A version of this column first ran in USA Today.
Menopause may be having a “moment,” but I really wish it wasn’t having quite so much of it with me. I’m in the throes of it all right now. Hot flashes, brain fog, insomnia, anxiety, lack of energy, joint aches, weight gain, words falling out of my head mid-sentence, and general ‘I don’t feel like myself anymore’ sum up several symptoms I go through regularly now that I’m almost 53.
I first mentioned these symptoms to my primary care physician and OB/GYN in 2018. They ordered lab tests and told me the results were within “normal ranges.” They recommended classes through my healthcare provider to deal with stress. One doctor told me I should exercise more, while another told me I was exercising too much.
I’m not great about insisting that I have a problem that a doctor should pay attention to. As time went on and so did my menopause symptoms, I just kept thinking that I had to suck it up and soldier through it.
IS INSTANT ONLINE HELP FOR PERIMENOPAUSE AND MENOPAUSE SAFE?
Lucky for me — and the estimated 47 million women in the U.S. experiencing the effects of perimenopause or menopause — Silicon Valley entrepreneur Joanna Strober completely disagrees. “The lack of care for women in this age category is a complete abomination,” she tells me over the phone.
Strober is the CEO and co-founder of Midi, a relatively new online healthcare company offering virtual face-to-face appointments with menopause-trained doctors and nurse practitioners. She started the company after going through a similar host of hormone-related issues and getting zero help from her doctors. “I knew my body was really ‘off,’” she explained. “It started with hot flashes in my mid-forties, then I stopped sleeping.”
After a year of researching her symptoms and trying to figure out how to “feel like myself again,” Strober found a specialist who prescribed hormone replacement therapy (HRT). She said she felt dramatically better within the first two weeks.
“Looking back, I now see how the hormone transition affected not just my sleep but also my energy, weight, mood, and sex life … It’s embarrassing, and you’re scared your marriage will fall apart, or you’ll lose your job. It’s even more frightening if you don’t know how treatable this is. As soon as I was able to get [prescription HRT and over-the-counter supplements like magnesium for headaches], really my whole life changed.”
But Strober’s treatment was expensive, and insurance didn’t cover it. At the same time, she said many of her friends were suffering from similar situations. “There’s a quote about this being one of the biggest blind spots in modern medicine; that’s how we all felt. How could so many of us be suffering in silence?”
The latest statistics back up Strober’s sentiments:
- There are an estimated 20 million women potentially going through menopause, or the lead-up to it, right now, with symptoms that last anywhere from seven to 15 years.
- A spate of studies shows that 85% of all women experience menopause symptoms, 75% of women who seek care for these symptoms don’t receive any treatment, and 80% of OB/GYNs say they are not explicitly trained in perimenopause/menopause care.
- The numbers are even worse for black women, who often experience perimenopause earlier and longer than white women and have an even harder time addressing health care concerns.
THE MENOPAUSE MARKETPLACE IS BOOMING.
Midi is now one of over a dozen startups tackling “the big change” through various levels of intervention. Many of them prescribe oral or topical HRT, including estrogen, progesterone, and testosterone, along with creams and dietary supplements.
I had my first Midi virtual video appointment with a nurse practitioner specially trained in female midlife health just this past November. I also tried three others before landing on Midi for the long term, including Winona, Gennev, and Evernow.
Most start by having you answer a series of prompted questions and provide your health history. They also ask you to explain any additional concerns or symptoms and upload a photo ID to verify that you are who you say you are. From there, though, they differ quite a bit in cost, support, insurance coverage, and prescription practices.
WHY I CHOSE TO USE MIDI:
A few important distinctions set Midi apart for me. For starters, it’s available in 50 states and works with many major insurance providers. It starts with a comprehensive virtual video call with a licensed medical provider. That initial conversation lasted nearly an hour and felt like the first time in as long as I can remember that a medical professional took the time to really listen to me. (As I noted in my Prenuvo article, I complained to my doctor repeatedly about shoulder pain which he attributed to age but my Prenuvo scan found to be a partially torn rotator cuff.) The medical professional I spoke with immediately understood my symptoms, asked the right questions about my body, and seemed to hear my concerns. She also went over my recent lab results and talked with me about several options, including hormone replacement therapy and vitamin supplements.
