Tag: menopause symptoms

Menopause Treatment by Telemedicine: How It Works

On By Dr. Scott RennieIn Menopause & Women's HealthLeave a comment

For many women, menopause care has long been an afterthought in traditional medicine. The conversation often starts late, if it happens at all. Now, thanks to telemedicine, that’s beginning to change.

Over the last few years, virtual menopause clinics have emerged to fill a long-standing gap in women’s health. Clinics like Midi Health and Menopause RX connect women directly with clinicians trained in menopause care. According to the Centers for Disease Control and Prevention, about 42 percent of women now use telemedicine, and a growing number are using it specifically for midlife and menopausal health (Pevzner, 2025; CDC, 2025).

This shift matters. Research shows that most doctors receive little or no formal training in menopause management. A 2019 Mayo Clinic report found that only 7 percent of medical residents felt prepared to manage menopause (Mayo Clinic Proceedings, 2019). Women often report their symptoms being dismissed or overlooked. In a 2025 survey of 1,000 women aged 45 to 60, nearly 71 percent said their physician didn’t adequately prepare them for menopause or discuss treatment options (Pevzner, 2025).

That’s where telemedicine can help. Virtual menopause clinics provide timely access to clinicians who understand hormonal transitions and can offer evidence-based guidance. As Dr. Sherry Ross, an ob-gyn in California, explained in a Yahoo Health interview, these platforms solve many of the problems in the current healthcare system, particularly access and education (Pevzner, 2025).

Telehealth also reaches women in rural or underserved areas where menopause-certified specialists are scarce. The Menopause Society, formerly NAMS, highlights this benefit in its educational resources, noting that virtual platforms can deliver specialized care to women who might otherwise go without it (The Menopause Society, 2025). On my own panel, roughly 25 percent of women arrive already on hormone therapy started elsewhere; most others are still looking to start when they get to me. That tells me how far this shift has already gone outside primary care.

Virtual visits handle a fairly wide range of these symptoms: hot flashes, sleep disturbance, mood changes, low libido, and mild vaginal dryness lead the list, and each of these can often be addressed through careful history, lifestyle interventions, and evidence-based hormonal or non-hormonal therapies (Pevzner, 2025).

Of course, telehealth isn’t the right fit for everyone. Complex or potentially serious symptoms such as postmenopausal bleeding, abnormal discharge, breast changes, or pelvic pain still require in-person evaluation. As Dr. Robin Noble, a gynecologist in Maine, reminds clinicians, some conditions simply can’t be ruled out without a physical exam (Pevzner, 2025).

That balance is important. Telemedicine can’t rule out postmenopausal bleeding, abnormal discharge, or a breast change over video, and it shouldn’t try to. The best virtual programs integrate follow-up visits, communicate with the patient’s primary physician, and make sure screenings like mammograms and Pap smears stay on schedule (The Menopause Society, 2025).

When colleagues ask how to steer patients toward credible virtual options, I start with licensure: is the provider licensed and, ideally, certified by The Menopause Society (MSCP)? From there, check that the clinic’s data security is HIPAA-compliant, and don’t sign on until there’s a real process for ongoing monitoring and coordination of care (The Menopause Society, 2025).

Here’s where I push back on the marketing a little. Platforms like to say virtual care “closes the gap,” but a same-day video visit doesn’t fix a residency curriculum that gave menopause a few hours of teaching total. It gets a patient to someone who knows the topic faster. It doesn’t fix why so few primary care doctors learned it in the first place.

Some version of this comes up constantly: a woman held off on raising her symptoms because she didn’t want to waste the doctor’s time. Then she gets to someone who takes the question seriously, and what she finds is reassurance and a plan. That’s the kind of access we should all want for our patients: timely, informed, and respectful of their experience.

Menopause care is finally catching up with the rest of modern medicine, and telemedicine is a big part of why.

Scott Rennie, D.O.

References

Pevzner, H. (2025, July 30). Your complete guide to getting menopause help online. Yahoo Health. https://www.yahoo.com/lifestyle/menopause-telehealth-guide

Centers for Disease Control and Prevention (CDC). (2025). Telemedicine utilization data.

Mayo Clinic Proceedings. (2019). Menopause education in residency training.

The Menopause Society (formerly NAMS). (2025). Professional resources and video library.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Why Menopause Care Is Missing From Women’s Checkups

On By Dr. Scott RennieIn Menopause & Women's HealthLeave a comment

I hear some version of the same question most weeks on video visits, patients trying to figure out whether what they’re feeling is actually menopause.

Women often come to me with vague but frustrating symptoms. Trouble sleeping. Brain fog. New anxiety. Irregular or heavy periods. Weight creeping up despite no major changes. Sometimes joint pain, palpitations, or new migraines. Many times, we both suspect something hormonal. The connection to menopause doesn’t always click right away.

Most of us were never taught to see the menopause transition as its own physiologic phase with real preventive implications, not because we don’t care. Medical training gives menopause a brief mention inside reproductive aging, with the emphasis staying on fertility, not on what happens once it ends. Patients ask me about hormone therapy, sleep, mood, or sexual changes, and more often than I’d like, I don’t feel equipped in the moment to explain what’s happening or lay out the options.

The average woman in the United States reaches menopause at about age 51, according to the Mayo Clinic (2024). The years leading up to that point, called perimenopause, can last four to eight years. Hormone levels fluctuate widely during this time. These shifts affect body temperature regulation, brain chemistry, metabolism, and cardiovascular function. Symptoms can begin well before the final menstrual period. A woman in her mid-forties may show up with new anxiety, fatigue, or night sweats. That’s an easy substitution to make instead of perimenopause, and it’s one I watch for now specifically because of how often it happens.

