If you are experiencing symptoms of perimenopause or menopause, the treatment options you are offered should be based on your symptoms, medical history, individual risk factors, preferences, and the best available medical evidence.

They should not depend on whether your doctor personally “believes in” hormone replacement therapy.

Women absolutely have the right to decide that hormone therapy is not right for them. But physicians also have a responsibility to understand the evidence, explain the benefits and risks accurately, identify appropriate candidates, and allow women to make informed decisions about their own care.

Unfortunately, I continue to hear the same stories from women every week.

“My Doctor Told Me I’m Too Young for Menopause.”

Perimenopause commonly begins years before the final menstrual period.

During this transition, estrogen levels can fluctuate significantly, and women may experience symptoms including:

• Hot flashes and night sweats
• Difficulty sleeping
• Mood changes
• Brain fog or difficulty concentrating
• Vaginal dryness or discomfort
• Pain with intercourse
• Changes in sexual function
• Changes in menstrual cycles

You do not have to wait until your periods completely stop before discussing treatment.

ACOG recognizes perimenopause as the transition leading up to menopause and states that hormone therapy can be used to relieve symptoms of both perimenopause and menopause. 

“Your Hormone Levels Are Normal.”

This is another reason women are sometimes told they cannot be experiencing perimenopause.

But hormone levels can fluctuate substantially during the menopause transition. A single estrogen or FSH measurement may therefore tell us very little about what a woman has been experiencing over the preceding weeks or months.

In fact, ACOG states that routine hormone testing is not recommended before starting hormone therapy for menopausal symptoms because hormone levels change so much during this stage. Clinical symptoms, menstrual changes, and medical history are often more useful. 

Your symptoms should not be dismissed simply because one laboratory result happened to fall within a reference range.

“Hormone Therapy Is Too Dangerous.”

Hormone therapy is not appropriate for every woman.

That is very different from saying that hormone therapy is inappropriate for all women.

For properly selected patients, menopausal hormone therapy remains an established medical treatment. Systemic estrogen is considered the most effective therapy for menopausal hot flashes and night sweats, and estrogen therapy can also help prevent the bone loss that occurs around menopause. 

There are also multiple FDA-approved forms of menopausal hormone therapy, including estradiol patches, gels, sprays, oral medications, vaginal estrogen products, progesterone, and combination therapies. 

The appropriate medication, route, dose, and need for progesterone depend on the individual patient.

That is why menopause care should involve an actual medical evaluation—not fear, blanket rules, or one-size-fits-all treatment.

When Is It Time for a Second Opinion About Menopause?

Consider seeking a second opinion if your symptoms are affecting your quality of life and you are told:

“You still have periods, so it can’t be menopause.”

“Your labs are normal, so your symptoms aren’t hormonal.”

“You have to wait until menopause before we can treat you.”

“I don’t believe in hormone therapy.”

“Hormones cause cancer, so I don’t prescribe them.”

A second opinion does not mean that hormone therapy will necessarily be recommended.

It means you deserve an evaluation in which all reasonable options are considered using current medical evidence.

Sometimes the right answer is hormone therapy. Sometimes it is a nonhormonal treatment. Sometimes additional evaluation is necessary first.

The important part is that the decision is individualized.

Hispanic Women Deserve Better Menopause Care

For many Hispanic women, finding menopause care comes with another challenge: finding a physician who can explain complicated medical decisions in our language, understand our concerns, and actually listen.

You should not have to translate your symptoms before you can advocate for yourself.

You should not have to spend months waiting for an appointment just to be told that what you are experiencing is “normal aging.”

And you should not have to accept inadequate care simply because menopause has historically been undertreated.

Hispanic women deserve access to evidence-based medicine, in our language, delivered with respect.

Menopause Telemedicine in Puerto Rico, Florida and Texas

At Cabán Metabolic Wellness, I provide individualized perimenopause and menopause consultations by telemedicine for women in:

Puerto Rico • Florida • Texas

Telemedicine allows you to receive medical care without losing hours of your day driving to an office, sitting in a waiting room, or rearranging your entire routine.

During your initial consultation, we can discuss your symptoms, medical and family history, previous treatments, concerns about hormone therapy, and the options that may be appropriate for you.

The goal is not to convince every woman to use hormones.

The goal is to make sure you have enough accurate information to make an informed decision about your own health.

You Have the Right to Ask for Another Opinion

If you have been living with symptoms that are affecting your sleep, sexual health, concentration, mood, comfort, or quality of life—and the answers you have received don’t make sense—it may be time for another conversation.

Women do not need someone to “believe” in hormone therapy. We need physicians who understand the evidence.

If you live in Puerto Rico, Florida, or Texas, schedule an initial menopause consultation with Cabán Metabolic Wellness.

We can review what you have been experiencing, discuss your options, and determine together whether ongoing menopause care is right for you.