Have you noticed a Menopause care gap? I hope for your sake, it’s been smooth sailing. I definitely fell straight down the gap into the valley of unresolved symptoms and lived there for too long.
When my oncologist casually mentioned that my breast cancer treatment would push me into menopause, I heard him, but it didn’t land. It felt like unnecessary noise because it was said in passing as a non-event and at that moment, I was focused on one thing: getting rid of the cancer.
That’s how it can feel when you’re in the middle of a serious diagnosis. Everything else becomes fluff that you do not have the bandwidth to manage. You’re not thinking about what comes after treatment. You’re thinking about getting through it.
So when he mentioned in a separate conversation, again, in passing, that he would be fine with me trying vaginal estrogen, I heard that too. However, I had no idea what vaginal estrogen was for. He didn’t offer to write a prescription. He didn’t explain what I might need it for or when. And I didn’t ask, because I was still focused on the Big C.
Nobody prepared me for what was coming. And when it hit, it was NO JOKE.
I Didn’t See It Coming. Looking Back, It Had Been Coming For Years.
Here’s what I know now that I wish I had known then: years before menopause is crucial and symptomatic, too. The menopause pregame, Perimenopause, is a hint of what’s to come. Menopause doesn’t just arrive. For most women, the transition begins years before their last period, and it announces itself quietly through symptoms that are easy to miss, misattribute, or simply push through. It may sound silly now that I wasn’t aware of this, but the attention on perimenopause was not there when I was going through it. Not one clinician used that term to describe what was happening to me. All those hormone fluctuations were wreaking havoc, but I just attributed it to the other health issues I was managing and to being an over worked mom and wife.
For years before my BC diagnosis, I was waking up at 2:00am every night, mind racing, unable to get back to sleep. A functional medicine physician eventually prescribed progesterone because my levels were low and it was affecting my sleep. She never called it perimenopause. She treated the symptom without naming what was driving it. I had no framework for what was actually happening in my body.
Looking back, the signs were there. I just didn’t have anyone connecting the dots for me. And neither, it turned out, did most of the doctors I was seeing.
When Menopause Hit, I Fell Apart.
Chemically induced menopause, the kind that comes from breast cancer treatment rather than the natural progression of age, is its own experience. There is no gradual transition. There is no easing in. The treatment that was supposed to be saving my life was simultaneously throwing my body into a state it had no time to adjust to.
I had extreme joint pain. I could not sleep more than a few hours at a time. I hot flashed all day long -relentlessly, throughout every single day and night. My brain fog was significant and persistent. My emotions were dysregulated in ways I hadn’t experienced before — irritability, mood swings, a short fuse with the people I love most. I was not myself. And I had no map for how to find my way back. And again, I didn’t jump to the diagnosis of Menopause because no one was naming it for me. At first, I thought it was my BC treatment. My oncologist and I decided together that I would stop endocrine therapy because I was so damn miserable. However, my symptoms did not reverse as much as I expected when stopping the medication. It took me months to register, “this is menopause.”
For women with a breast cancer history, menopause carries an additional layer of complexity. There is genuine fear and caution, and a frustrating lack of data around hormone therapy. The other specialists she sees, who may dabble in helping their other patients with menopause, either do not want to touch helping you with your menopause with a ten foot pole. Or, they just default to no options for you as their solution. The cautious “no” that they believe is the safest answer. The options that might help other women are not always available or straightforward. You are navigating symptoms with fewer tools and more restrictions, at the exact moment when you are also recovering from everything treatment put your body through.
*Please know that I understand: menopause is tough on almost all women and highly individualized in symptoms, timing and intensity.
I never received a heads up or a consultation on what was coming. Nobody walked me through what to expect or how to manage it. And that wasn’t because my care team wasn’t good. They were. Each specialist I worked with was doing their best within their area of focus. Great, right? What was that vaginal estrogen for again?
No One Owns Menopause. And That’s Costing Women.
Menopause sits in a gap between specialties. Gynecologists, oncologists, endocrinologists, internists, functional medicine practitioners — all of them may treat menopause symptoms. None of them are required to. None of them are specifically trained in it unless they have sought out that education on their own.
My oncologist was focused on treating my cancer. That was his job and he did it well. My other specialists were each focused on their own area. Nobody was looking at the full picture of what was happening to me hormonally. Nobody’s job description included: help this woman understand and navigate menopause.
That is not a criticism of any individual on my care team. It is an indictment of a GAP that has never assigned ownership of one of the most significant health transitions in a woman’s life.
And it means that women are largely left to figure it out on their own, at a time when they are already exhausted, overwhelmed, and asking too much of themselves.
The Menopause Moment Hasn’t Fixed the Care Gap.
Menopause is having a cultural moment right now. It’s on podcasts, in bestselling books, all over social media. And that visibility is crucial. It’s reducing stigma and getting women talking to each other about what they are experiencing, what has been helpful for them, and tips and tricks along with the camaraderie of normalizing the entire “event.”
But visibility is not the same as access. The conversation has arrived. The care infrastructure hasn’t.
Many women are still being told their symptoms are just normal aging. Still being handed antidepressants as the universal bandaid. Still paying significant out-of-pocket costs to reach providers who have prioritized and gone the extra mile for menopause education. Still experiencing perimenopause for years without anyone naming it. And, let’s not even start on the cardiovascular implications of menopause that seem to be rarely mentioned in women’s care.
The noise of the menopause moment can make this harder to navigate, not easier — because now there are also supplements to buy, programs to join, and influencers to follow, and distinguishing what is evidence-based from what is being sold to you requires its own kind of expertise.
What I Wish I Had Then.
I wish I had someone who could see across my care team and connect what each specialist was doing to what was happening in my body as a whole. Someone who understood the medical landscape well enough to know what questions to ask, which conversations to push, and what I was entitled to pursue even within the restrictions of my treatment history.
I wish someone had named perimenopause years before my diagnosis, so I wasn’t blindsided when menopause arrived.
I wish my oncologist’s passing mention of vaginal estrogen had come with a prescription, an explanation, and a conversation about what my options to alleviate symptoms were.
I wish someone had advocated for me to look at my cardiovascular markers before menopause and after. To seek an understanding of my cardiovascular health
Where was Judy Bloom’s follow-up book on menopause? “Are You There, Menopause? It’s Me, Confused.”
I didn’t have that person. I navigated it alone, while recovering from a breast cancer diagnosis and journey and juggling everything else in my life.
That experience is a significant part of why I built Sprimont Health. Not to add to the noise, but to help women find their way through it.
Nothing in this blog constitutes medical advice. Every situation is unique and medical decisions should always be made in partnership with your healthcare team.
👉 If you’re navigating menopause (or perimenopause!) and want someone in your corner who understands both the clinical landscape and the human experience of going through it, I’d love to talk. Book a free Clarity Fit Call at sprimonthealth.com.