Is This How Medicine is Supposed to Work?

My experience with an online menopause clinic.

Last spring I decided enough was enough. I was ready to see a menopause specialist and talk about menopause hormone therapy.

Six months later I finally got off the waiting list at my local menopause clinic but the earliest appointment wasn’t for another 5 months. Sigh. By this point I was growing impatient and decided to also book a telemedicine appointment with an online clinic. Depending on how that went, I could either keep or cancel my local, in-person appointment.

I initially tried to book an appointment through Gennev - I like that they don’t create any conflicts of interest by selling supplements or compounded drugs like many of the menopause-focused telemedicine companies do. But I couldn’t get the Gennev online scheduler to work so I ended up scheduling with Midi. I was able to book with a nurse practitioner licensed in Ohio for an appointment just a few days later. Hallelujah!

Logging on to the patient portal and into the video call was easy and the nurse practitioner was friendly. She listened to my symptoms and then made recommendations for starting a low dose estradiol patch and confirmed that I didn’t need progesterone because I have a progesterone IUD to protect my uterus.

And then things went a little bit off the rails when she asked, “And would you like to start testosterone or a GLP-1?”

It felt like she was asking, “And would you like fries and a drink with that?”

I replied that I didn’t have any weight concerns or symptoms that would justify starting testosterone, so no thank you.

She countered with the potential benefits of testosterone (information she told me she got from a menopause influencer she follows on Instagram, who I’m familiar with and who unfortunately spreads misinformation about testosterone for midlife women) and said that I might like how I feel on it, so I should consider trying it.

I reiterated that I wasn’t interested in taking any medication that I didn’t need and risk dealing with potential negative side effects. After that we closed the call.

We met again via video call a month later so we could talk about how I was tolerating the estradiol patch and talk through next steps.

And at this second appointment, she again offered me testosterone as well as oral progesterone.

I declined both. My uterus is already protected by my Mirena IUD - something she had confirmed during our first visit - and I have no symptoms that indicate I need additional progesterone or to start testosterone.

Her argument again was that while I didn’t technically need to take either of them, I simply might like how I feel while taking them.

After going back and forth several more times, I realized that I wasn’t a patient with medical concerns so much as a customer she wanted to keep happy. She was metaphorically handing me a menu of prescription drug options to sample, and giving me her recommendations based on what she thought I might like, rather than based on the symptoms I had hoped to treat.

I ended the video call flustered and frustrated. This isn’t how medicine is supposed to work, right?

I’ve had 8 weeks since that last telemedicine visit to process my experience before sharing it with all of you. And here’s where I’ve landed:

I think it’s important to recognize that for much of the past 25ish years, most clinicians were unwilling to prescribe menopause hormone therapy at all, even to women with severe, debilitating symptoms. The fact that I could make an appointment, meet with a clinician 2 days later and have a prescription in hand a few hours after that feels miraculous.

But I also worry that the pendulum has swung too far in the opposite direction. Now we have online telemedicine clinics that are designed to make menopause care as quick and easy as possible, with a very customer-forward approach. Because happy customers return, and happy customers tell all their friends.

I keep thinking about my husband, who trained for 60-80 hours a week for thirteen years and had to pass a sixteen hour exam to become a board certified cardiologist. Can you imagine if patients came to see him with a list of cardiac symptoms and he said, “And how about a statin or a beta blocker? You don’t have any symptoms or conditions that either of those drugs treat but you might like how you feel when you take them. A doctor I follow on TikTok says all patients should at least have the option of taking these medications, so if you want to try them I’m happy to write the prescription. It’s up to you.”

That would be utterly absurd right? It’s bad medicine.

Call me crazy, but I want to be shepherded through this process by a competent, knowledgeable provider I can trust. Because I recognize the vast limitations of my own knowledge and value the expertise that comes with a bajillion years of medical training and clinical experience. I want to be a patient, not a customer

Thankfully, I have an in-person appointment in a few weeks with a physician who is certified through The Menopause Society. Here’s to hoping she can better guide me through what truly feels like the wild world of menopause hormone therapy.

So after all that, would I recommend telemedicine?

Yes, but with reservations.

I would absolutely go into the experience having read through my menopause hormone therapy series and/or The Menopause Society’s Position Statement on Hormone Therapy (or their patient handout). That way, if your telemedicine provider asks, “And would you like fries and a drink with that?” you’ll at least have some idea how to answer.

Have you used telemedicine? I’d love to know what your experience was like. Reply to this email or better yet - leave a comment so we can all learn from your experience.

Until next week,

Rebecca

P.S. Once you hit a certain age …

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