Medically reviewed by Dr. Tamara Neuhaus MD
I remember July 2002 quite profoundly. That was the month I started my internship in Obstetrics and Gynecology. Nine days into my training, the Women’s Health Initiative (WHI) released their findings on the largest hormone therapy (HT) study ever done (161,808 women) and consequently halted the study citing excess risks of heart disease, stroke, and breast cancer.
An emergency meeting was called for the entire Ob/Gyn department at my hospital, and my future mentor stood in front of everyone to share the findings. I could tell, in that moment, that something big was happening. The seasoned physicians were angry, the younger ones were confused, and the residents, frankly, were bewildered. What I didn’t understand was the extent to which this study and its bungled interpretation would disrupt the care and research of women in peri/menopause for decades to come.
Over the four years of my residency, our attending physicians dedicated little to no teaching time to the art of managing peri/menopause with hormones—a trend that persists today with 80% of Ob/Gyn residency programs offering no formal education on the topic. And almost every woman who was taking combined hormone therapy (estrogen + progestin) in 2002 stopped taking it on the advice of their doctors. “Just suffer through. It’s temporary. You can try herbals or yams or soy. Menopause won’t kill you.” Those became the mantras.
But still, I couldn’t shake my fascination with hormones and hormone pathways. My favorite cases and lectures involved analyzing bleeding patterns and learning how estrogen and progesterone play out in our bodies. I was geeking out on birth control pills and different generations of progestins way before it was cool (and believe me, it’s very cool). I did my resident research project on a hormonal disorder called polycystic ovarian syndrome (PCOS) and strongly considered specializing in reproductive endocrinology and fertility (using hormones to aid conception).
And yet like so many Ob/Gyn residents, when I graduated, I joined a practice and immediately got busy performing surgeries and catching lots (and lots) of babies. Time flew by, my practice evolved, and both my patients and I grew older and wiser. We had entered our post-reproductive years, and my patients were looking for relief from symptoms of perimenopause. I realized I needed to learn how to care for them.
Thus began my three-year foray into learning all I could to support women in their mid-life phase. I spent time reading menopause literature, talking to experts, working with a naturopath, and proudly becoming a North American Menopause Society (NAMS) Certified Provider.
I studied the nuances of the WHI study and how to safely prescribe hormones based on individual health histories and menopause symptoms. We know now that there were some significant flaws in the study and how the data was interpreted. First of all, the average age of the women studied was 63. And the results were extrapolated to healthy 40- to 50-year-olds. Second, the hormone treatments studied were not the bioidentical hormones that are available today.
I also researched non-hormonal prescriptions proven to alleviate menopause symptoms, and spent time learning about herbal remedies, botanical treatments and lifestyle changes that women have used for thousands of years. There is a surprisingly large number of options for women these days, and it’s been fascinating to learn about them.
Fast forward to July 16, 2018, another day I remember profoundly. This was the day I learned that I carry the BRCA2 mutation—a genetic glitch that puts me at significantly greater risk for breast and ovarian cancers. Having counseled my own patients with this mutation in the past, I already knew that I would choose preventive surgeries. I also knew that meant I would be choosing menopause—at age 42. Suddenly, embarrassing hot flashes, drenching night sweats, brain fog, and irritability became exceptionally personal. My patient relationships deepened with empathy. Practically overnight, I went from knowing how to help them, to experiencing what they were experiencing, and knowing first-hand how it was impacting them.
Now, I don’t have a corner on the empathy market. I’m not the only female gynecologist who has gone through menopause. But for the past 3 years, I’ve been living, breathing, and researching menopause and perimenopause. In the process, I’ve made myself an expert on a medical issue that affects more than half of our population, yet has been largely ignored. My deep knowledge of, passion for, and exclusive focus on this life stage has allowed me to call myself something new to medicine: a menopause specialist.
And here is what that is:
A menopause specialist is up to date on the current science (because it’s always evolving), best practices, and promising innovations in peri/menopause care.
A menopause specialist will partner with you as your peri/menopause experience changes over time.
A menopause specialist understands the nuances of how the symptoms show up, across populations.
A menopause specialist knows what's likely to work—across natural and medical treatment options—and understands the art of prescribing personalized treatments.
A menopause specialist knows what questions to ask.
They say that a doctor’s practice ages with her. This couldn’t be more true for me. And it has a lot to do with why I leapt at the chance to join a digital health start-up intent on reimagining peri/menopause care. I am passionate about the need to provide this service because it’s profoundly needed and profoundly personal for me. Here at The Cusp, I have the time and resources to focus all of my attention on how to help women through their menopause transition. And I’m surrounded by a team of other menopause experts who share that focus. The simple fact is that we’ve taught ourselves things most gynecologists haven’t been taught. And with this knowledge, we’re creating a new medical specialty where there should have been one all along.