Women Who Don’t Know Better Will Believe Him and Leave Feeling Silly for Caring

Written by: Meredith Paci | Functional Health Coach

This one is for any woman who has sat in an exam room and left feeling smaller than when she walked in. It is also for anyone raising a daughter, and anyone who knows or loves a woman who is about to walk into an appointment of her own.

In this week’s newsletter [LINKED HERE], I shared what happened to one of my clients when she went to a specialist for a second opinion. In short, she was told that if she wasn’t trying to get pregnant, her hormones didn’t matter, she was called silly for worrying, and when she stood up to leave, she was told to sit down because he wasn’t done speaking. She walked out. Her biggest concern afterward was for the women who would sit through that same appointment and believe him.

Before I go further, I want to be clear about something. I am not here to bash providers. Providers are necessary, there are fantastic ones out there, and Sarah and I work alongside them every week. There are also rotten people in every career path, period. In medicine, the stakes are higher. When an appointment is about the most private parts of your body, and you may be lying on an exam table with your legs in stirrups, you are about as vulnerable as a person gets.

My client’s story is one example. I hear a version of it every week. So this piece walks through how appointments too often go, how they should go, and what you can do to walk in prepared.

How appointments too often go

These are a PG glimmer of SOME of things women I have worked with have been told:

• Your hormones don’t matter if you aren’t trying to get pregnant.
• You’re silly for worrying about this.
• For low libido or painful sex: lie there and let your husband take care of it.
• Also for painful sex: drink some wine and loosen up.
• Have you tried relaxing more? Maybe take a vacation.
• This is your new normal. You’ll just have to get used to it.

I’ve been on the receiving end of this multiple times both long before and even after I was put into surgical menopause. An example I talk about often was while I was seeking care just prior to the surgery to remove my final ovary (while I was walking around with a partially twisted ovary mind you), I was told to buy myself some flowers and book a massage because that would make me feel better. As much as I believe in a good RMT (registered massage therapist), I have yet to see evidence that a massage preserves my bones, my brain, my blood sugar, or my heart.

Look at what those answers have in common. Each one shrinks the concern down to something else. Hormones get reduced to fertility. Pain during sex gets reduced to a relationship problem or nerves. Losing your ovaries overnight gets reduced to needing a treat. None of them answers the question the woman walked in with.

I believe one appointment, encouraging or dismissive, can shape the direction of a woman’s health for years. I can’t point you to a study that measures that. It is what I have seen in my practice, often and for years. A woman who is told her concern is silly often stops bringing it up, and the problem keeps going without anyone looking at it. It is a big part of why I work in functional health, and why I will always keep furthering my education.

Why your hormones count whether or not you want a baby

Your ovaries make several hormones, including estrogen, progesterone, and testosterone. Their jobs reach far beyond preparing your body for pregnancy.

1. Bones. Estrogen and Progesterone are important for your bones. When they drops, bone breaks down faster than it rebuilds.
2. Heart and blood vessels. Estrogen helps keep blood vessels flexible and supports healthy cholesterol levels.
3. Brain. Estrogen acts directly on the brain, including areas involved in memory and mood.
4. Vaginal and urinary tissue. Estrogen keeps these tissues thick and resilient. Without it they thin out, which raises the risk of painful sex and recurrent urinary tract infections. In older women, a urinary infection can spread and become serious.
5. Gut. Estrogen and the bacteria in your gut influence each other, and lower estrogen is linked to a less diverse microbiome. This research is still early.
6. Testosterone, which women make too (a lot of it actually and why we have estrogen), contributes to libido, sleep, vitality, muscle, and bone.

When these hormones drop years before the usual age of menopause, the risk of bone loss and heart disease goes up, and some studies link early estrogen loss to later changes in memory and thinking. Much of that comes from observational research, meaning studies that follow women over time and compare outcomes. Those studies show an association more than a proven cause, and you can still put two and two together. The bone and heart findings are strong enough that guidelines act on them.

A woman who knows this can tell when a provider is wrong. A woman who doesn’t has no way to tell bad advice from good advice, so she believes whoever has the authority in the room, especially when that authority gets flexed and she is told to sit down.

Guidelines are meant to guide

Guidelines are built from evidence, and they exist to protect patients from harm based on what we know. In my opinion, a provider who hides behind a guideline when the person in front of them doesn’t fit it is as dangerous as one who ignores guidelines altogether.

In my client’s case, there was no guideline to hide behind. The 2024 international guideline on premature ovarian insufficiency (POI), meaning the ovaries slow down or stop working before age 40, was published by ESHRE together with ASRM, the European and American societies for reproductive medicine. It calls for evaluating women under 40 whose cycles have stopped for at least four months. It recommends hormone therapy until at least the usual age of menopause to lower long-term health risk, whether or not a woman has symptoms, and it does not limit that care to women who are trying to conceive.

The advice against routine hormone testing that he may have been reaching for comes from menopause guidance written for women over 45, which in my opinion is outdated at best. And we are not talking about a woman over 45.

