culture “wakes up” to the inevitability of this phase of life, more providers are becoming interested in treating it — and more patients are seeking out specialized care. It helps that celebrities like Oprah Winfrey and Drew Barrymore are using their platforms to educate people on the realities (and persistent taboos) surrounding perimenopause and menopause.
How do menopause specialists differ from your average OB-GYN? And what are the benefits of working with a specialist to address menopause-related issues? Flow spoke with multiple experts to better understand this emerging specialty. Here’s what they had to say.
What is a menopause specialist, and what issues can they treat?
Menopause specialists are clinicians with robust expertise in the world of menopause-related healthcare. They can be obstetrician-gynecologists, but they don’t have to be.
These providers go to great lengths to understand “the full scope” of how menopause affects the body, says Flow Advisory Council member Dr. Jessica Shepherd, an OB-GYN, menopause expert, and chief medical officer of VeryWell Health. That includes changes in “cardiovascular health, sexual health, and metabolic health,” she tells Flow.
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Practically speaking, menopause specialists can treat a wide range of concerns, including vasomotor symptoms like hot flashes and night sweats, vaginal dryness, weight gain, sleep disorders, thyroid disorders, and changes in lipid, heart, or bone health.
Since they work with women at midlife, these providers are familiar with the intersection of breast cancer treatment and menopause. They deeply understand how the transition into menopause affects chronic reproductive health issues, such as polycystic ovarian syndrome (PCOS).
They’re also well-versed in the pros and cons of menopause hormone therapy (MHT), which can be used to alleviate hormone-related symptoms like hot flashes, vaginal dryness, or night sweats. “Sometimes, doctors are not experienced or equipped to help start the [MHT] process,” explains Dr. Shepherd. Consulting with a menopause specialist can rectify that.
How do menopause specialists differ from regular OB-GYNs?
Although it may seem counterintuitive, menopause specialists aren’t always OB-GYNs. There is no medical degree for this specialty, explains Dr. Sophocles, so providers can be OB-GYNs, urologists, internists, nurse practitioners, or “any other clinician who has an interest in menopause.”
The North American Menopause Society (NAMS) offers a formal Menopause Practitioner certification, which is a route that many menopause specialists take to get training and verify their expertise. To become a Certified Menopause Practitioner, or NCMP, providers must pass a 2-hour exam, obtain continued education annually, and get re-certified every three years. It’s a robust program that does a “deep dive” on the full-body affects of menopause, says Flow Advisory Council member Dr. Heidi Flagg, an OB-GYN, menopause specialist, and clinical assistant professor at NYU Grossman School of Medicine.
If your current OB-GYN is also a menopause specialist, you can obtain routine and specialized treatment from the same provider — a “one-stop shop,” as Dr. Flagg puts it. But for many patients, that won’t be the case. It all depends on what’s available to you. And if your menopause practitioner isn’t an OB-GYN, you should still seek regular gynecological care from a board-certified professional.
What are the benefits of working with a menopause specialist?
As experts in a historically overlooked topic, menopause specialists understand the importance of validating patients’ concerns and treating them with compassion. Most of Dr. Flagg’s menopausal patients come to her with “some level of suffering and frustration,” she explains. Whether they’re struggling with sleep disorders or sexual dysfunction, these women are struggling — and they’re turning to clinicians for help, not dismissal. It’s no wonder Dr. Flagg “[wipes] a lot of tears” in her practice.
“Working with a specialist allows a patient to be heard,” adds Dr. Sophocles. Then, and only then, can a provider “open a dialogue about treatment options.”
Dr. Shepherd agrees — in fact, she “firmly believes” that every woman going through menopause should see a specialist regardless of her symptoms. Hot flashes and night sweats are just the tip of the iceberg: Menopause can usher in a wide variety of changes to multiple organ systems, which can go unnoticed (or unaddressed) by clinicians who aren’t experts.
Changes in bone and cardiovascular health are prime examples, says Dr. Sophocles. “A woman could see a doctor for joint pain and shortness of breath and be misdiagnosed with bronchitis when, in fact, these are actually symptoms of menopause.”
How to find a menopause specialist near you
Curious about consulting with a menopause specialist? There are plenty of resources to help you find a provider in your area. Drs. Sophocles, Shepherd, and Flagg recommend NAMS, which has a digital database of members and certified practitioners in the U.S. and beyond. You can filter your search by state, zip code, and travel radius. (Pro tip: You can also search your OB-GYN’s name to see if they double as a NCMP.)
Additionally, Dr. Shepherd shouts-out Alloy and MiDi Health, two virtual care centers designed for midlife women and centered on menopause care. Both platforms can connect patients with specialists.
And when in doubt, “talk to your friends and get a recommendation,” adds Dr. Flagg. “I still find that in my practice, many of my patients find me through word of mouth.”
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