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It can take ten to 12 years for a person to experience perimenopause and menopause. The phases cannot be nailed down by a lab test, so it becomes important to troubleshoot the condition with your doctor. Women look to providers and often come up empty-handed on solutions to their symptoms. HerMD, which opened a Franklin location December 2022, seeks to help fill that gap by specializing in the gynecological side of OB/GYN while many clinics focus on pregnancy. 

HerMD OB/GYN Dr. Michelle Montville sat down with Nfocus to discuss what patients should be asking their providers.

What are some good questions for people to ask as they go through perimenopause and menopause? 

They wonder a lot about the timing. The length of the menopause transition, what to expect there. They wonder how to optimize their health moving through the transition — what are the things that they can do that are non-medicine — lifestyle and behavior modifications that can optimize their health. I think a good question to ask is how does her risk for certain health conditions change through menopause and after, and what kinds of screenings are then offered to women as they are older and go through menopause? I think those are all really good questions.

What are some of those non-medical changes that can help?

We encourage optimizing sleep, really good nutrition and exercise. All of the common sense stuff. But there are some really specific needs for women in perimenopause when it comes to quality sleep and a high protein, anti-inflammatory diet. As far as exercise is concerned,  it's making sure that they're incorporating some strength training and mobility exercises to maintain muscle mass.

I’ve heard that when you’re studying to become an OB/GYN, there isn’t much focus on the gynecological elements. Has that been the case in your own education? 

There's definitely a gap in the education for OB/GYN still to this day and so I think only 20 percent of OB/GYNs will be exposed to menopausal and sexual health care during their training. At HerMD, we can proudly say that 100 percent of our providers are menopause and sexual health trained.

What I've noticed since we've started seeing patients in our location, is just how relieved women are to be able to come to our space and have the opportunity to talk about these symptoms with somebody that’s skilled and able to help them through.

What are some things that patients tend to be surprised by when you’re educating them about menopause?

I think they are relieved to know that there are a lot of options available to help them with symptoms. A lot of people are candidates for hormone therapy when they believed they were not. I think they’re surprised to know the breadth of options. 

I do spend a lot of time explaining why hormone therapy is actually a quite safe option for the majority of patients and how it can help, but we always offer alternatives. For women that may not be hormone therapy candidates or they just prefer not to go that route, we talk about antidepressants and some supplements that may be useful. I always make sure I go back to those other lifestyle modifications that can actually help them quite a bit.

Perimenopause and menopause can be the first time a woman deals with more acute mental health struggles. How do you approach that with a patient?

We do spend a lot of time addressing mood disorders, anxiety and depression because it can be made acutely worse by menopause, or even women who have never had a history of mental illness will develop depression or anxiety within the transition. We just first start recognizing that they're not going crazy. These symptoms are real and she's not feeling well. Then, through shared decision-making, we can decide if it's something that we feel can be helped through hormone therapy, or if it's something that we can address with a referral to a counselor, or if we can even do SSRIs and other medical interventions in our office.  It starts by acknowledging that a lot of women for the first time ever feel not their best emotionally and mentally during their 40s and 50s.