As more women seek clarity and support during perimenopause, Dr. Lindsay Klein, a board-certified internal medicine physician, is passionate about helping women navigate this often-overlooked stage of life. A Fellow of the American College of Physicians. Dr. Klein brings over a decade of experience in primary care internal medicine, including 10 years at John Muir Health, and now practices at Banner Peak Health.
Dr. Klein's areas of interest include stress management, cardiovascular health, preventive care, and menopausal hormone therapy. In the following Q&A, she shares practical guidance on what women can do when facing perimenopause—from recognizing symptoms to exploring treatment options and reclaiming a sense of balance and well-being.
Q: How can women push back when their concerns or symptoms are dismissed? What can women do to ensure they are taken seriously and heard?
A: Unfortunately, it does happen quite a bit, especially to women in their early 40s, when they're having symptoms of perimenopause, they kind of do get dismissed or told at least, “Oh, you're too young for that.” I think what it comes down to is having a good relationship with their provider, whether that's their OB/GYN or their primary care doctor. Have a dedicated visit to bring up those concerns. In many traditional healthcare models, people are overwhelmed. And if the patient comes in with a list of, you know, 10 various issues going on. It's really hard for that doctor to address those issues in the 10 to 15-minute visit that they're allotted.
I'm fortunate in my practice not to have those time constraints. And I relish that, because it really does allow me to say, “Okay, well, tell me about your sleep. Tell me about your symptoms, when did they start?” and really take a good history, because you can find out a lot. So I think a lot of it just comes down to whether the patient can. If they can, they really should say, "I'm having these specific symptoms," and set up a dedicated visit to talk about them. If they're still getting pushed back after that, then they probably need to find someone else.
Q: What are the symptoms women should look out for when they are heading towards perimenopause?
A: The things that are talked about the most are hot flashes, but there are a lot of other symptoms that don't get talked about as much, and that are quite prevalent. Other symptoms include sleep disruption, insomnia, mood changes, brain fog, and joint pain.
I think joint pain often gets missed. People say, "Oh, well, you know, you're just getting older. You need to stretch more. You need to exercise more.” And with a lot of those patients, not all, but with many, you put them on hormone therapy, and they do feel better.
Q: Should women be seeing their ob-gyn, a primary care physician, or a menopause/hormonal specialist when they experience symptoms?
A: I'm a primary care internist, and so because I have a special interest in women's health and hormone therapy, I feel perfectly comfortable talking about these issues and prescribing hormone therapy, but there are many primary care doctors who are not. From a basic standpoint, most women should start with either their primary care doctor or their OB/GYN. Unfortunately, though, women should know and realize that even their OB/GYN does not get a lot of training in menopausal hormone therapy, and so that's an area of medicine that is really booming right now. There's a lot more being talked about than there was 10 to 15 years ago, but it's a lot of doctors learning from each other, from podcasts, and from other folks who are now considered experts in those fields. And so it really takes a physician who has some experience in it and who's willing to take the time to learn about it, which can sometimes be hard to find.
Q: When is it time to seek a second opinion, find a menopause-certified provider, or simply switch doctors?
A: If women are having these symptoms, and they're a little gun-shy about bringing it up to their doctor, and they're curious, one simple thing that patients can do is actually check on the Menopause Society website, at menopause.org, to see if your doctor is menopause certified. And so you may want to first bring these issues up with the person who is already menopause certified.
The other thing I would say is just to do a gut check. If you brought it up with your primary care doctor and don't feel like you got any traction, maybe bring it up with your OB/GYN. And if you really don't get traction there, it might be time to check the Menopause Society website to find someone in your area who's menopause-certified and go see them. It may not end up being a long-term relationship. Sometimes it's just a matter of finding the right combination of hormones, and once you find the right one for you, you can go back to one of your doctors and say, “Listen, I went to see somebody else, and they put me on this, and it's working for me. Can you, can you take over at this point?”
And I would say that most doctors, I think, don't get offended by that, especially because there are a lot of women now who are turning to these telehealth medical organizations to get their needs met because they're not getting them met with their primary care doctor or with or even with their OB/GYN.
SIDEBAR:
Dr. Klein received her medical degree from The George Washington University School of Medicine and Health Sciences. She completed her residency in internal medicine at Cedars-Sinai Medical Center in Los Angeles. Visit Bannerpeakhealth.com/