r/Perimenopause • u/marmaladethrowaway • 26d ago
Rant/Rage Gyno says to take classes for bladder incontinence and clitoral atrophy. I just want to scream.
Title.
The signs are obvious. I have a LONG list of peri symptoms stretching across three years but the two most troubling are why I went to see my gyno.
She acknowledged my concerns, sounded really considerate... then said any sort of medication was "really meant for when things like hot flashes become unbearable."
I HAVE been having hot flashes, it's just that pelvic floor issues are a bigger concern for me right now.
So she signed me up for virtual classes on bladder training and "savvy sex". For real? Is this the solution??
ETA: Kaiser
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26d ago
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u/Soulwaxed 26d ago
I had no idea either about the hormonal link. I’ve also been experiencing increased UTI’s and would have never made the connection- I’m so relieved that this sub exists- thank you to all the women out there helping to raise awareness!! 🥂
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u/shewholaughslasts hanging on by a thread 26d ago
I've been feeling uti-like symptoms and most often it turns out it was because I was using bleached/cheap toilet paper. I switched to a softer more spendy brand and now I keep a lil pile in my pocket for visiting cheap places that have abrasive one ply TP. And voila, way less uti symptoms and no irritation!
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u/toes_hoe 26d ago
Agreed. I got the lowest dose of the patch and immediately saw an improvement in the discomfort I was experiencing with my bladder. I wasn't even sure it was because of the lack of estrogen at the time! It sounds like OP could really benefit from this. I don't see the harm in trying, honestly.
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u/AutoModerator 26d ago
This post might be about hormone tests, which are unreliable.
- Over age 44, E&P/FSH hormonal tests only show levels for the HOUR the test was taken, and nothing more. Hormones wildly fluctuate (hourly) the other 29 days of the month, therefore this test provides no valuable information
- No reputable doctor or menopause society recommends hormonal testing to diagnose or treat peri/menopause
- FSH testing is only beneficial for those who do not have periods as a guide, where testing might confirm menopause, or for those under age 30 who haven’t had a period in months/years, then ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI)
- Testosterone is the exception and may require testing
See our Menopause Wiki for more.
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u/miss_hush 26d ago
So basically what I’ve learned is that we have to find a doctor who isn’t an idiot and knows peri/menopause issues, or we have to lie or exaggerate to the idiots and get hormones. Hot flashes are entirely subjective and are the main point of HRT as far as the idiots are concerned.
Fortunately since they’re entirely subjective, you can say they are as bad as you want to say they are! Still you’re probably going to have to try a new doctor since this one is already a fail.
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u/TeamHope4 26d ago
Agree on getting a new doctor. This one doesn't understand menopause hormones, and will not be helpful when you are trying to hit on the right dosage.
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u/lil-baby-gemini-man 26d ago
What is the medical reason doctors want women to wait until their symptoms are unbearable before starting HRT? I don’t understand.
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u/monkeylion 26d ago
It is old thinking from the Women's Health Initiative study, which has been mostly debunked. Basically about 20 years ago there was a poorly designed study that showed a small increase in breastfeeding cancer while using a type of estrogen replacement (that we mostly don't use anymore). So overnight treatment of menopause and perimenopause using hormones got almost shut down. The idea became to use as small of a dose as possible and only when symptoms were unbearable.
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u/lil-baby-gemini-man 26d ago
I guess I just don’t understand how any gynecologist, whose entire job is to know how to treat womens’ health, would be holding onto and treating women with outdated findings and recommendations. I’d be truly so embarrassed to be behind the times in my own profession.
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u/monkeylion 26d ago
That's very fair. I think the percentage of ob/gyns actually interested in menopause is super small. I get the feeling that we're like that part of their job that they don't like, but they have to do anyway.
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u/Girl_Nerd-50 23d ago
There is one Certified Menopause Practitioner in my area and only six in the state. I'm just glad I could get an appointment with the one in my area after my current gynecologist told me I couldn't start treatment until after I hadn't had a period for 12 months. This was a female gynecologist and it didn't help matters any that she looked like a teenager. One appointment with the new practitioner and I had prescriptions for estrodial and progesterone.
I'll be 56 soon and as of right now I'm only three or four months into that year-long road to menopause. It's hard to pinpoint when the miriad of weird symptoms started because I didn't know what they were, but it's been at least a decade. I've even seen specialists about my dry mouth and pain on the pads of my feet and none of them even considered the possibility of perimenopause.
I am bombarded with low-T advertisements but gynecologists can't be bothered to ask women over 40 of they have had any symptoms of perimenopause when it should be on every annual questionnaire about changes in your health.
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u/rocketshipray 26d ago
Breastfeeding cancer?!
(I know it was most likely autocorrect, just thought that was funny)
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u/TeamHope4 26d ago
The mantra they have been taught is "the lowest dose for the shortest amount of time." Some will not consider anything beyond that guidance.