That “usual age of menopause” is a floor, people. I don’t believe there is an age at which hormone therapy should automatically stop, and current guidance doesn’t say it should. The Menopause Society’s 2022 position statement advises against routinely stopping hormone therapy at 60 or 65. I’ll write about that separately.

Guidelines are written to do no harm. He did harm.

How appointments should go

A few days after that first appointment, my client saw a different provider, and it was a complete turnaround. Here is what good care looked like in that room, and what you can look for in yours.

1. You are listened to. My client described it as being talked with instead of talked at or talked down to.
2. You are asked what you want out of the visit. My client said she wanted to rule out anything being missed and to have peace of mind. The plan was built around that answer.
3. What is working gets protected, and the decision stays yours. They discussed what my client is currently doing and what another option could look like. The provider felt my client was in a great, stable place and that it wasn’t worth disrupting. Then she gave my client the information and left the decision to her. That is the lesson: a good provider gives you their opinion and the information behind it, and you decide.
4. Options come with their limits. She laid out tests and suggestions that could rule different things out, and she was upfront about what each one could and couldn’t tell them, which ones were worthwhile now, and which ones weren’t yet. She talked openly about what is out there and about her own beliefs and experience, and she let my client decide what she wanted.
5. Your provider knows where their scope ends. For one possible next step, she said she would refer my client to another specialist team who could treat whatever they found during the same procedure, so my client wouldn’t have to go through a second one.
6. You decide together. My client left with decisions, options, and a plan she helped build.

That is the kind of provider, and honestly the kind of coach, I went looking for after my surgery. I walked into those early appointments with a knowledge base, and I sought out what I knew I needed. I also looked for a provider who knew more than I did, one who would bring me into the conversation, make me part of the decisions, and leave me excited about the direction and the possibilities.

How to walk in prepared

This is why I meet with my clients when their blood work comes back and before their provider appointments. It is why we do care coordination. Together we sort through their concerns, what is working, what isn’t, and what lines up with their blood work and what doesn’t, so they walk in prepared. Here is where you can start on your own.

1. Know why you’re going. Can you say in one sentence what you want out of this visit? What are your goals? Write it down and say it early. It is the question the second provider asked my client, and having the answer ready keeps the appointment pointed at your concern.
2. Write your questions down. It is easy to lose your list when someone talks over you. And frankly, an appointment can be emotional, and you may get nervous even with a provider you feel very comfortable with. A few questions that work in almost any appointment: What would you want to rule out for someone with my history? What can this test tell us, and what can’t it? If this isn’t something you treat, who would you refer me to?
3. Bring someone. I can truthfully say I have never regretted bringing my husband along when I could. A second person hears what you miss and can ask the question you froze on. After hearing the provider speak, they may also think of a question you hadn’t. If you work with a coach, ask whether they can join a virtual appointment. Sarah and I join appointments for our clients regularly.
4. If it goes badly and you don’t have a backup provider, you still have options. Ask for a referral to someone else who treats your concern, request a copy of your records, and get a second opinion. And by God, reach out to Sarah or me. This is what we do.

If you love a woman who has an appointment coming up, offer to go with her.

Where I land

What is well supported: losing ovarian hormones years before the usual age of menopause has long-term consequences, and the international guideline recommends evaluation and hormone therapy for women in that situation without tying it to pregnancy plans. Hormone health also reaches well past estrogen. Progesterone, testosterone, thyroid function, and digestive health all play a part, and a good appointment looks at the whole picture.

What is my opinion: the knowledge you bring into an appointment is what lets you tell good advice from bad, and a single appointment can change the direction of someone’s health for years. I hold that as an observation from my practice, and I will keep watching for research that tests it.

That said, whether a woman knows more or not, no woman should be treated the way my client was.

If you’re a coach

When Sarah and I join our clients’ appointments, we hear what the provider hears. We see how our clients change when they’re in front of a provider, and we learn how to support them differently afterward. We also build a referral list from the good experiences our clients bring back to us.

I would write this even if we didn’t offer a mentorship. We want more educated people in these rooms supporting women. If you’re a coach and want to learn how we do it, our group mentorship is where we teach it. If you work with a coach outside Fortify, ask them to reach out to us. [REQUEST A CALL HERE FOR MENTORSHIP]

Have a question you’d like answered in a future piece? Send it through our anonymous [Ask Fortify HERE].

If you have an appointment coming up, or you've just left one that didn't sit right, book a 1:1 strategy session with Sarah or myself and we'll work through it with you. [INQUIRE HERE]

Sources

• ESHRE, ASRM, CRE, and IMS Guideline Group on POI. Evidence-based guideline: premature ovarian insufficiency. Human Reproduction Open, 2024. https://academic.oup.com/hropen/article/2024/4/hoae065/7918369
• The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement. Menopause, 2022. https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
• NICE. Menopause: identification and management (NG23). https://www.nice.org.uk/guidance/ng23

Meredith Paci is the co-founder of Fortify Health Coaching. I am not a licensed medical provider. The content in this post is educational and does not constitute medical advice or a patient-provider relationship.