The initial visit cost $250, with subsequent shorter follow-up appointments running $120. When it came to the menopause hormone prescriptions, she recommended that I start with a low-dose estradiol patch and dietary supplements, including Vitamin D, L-Theanine, and Ashwagandha, for help with sleep.
The cost for those has been about $100 for a 90-day supply. I’ve been on this regimen for six weeks and can’t believe how much better I feel. I sleep through the night, have more energy, and haven’t had any hot flashes.
My insurance does not cover this care, but I shared all the information with my primary care physician, who supports it.
Here’s a quick summary of the others I’ve tried:
Evernow requires a membership fee of $49 a month, $129 for three months, or $348 for 12 months. They say your insurance might cover prescription costs at your local pharmacy. If you have questions, you can text them through your Evernow dashboard 24/7. Currently available in 37 states.
- Winona was the least hands-on of all the services I tried. It made me nervous that they reviewed my responses to questions, diagnosed me with “menopausal and perimenopausal disorder, unspecified,” and sent medication to my door without looking at recent lab tests or talking with me. The DHEA supplements they prescribed cost $27 for a three-month supply. (I’m not going to take them, and they said that I cannot return them, even unopened and sealed in all of the original packaging.) They don’t work with insurance providers.
- I like Gennev, and it’s a solid second choice for me, but it’s not as personalized as Midi. You can start with a 30-minute virtual video call with an MD menopause specialist ($199) and/or take its “menopause assessment,” which is a series of general questions that try to pinpoint where you might be in your “menopause journey.” They also offer 30-minute virtual appointments with registered dietitians ($99) and sell a line of branded supplements. Works with Aetna insurance.
WHEN IT COMES TO MANAGING MENOPAUSE, BE SURE TO ASK THESE QUESTIONS:
According to data from Grand View Research, the global menopause market is around $18 billion and is projected to reach $24.4 billion by 2030. At this stage in the menopause marketplace gold rush, it’s totally “buyer beware.” Many online storefronts hawk ‘lotions and potions,’ unregulated herbal remedies, and even powerful antidepressants, all with a simple tap of an app.
After going through this entire process myself and researching it extensively for this article, here is a list of essential questions to consider:
- Can you talk directly with a doctor or clinician, and are they board-certified, licensed, etc?
- Do you feel like they understand your personal and family health — holistically — before they prescribe medication?
- Have they explained the medication’s risks and benefits?
- Do they respond to your questions quickly?
- Is there follow-up with doctors or clinicians after they prescribe medication?
- Can you share the telehealth notes and prescription history with your primary care physician?
56-year-old retired firefighter Toi-Yan Littlejohn agrees. She suffered from perimenopause symptoms for years before finding relief. “This whole topic is still kind of taboo, especially in the [black] community,” she tells me over the phone. “After going through several doctors who dismissed it, I finally found a concierge specialist who introduced pellets [hormone implants injected under the skin]. They were great, but insurance didn’t cover them, and they cost about $500 every three months.”
Littlejohn saw Midi advertised on TikTok and has been a patient for over a year. “I’ve been married for 29 years. Without this, I would not still be married. I had a lot of rage and anger in addition to hot flashes, insomnia, and weight gain. I was downright mean,” she laughs. “It’s funny now, but it wasn’t then. No one ever tells you about all of this. It’s changed my life. I have more energy, lost 15 pounds, and feel amazing.”
“This is not ‘menopause tech,’ it’s not Thumbtack. It’s not a smartwatch. It’s not a cooling mattress. This is women’s healthcare,” Midi’s Joanna Strober adds. “This is about making sure women have access to the highest quality care available today.”
######