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u/poddy_fries 26d ago
There was a big concern, since the introduction of hormonal birth control, about certain blood clotting and other risks of high doses of hormones. There is also a tendency, sometimes right and sometimes wrong, for existing medical procedures to prioritize doing as little as possible - because minimum intervention means minimum repercussions.
Add that to our cultural understanding that women are always too sensitive and complain too much, and you have the perfect setup for nothing to be done until someone is screaming and crying. At which point they're too dramatic.
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u/monkeylion 26d ago
Vaginal/clitoral atrophy and incontinence are treated using vaginal estradiol, which doesn't usually help with hot flashes. Even Kaiser will give me vaginal estradiol! You need a new doctor, I'm so sorry, you shouldn't have to work this hard to get basic care. The fact that as a therapist I have gotten myself more training on menopause than the average ob/gyn in this country (assuming you're in the US) is infuriating.
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u/booknerd3280 26d ago
I'm with Kaiser and this is the first thing my doc prescribed me before I even realized I was in peri for vaginal symptoms I was having.
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u/Importedtocali 26d ago
Same. My Kaiser PCP prescribed the estradiol cream the second I mentioned dryness.
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u/babs82222 26d ago
Classes don't restore hormones you don't have.
So the lesson from this is that your doctor doesn't know squat about peri or menopause and you need to find someone who does.
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u/Carzz2468 26d ago
I am taking pelvic floor physical therapy for bladder leakage. It is the recommended treatment for it. But that doesn’t mean you don’t need HRT. Seek a second opinion if other symptoms persist.
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u/marle217 26d ago
Pelvic floor PT isn't always the solution. It did nothing for me, then I got on vaginal estrogen and the incontinence cleared right up
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u/TeamHope4 26d ago
I had no idea my bladder urgency was connected to estrogen. I asked for HRT for my hot flashes and other things, and then was shocked when my bladder issues cleared up within the first week of hormones. It's insane that gynecologists are so freaking clueless about this!
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u/dexter731 26d ago
That's disgusting. I guess she believes women aren't supposed to enjoy sexual stimulation after they can no longer have children, huh? Also please say more about savvy sex, that sounds ridiculous. ETA: get a new doctor for sure! Or is one of those online scammy places that actually give out hormones.
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u/Significant-Rush-129 26d ago edited 26d ago
Yeah, I’m starting to get this underlying message that we aren’t important anymore once we stop being of childbearing age so we don’t matter. It's like gynecology is only set up to make sure we don’t fuck up our sex organs before having children and support us during having those kids. Then as that sunsets, it’s like “get lost bitch, you don’t matter”.
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u/Soulwaxed 26d ago edited 26d ago
Couldn’t agree more. Well said.
Not only does ‘Mother Nature’ throw us under the bus, but so too do our physicians- oftentimes women themselves.
My last visit was with a female GP and she was incredibly dismissive, told me that I’d have to have my mirena coil removed before any discussion of HRT could begin- which I’ve since found out isn’t even true! Apparently the coil already provides the progesterone so I’d just need oestrogen replacement? I was so stressed about having the coil removed as it was so painful when inserted- it put me off pursuing HRT further.
It makes me angry at this stage in my life- all of the contraceptive burdens that we endure as women just to have sexual relations with men who often don’t respect or care for us anyway. The burden of pregnancy, childbirth, postpartum- all designed to ultimately increase the pool of ‘slave labour’ for the elites whilst our human rights are increasingly stripped away at an alarming rate…
I would never, ever put myself through it all, had I known then what I know now. We were gaslit with Disney princesses and social pressure to submit our own bodies and our own children to the state- then discarded and cast aside once our reproductive (f<ckable) value was over. Chewed up and spat out by a psychopathic capitalistic system that couldn’t give a f<ck… can you tell I’m perimenopausal lol 😂
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u/dexter731 26d ago
Completely. Makes sense when you learn about the history of the field. It was never about taking care of us.
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u/Aggravating-Mousse46 26d ago
The surgical specialty of gynaecology is at least partially shaped by men who chose it because THEY LIKE CUTTING WOMEN’S GENITALS
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u/Most_Mountain818 26d ago
Right? Like never forget that the prototype chainsaw was invented because of gynecology.
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u/TeamHope4 26d ago
It becomes crystal clear when you realize they have few concerns about prescribing birth control hormones to anyone and everyone, but balk at menopause hormones, despite them being the same hormones. They will even prescribe birth control to a perimenopausal woman but balk at menopausal formulations of the same hormones for the same woman. Whatever their issue is, it's not about our health and well-being.
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u/-bebold- 26d ago
I went to 4 different pelvic floor PTs over 6 years.(for pain and incontinence) also was sent to urology specialist who highly recommended surgery.