There are several reasons why menopause-related concerns get missed. Many women are still menstruating irregularly and do not yet think of themselves as menopausal; primary care visits are short and filled with competing priorities. The confusion that followed older studies on hormone therapy still lingers. I’d rather be direct about where I land: the newer safety data is solid, and hesitation still rooted in the old fear is outdated. Newer research from The Menopause Society and the National Institutes of Health shows clear safety and benefit for most healthy women under 60 or within 10 years of menopause onset (The Menopause Society, 2023; NIH, Office on Women’s Health, 2024).

I ask every woman in her forties about menstrual changes, hot flashes, sleep, mood, libido, and vaginal or urinary symptoms, because awareness starts with the question, not the answer. Simple questions open the door. If a patient raises the issue herself, I’d rather start the conversation than defer it to a specialist on the spot.

I lean on The Menopause Society’s practical resources and CME, and I’m working through their Menopause Society Certified Practitioner (MSCP) program myself. Reading Menopause Practice: A Clinician’s Guide or reviewing their treatment algorithms has strengthened my own confidence here. Other organizations such as the NIH, AAFP, and Cleveland Clinic also offer free CME courses and case examples.

Treatment doesn’t always mean prescribing systemic hormone therapy right away. I explain the range of choices and personalize them: for some patients that means hormone therapy, for others it’s non-hormonal medications, localized vaginal treatment, or lifestyle interventions. For a symptomatic perimenopausal patient who still needs contraception, I favor continuous combined hormonal contraceptives, since standard menopausal hormone therapy can produce breakthrough bleeding in that setting; a typical low-dose choice is ethinyl estradiol 20 mcg plus levonorgestrel 100 mcg orally once daily, often continuously. If contraception isn’t a factor, my usual starting menopausal regimen is transdermal 17-beta-estradiol 0.025 to 0.05 mg/day plus micronized progesterone 100 mg nightly, continuously, if the uterus is present. Weight-bearing exercise, protein intake, and good sleep remain foundational regardless of what else we add. My job is to know the options well enough to guide that discussion, and to know when a referral actually helps more than I can.

When menopause management becomes part of preventive care, patients feel seen and supported. It becomes a normal part of the health conversation, the same as colon screening or cholesterol management; I try to keep these discussions inside the relationship I already have with a patient, rather than routing her to someone new for something I can manage myself.

Menopause represents a turning point for cardiovascular, metabolic, and bone health, and recognizing it early is a real opportunity to prevent disease later. My honest read on where primary care gets this wrong: it’s decades-old caution about hormone therapy that the newer data no longer supports, not a lack of caring. Women deserve clinicians who treat that caution as outdated and prescribe with the confidence the evidence now allows.

Scott Rennie, D.O.

References:

Cleveland Clinic. Menopause and Preventive Care: What Every Woman Should Know. 2023.

The Menopause Society. Menopause Practice: A Clinician’s Guide, 6th Edition. 2023.

Mayo Clinic. Menopause: Symptoms and Causes. Updated 2024.

NIH Office on Women’s Health. Menopause and Heart Health. 2024.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Perimenopause and Menopause Symptoms and How to Manage Them

On By Dr. Scott RennieIn Menopause & Women's HealthLeave a comment

Menopause comes up on my schedule most weeks, and patients still arrive unsure what to expect from it. So it helps to start with definitions. Perimenopause is the transition before menopause. Hormone levels fluctuate, cycles become irregular, and the phase can run several years. Menopause itself is twelve straight months without a period. The average age in North America is around 51.

Symptoms vary more than most patients expect. During perimenopause, bleeding may be heavier some months and absent others. Hot flashes and night sweats are common. Some women notice mood changes or brain fog. Others raise vaginal dryness or discomfort with intercourse, usually only after I ask directly. Sleep problems come up constantly, and they are often just night sweats wearing a different hat. In full menopause those symptoms can continue, though bleeding stops for good. Skin and hair changes, weight shifts, and urinary urgency show up here too.

One patient in her late forties came to me worried she had a thyroid problem. She felt “off,” with fatigue, poor sleep, and irregular cycles. Her lab work came back normal, but her story fit perimenopause cleanly. That visit turned into the conversation she had actually needed, about what was happening in her body and what we could do about it.

Treatment follows the symptom pattern and the patient’s health profile. For hot flashes, hormone replacement therapy is the most effective option we have, though it is not right for everyone. Non-hormonal options including SSRIs and gabapentin also reduce vasomotor symptoms. Vaginal estrogen, as cream or tablets, works well for dryness and discomfort. Lifestyle changes carry real weight: a cool bedroom, less alcohol, regular exercise, stress management. Cutting caffeine after mid-afternoon sometimes does more than patients expect.

Preventive care deserves attention in this phase. Bone health matters more once estrogen declines, so I bring up calcium, vitamin D, and weight-bearing exercise. DEXA scans depend on age and risk factors. Cardiovascular risk climbs after menopause, which makes cholesterol, blood pressure, and diabetes screening worth staying current on. Breast and cervical cancer screening continue as appropriate. Colon cancer screening tends to land right in this age range as well, and over video I have to ask about it directly, because nobody volunteers that they are overdue.

Menopause is a normal stage of life that still manages to catch people off guard. Family physicians are well placed to normalize the conversation, take the symptoms seriously, and point patients toward both relief and prevention. Medication is not always part of that. Listening and practical support always are.

Scott Rennie, D.O.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.