This is going to be a long one. Thanks, in advance, for getting to the bottom with me.
A curious and scary collection of symptoms coalesced about a month ago. I woke up with vertigo one morning (room spinning). I felt pronounced numbness and tingling in my hands and face. More headaches over the course of some days. An odd pulsing/swooshing sound in my head. Changes in my vision that produced what appeared to be a drop shadow on text when looking at black screens.
From my extensive peri/menopause research over the last year, I knew that all of these things could potentially be hormonal, but they were scary enough that I wanted to get guidance from medical professionals.
I first tried to schedule a “wellness visit” with my local doctor and the earliest appointment I could get was eight weeks out. (We live in a rural area. Quality healthcare and timely scheduling is a real issue. For more context, my family and I try really, really hard to stay out of the US healthcare system. We’re fortunate to have pretty good insurance and are in a position of privilege in that our deductibles are low enough that a health crisis won’t bankrupt us, but we have strong feelings about the state of this system and try to avoid participating in it wherever we can.) I took the appointment, but decided the following weekend I wasn’t willing to accept that.
I called another clinic where I had previously seen a nurse practitioner that I really appreciated (the 45-minute drive is the ONLY thing that prompted a switch to the other doc mentioned above), but they didn’t have any appointments the following week. I called the local clinic back to see what my options were for a “sick visit.” The OB/GYN could see me Thursday (better). She was the only Menopause Society Certified Practitioner in our county (until she wasn’t or wasn’t accepting new patients and we were left with zero) and within a 40-mile-ish radius, and one of only two within less than two hours. I got a call a little while later saying she wouldn’t actually be in the office that day but could see me the following week. I declined.
Eventually I got an appointment with the GP later in the week due to a cancelation. I left with a migraine prescription, some exercises to induce vertigo to prevent more vertigo, and an order for an MRI (“to rule out MS.”) No discussion about why migraines and MS were the only two considerations and a blatant dismissal of any connection between headaches and perimenopause. It became very clear at that point that I was significantly more informed about perimenopause than the physician, though I didn’t disclose that. I did, however, decide I would not be back to see her.
The next afternoon, I felt pronounced numbness and tingling in my hands and face. I sat with that for a bit, testing myself to see if I could raise both arms, if both sides of my face could smile, and reading through other stroke indicators. It didn’t seem to be a stroke, but it was scary nonetheless. The closest ER is 30 minutes away. The closest urgent care is less than five. I eventually opted for urgent care, only for them to help me make a decision about whether or not I should go to the ER.
I left feeling incredibly upset and deeply regretful about having made that choice (though grateful my husband arrived a few minutes after I did to witness it). Rather than take a compassionate approach, the people I saw there were condescending, rude, and dismissive, and shamed me for not following the treatment protocol (taking the migraine med I didn’t want in the first place). They gave me a glucose test almost as a consolation prize trying to appease me with a test or diagnosis of some sort.
These were my first experiences with what unfortunately seems to be status quo during this life phase, medical gaslighting, and even worse and more prevalent for Black women and other historically marginalized communities. (Note, if you follow the first link, that healthcare practitioners are starting to move away from describing hormone therapy as HRT/Hormone Replacement Therapy and instead toward saying Menopausal Hormone Therapy or MHT instead as we’re not actually replacing lost hormones.)
The numbness and tingling eventually subsided a few hours later.
I called the other clinic 45 minutes away and told them I wanted to return to the NP as my primary. I was able to get an appointment with her later the next week. The nurse suggested a wellness visit, since I was due anyway, and that would allow for more space for conversation and evaluation. Five tubes of blood were drawn and a pelvic ultrasound ordered. I was again most definitely not in perimenopause because according to this visit, one of the indicators is irregular/unpredictable cycles. My cycles have been very consistent, just double the length of bleeding I used to experience (over the last 15 months.)
I also scheduled a separate $350 menopause consult appointment with a NAMS-Certified Menopause Practitioner for the following week two and a half hours away to get a fourth opinion. (Again, acknowledging the extreme privilege here to 1) be able to afford this, 2) to have a supportive day job manager and 3) to be able to use sick time to do this for a whole afternoon during the week.)