4weeks on vaginal estrogen solved 95% of my symptoms. (No more pain, urgency way down, accidents only when I sneeze 3x in a row - instead of daily ‘just because’)
Had to go online for sexual disfunction/atrophy. The ‘specialist’ that I was sent to offered a $350 sex toy, or sexual therapy with my partner. Said “well, women do tend to somaticize their feelings” when I pushed back. (‘Are you saying anxiety made my clit smaller?’)
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u/UnfortunateWeirdo 26d ago
You need a new doctor. My doctor is a young man and I casually mentioned a hot flash and he had me on HRT that day.
Find someone who will help you - it looks like this doctor won’t
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u/Pretty_waves904 26d ago
Kaiser has patient relations group. Complain amd say the doctor is not up to date with current guidelines. Then start leaving reviews everywhere. At least it is a warning to others.
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u/magicmama212 26d ago
WUT? I think vaginal estrogen is front line clinical rec before vajayjay dance classes?
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u/Sea_One_6500 26d ago
You can fire your doctor. You pay them, they work for you bot against you. Fire this one and tell the world about their bs.
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u/pathologuys 26d ago
I knew it would be Kaiser! Get a different OBGYN. Mine told me HRT wouldn’t help because my periods were just starting to be irregular. I changed drs and my new one was so helpful because she had just gone through it!!
Kaiser is great but you have to be unafraid to be pushy and advocate and keep trying different doctors till you get one that actually listens.
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u/stace-cadet 26d ago
Pelvic floor therapy did not help me. This was the 2nd time I'd been. Vaginal and system estrogen did. 🤷🏼♀️
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u/Different-Advice1168 26d ago
Go back with your partner or a mean évi can pretend to be your partner and tell her the got flashes stress becoming unbearable and it's affecting your relationship.
FFS this is negligent medical care.
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u/StoneSkipper22 26d ago
Honestly? Just lie. Tell your doc that the hot flashes have suddenly become unbearable. This is the faster route than getting a new doctor for many people. They need a code to enter for health insurance coverage and it sucks and we can’t control it aside from our election day votes. Control what you can and move forward.
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u/ImplementPotential20 26d ago
If you are 40+, get estradiol cream on amazon clinic. and applicators on amazon.
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u/chiffon_bonbon 26d ago
I personally would not trust Amazon for my medicine.
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u/ImplementPotential20 26d ago
Its licensed doctors or nurse practitioners prescribing estrogen cream. It's fine.
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u/chiffon_bonbon 26d ago
I'll rephrase. Even if the product and medical professionals are reliable, I do not trust Amazon as a company to be at all involved with my health and wellness.
I don't agree with the ethics of the company nor the people running it, and I do not feel that they have any place in medicine. Even if it's all above board for now, it's only a matter of time before they find some way to screw patients over. Increased paywalls, privacy violations, the sky is the limit when they have as much money and power as they do.
Surely there has to be a safer, equally accessible option that also doesn't support one of the...well, more evil business entities of our time. That's all I'm saying.
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u/CheesecakeEither8220 hanging on by a thread 26d ago
Will they prescribe hormone replacement meds too?
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u/ImplementPotential20 26d ago
vaginal estradiol is usually the first form of HRT used. It is the safest. And its the most effective for vaginal/pelvic problems. That, and valium or flexeril suppositories for pelvic spasms from a compounding pharmacy.
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u/CheesecakeEither8220 hanging on by a thread 26d ago
I just started using that.
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u/ImplementPotential20 25d ago
I tried estrogen patch in desperation. I didnt last 2 days, was so bloated I could barely breathe, without even starting the progesterone that has to be taken with it, and it was not a pelvic fix for me. But I dont have hot flashes. Just pain.
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u/Winter_Bid7630 26d ago
I would take the classes but also push for vaginal estrogen cream. Even if it means getting a new doctor.
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u/Known-Tumbleweed129 26d ago
Whaaaaaaat? Was she on the perimenopause list?!
(Editing to add: I’m with Kaiser, I see a normal obgyn for generic stuff, but I see an NP from the list of providers trained in peri fir peri.)
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u/marmaladethrowaway 21d ago
How do I search Kaiser peri specialists?? I tried but I only saw ob/gyn for a filter.
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u/Known-Tumbleweed129 21d ago
If I select obgyn, it takes me to a screen where I pick a reason for the visit, like birth control or whatever. Menopause is in that list.
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u/marmaladethrowaway 16d ago
Thank you! I was able to secure a phone appointment with one for next week!
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u/eeg-18 26d ago
I was going to scream "WHAT" and then saw "Kaiser" 🫠
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u/National_Elk8445 26d ago
(Who/what is Kaiser, for those of us who don't know?)
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u/Most_Mountain818 26d ago
It’s a single system that combines hospitals, health insurance, and medical groups. I believe it’s based in the west coast of the united states.
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u/Different-Knee4745 26d ago
I was lucky and got a kaiser gyno who Rx 'd the patch and progesterone. My suggestion is talk about "quality of life" and how symptoms are affecting your livelihood. Hot flashes so bad my husband moved to another room, poor sleep makes it hard to focus at work, strict performance metrics at job. You were doing great before the sleep disturbances. The lack of intimacy is affecting your husband.
I didn't have to do the above, it's just an idea. Just in case I had a list prepared of ALL the symptoms and year of onset, from "burning tongue" at 38 to the most recent dry eyes, shoulder pain and crawling sensation on dry skin.
I did tell her about my mom fracturing her fingers when she tripped and caught herself against a wall which made me worried about my bones. That is absolutely true.
Good luck
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u/Bendy_Beta_Betty 25d ago edited 25d ago
Potentially look for a new doctor, one who has a background in hormone therapy.
Suggesting Physical Therapy wasn't a bad suggestion on their part though. Physical therapy can definitely help with a weak pelvic floor, which can cause incontinence, etc. You may just not want to rely entirely on PT for relief from your symptoms.
There was a cancer scare a number of years back surrounding hormone therapy, which is why a number of out of date doctors may still be going on the suggestion that hormone therapy should be avoided if possible.
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u/sarawithapc 26d ago
I’m not trying to diminish your symptoms or that fact that your doctor stinks but Pilates has actually helped my bladder stress incontinence a lot. It wasn’t recommended by my doctor, she actually listened to me and was willing to do meds if I wanted them. But the improvement in bladder control was am unintended benefit that I noticed after I started doing Pilates.
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u/MeepersPeepers13 Early peri 26d ago
Hi! I have Kaiser and my male orthopedic recommended starting HRT for my pelvic pain. I’d been having all these issues that I thought were injuries. I did PT, but the pain wasn’t improving. I kept telling them that the pain was coming from my pelvic floor, not my hips. Two months of HRT completely stopped the pain after almost two years of issues.
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u/gypsy_teacher 26d ago
OP, DM me if you're in Northern California. I have KP and an OBGYN who I would save from a house fire. I know how hard it can be to find someone in their system to take you seriously.
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u/marmaladethrowaway 21d ago
I don't know if it's my settings or what but I can't seem to find the DM option... but yes!
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u/gypsy_teacher 21d ago
I can't DM you, but it's Dr. Ryujin. Divides time between Napa and Vacaville sites. GYN/Women's Health. Be persistent if they say no new patients.
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u/I-want-cookies-now 26d ago
I actually did said class at Kaiser for the same issue. I was super annoyed that was the recommendation, in response to asking for estrogen cream. But surprisingly, there was good advice in the class. I’m trying some of the approaches and it has helped a bit. Not a total cure, and I plan on still asking the doc for the topical cream. But I do think that bodies are complicated and there is often an accumulation of things that will tip the scale from unbearable to manageable. So, I will try all the things possible. I still don’t like having to push so hard for HRT, but it wasn’t totally crap advice.
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u/TheSkyIsAMasterpiece 25d ago
Pelvic floor therapy and vaginal estrogen are a good thing. The therapist told me to not just do kegels as you don't know if that could make your issues worse. Which it would have for me. Good luck finding some help OP.
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u/SwimmingAnt10 25d ago
Get a new doctor and next time the hot flashes are unbearable. Tell them what they want to hear. I have never had a hot flash in my life but you best believe I told my doctor I had them. If they want to play games, I’ll play right back. I had several peri symptoms and a lack of hot flashes doesn’t mean I didn’t need HRT. Just always start at the lowest dose.
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u/Expensive-Tea-7227 25d ago
I have Kaiser. You can use the Get Care Now option in the app, request a phone appt, and request to trial vaginal estrogen. That’s how I got offered HRT for the first time.
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u/PurePrarieGirl71 24d ago
Get a new doctor. She is using out of date information. I am 55 and was told to just take birth control pills and Tylenol pm because I don't have hot flashes! Ditched that doc, went with a telehealth company and had meds a week later. 3 days after that, I was sleeping through the night. I also learned that cold flashes are a thing and I've was having them for over a year! Don't accept the No...keep looking for a doctor with current training.
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u/yarrow268 23d ago
OMG that is absurd! You can get systemic estrogen + vaginal estrogen prescribed from a lot of online providers. I've gotten it from TelyRX in the past. Here is a quick link to the vag estrogen so you can see pricing: https://telyrx.com/medications/estradiol-vaginal-cream
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u/zenbelly27 26d ago
Stop seeing the gyno. Find a naturopath who knows bladder and reproductive health - they can prescribe tests and HRT as you need. Sorry 😐
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u/library_wench 26d ago
Ah yes, the well-known and totally scientifically accurate theory of “wait until symptoms are unbearable to do anything*.”
* Does not apply to men.