My bloodwork came back within normal ranges.
| TSH | VITAMIN D25-HYDROXYVITAMIN D SERUM | IRON | TIBC | % SATURATION | UIBC (CAL) | FOLATE |
| VITAMIN B 12 | CHOLESTEROL | TRIGLYCERIDES | HDL | DIRECT LDL | VLDL (CALC) | CHOL/HDL |
| SODIUM | POTASSIUM | CHLORIDE | CO2 | GLUC | BUN | CREATININE |
| eGFR | T. BILIRUBIN | ALT (SGPT) | AST (SGOT) | ALK PHOS | T. PROTEIN | ALBUMIN |
| GLOBULIN | A/G RATIO | CALCIUM | WBC | RBC | HGB | HCT |
| MCV | MCH | MCHC | RDW | PLT | MPV |
I went in for my MRI on a Sunday at the local hospital. The woman who checked me in couldn’t tell me how much it would cost. How fucked up is that?
I scheduled one more round of blood tests (I wanted to rule out B-12 deficiency for myself and learned about testing MMA and Homocysteine for this. Along the way, I learned that the symptomology for Vitamin B-12 deficiency can look similar to that of MS. Using Ulta Lab Tests for this was a great experience.)
On Monday I drove up north and completed the additional blood work and went for the menopause consult. I got to spend more than 90 minutes in a compassionate, supportive, educational, and empowering visit. The foundation for the conversation was North American Menopause Society’s Menopause Health Questionnaire. (While I don’t love that it was last updated in 2005, it’s incredibly comprehensive and I’d highly recommend you take the time to fill it out to share with your doctor or nurse practitioner, regardless of whether they are a member of the organization or a certified practitioner.) We talked through the data from the Women’s Health Initiative (WHI), how hormones fluctuate throughout the month, risks vs. benefits of various treatment options, and sexual health.
Tuesday I heard my MRI came back with “nothing remarkable.” My vision changes were fortunately explained by an astigmatism that day, too.
And Wednesday’s pelvic ultrasound, normal, too.
The conclusion? “It must be hormonal.”
Along the weeks-long and intensely emotional journey, my husband reminded me about Occam’s Razor, “a principle attributed to the 14th century logician and Franciscan friar William of Ockham.”
“Isaac Newton stated the rule as: “We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances“.
The most useful statement of the principle for scientists is “When we have two competing theories that make exactly the same predictions, the simpler one is the better.””
AND, “Occam’s razor also comes up in medicine. When there are many explanations for symptoms, the simplest diagnosis is the one to test first. If a child has a runny nose, it probably has the common cold rather than a rare birth defect. Medical students are often told, “When you hear hoof beats, think horses, not zebras”.[14]“
Explanations of Benefits are just starting to roll in. I suspect we’ll ultimately be out more than a thousand dollars out of pocket, plus hours on the road, hours of research, and dozens of hours of worrying. (Yes, I am absolutely grateful everything came back normal, at least.)
While three of the medical professionals I saw were in agreement that the MRI was indicated, it’s all about delivery of the messaging. And three of the four people I saw were not focused on the most simple explanation when talking through my path forward, unfortunately.
This all has me wondering what the collective societal and healthcare costs are of the lack of education on all fronts. Given that more than 1B women are estimated to be post-menopausal by next year and perimenopause symptoms can be similar to those of so many other, much scarier, conditions and diseases, I am certain the numbers and costs are not small.
Want to share your story? Send a note to hello at menopausey dot com or complete the anonymous survey (as a peri/menopausal human or a partner to one) to help shape the future of Menopausey and peri/menopause health, education, and community.
You’re not in this alone.
Header image generated by Adobe Firefly. Prompt: “A white woman patient in her 40s is in a doctor’s office. The patient is confused and feeling small and dismissed by her healthcare professional. She is visibly frustrated. She doesn’t know who to trust. The patient is the primary subject of the photograph. The doctor is in the background.”
