How to advocate for yourself at the doctor
It's our experts' most common recommendation. But it's not always that easy.
So often in this newsletter I write, “Talk to your doctor.”
If I have learned one thing from nine months of writing this newsletter, it’s how important that is. Healthcare is not one-size-fits-all, and what might be good for your best friend or favorite influencer might not at all be right for you. The only way to figure out what you need is talking to your own healthcare provider — or providers.
But I also know that saying this time and time again can ignore the reality that talking to your doctor isn’t always simple. Our healthcare system is complicated on a good day, and access to a well-informed provider isn’t always a given. We know how woefully underresearched menopause is and how few providers have training in menopause care. Layer on top of that the kinds of systemic bias that some patients also face, and talking to your doctor is far from a simple charge.
That’s why I wanted to talk to someone about how we all can best advocate for ourselves in the exam room.
Cue the expert
Dr. Uché Blackstock spent 17 years as an emergency care physician before founding Advancing Health Equity, a consulting firm that works with healthcare leaders and organizations to create more equitable and more accessible systems of care. She’s also a 48-year-old Black woman — so when it comes to thinking about how to navigate the challenges of midlife healthcare, this work isn’t just theoretical.
“Even with my medical training, I didn’t immediately recognize what was happening to my own body in my early 40s,” Blackstock told me. One of her earliest perimenopause symptoms was insomnia — a symptom she wrote off as stress from the balancing act of midlife as she raised children, built a company and was increasingly involved in public-facing work.
“What I didn’t realize is that these sleep changes that I was having were early signs of perimenopause, and it came to the point where it was really profoundly disrupting my quality of life and also my functioning. Looking back, I wish someone had helped me connect the dots earlier.”
What she wants others to know first and foremost is that it’s OK to feel overwhelmed and confused.
“Here I am, a highly educated, medically-informed individual, and I’m still struggling to recognize what’s happening to my own body as it is going through this stage of life.”
A system not designed for us
Giving yourself grace is a prerequisite to the often necessary act of advocating for yourself, she said.
“I always struggle with this self-advocacy part because it feels so unfair to put the burden on patients,” Blackstock said.
But it’s there because often medical providers don’t get training in treating perimenopause and menopause — because these changes are underresearched, and because perimenopause often begins earlier than many assume — which can lead clinicians to dismiss symptoms.
“I’m not knocking any clinicians,” she added. “We love our clinicians — but we want to recognize where the system can improve. The fact is that you have many physicians and clinicians that have received very limited education about the broad range of perimenopause symptoms, about how to even counsel patients around things like hormone therapy and knowing that the non-hormonal treatment options are.”
How to be your own best advocate
The first step to being your own advocate, Blackstock said, is tracking your own symptoms. Maintain a physical log you can share with your provider at your appointment. Regularly writing down data on your sleep, mood, hot flashes, libido, night sweats, brain fog and energy levels will help both of you see patterns and changes.
In a vacuum, just one of these symptoms may not immediately point to perimenopause, but a written record can tell a bigger story. Blackstock said it’s important to be as detailed as possible in your notes and outline both symptoms and their impact.
“Say, ‘My sleep has really gotten worse over the last six months. I’m waking up at three in the morning and I can’t go back to sleep, and now it’s affecting my work and ability to function.’ That specificity really matters.”
The next tool that Blackstock recommends is bringing a support person with you to a clinician visit. Having a trusted loved one or friend there — for moral support or to help be a spokesperson — can be especially helpful for women of color who have a history of being treated poorly by medical providers. It can also help if you’re not feeling your best and it’s harder to communicate.
Blackstock said to check with your provider’s office to confirm that they are OK with you bringing a buddy — but also that if they aren’t, you should find a new clinician.
“No one should have a problem with that,” she said.
There are other ways to prepare for an appointment, too: Role play with someone you trust so you can feel comfortable and confident communicating about your symptoms and their impact. You can also ask those you love and trust for their impression of what your symptoms are and how they are affecting you to get additional data points about their impact.
Understanding reproductive health
As both a patient and a physician, Blackstock said there are a few other important dynamics that are important to name: one, the inherent power dynamic in medical appointments and two, a culture of assuming that reproductive health is confined to a person’s childbearing years.
Both patients and providers alike can be reluctant to discuss a person’s reproductive health history and how it may influence the way they move through perimenopause and beyond.
“If there’s a history of postpartum depression, anxiety, your fertility, your hormonal history, history of fibroids or heavy bleeding — all of that matters,” Blackstock said.
All of this is also why Blackstock said it is so important that when you’re thinking about how to talk to your doctor, you first think about the doctor you’re talking to. It’s worth it, she said, to take the time to seek out providers of any specialty who have experience caring for people in perimenopause and menopause, and feel comfortable doing it.
This applies to your primary care provider and your gynecologist — but also your cardiologist, dermatologist or any other specialist you see. You can check the Menopause Society’s provider directory; many other medical societies also have directories and guides that will help you determine who has the training and expertise you need.
And if you’re repeatedly dismissed? “Find another provider,” Blackstock said. “Women deserve partners in care who will listen. You shouldn’t have to convince someone that your symptoms are real.”
Conversation starters
Blackstock stressed that “trust shapes communication.” That’s hard when so many patients are carrying with them decades of being dismissed or belittled, rushed or talked over. They have seen diagnoses missed or delayed — and their fear of it happening again is real and justified.
“If patients don’t feel heard, they’re going to delay care, they’re not going to ask the questions they need to ask, and they’re going to feel less empowered,” she said. That’s why it’s so important that you as a patient feel that you have all the tools you need to effectively communicate with your clinician — and ensure that they are listening.
Blackstock said some key questions she would recommend patients bring with them to a conversation are:
Could this be perimenopause or menopause?
What is your management plan or next steps for me?
What is my follow-up care going to look like?
Are there any treatments that we need to discuss or that you’re thinking about for me?
Is there anything we discussed today that would make you want to refer me to another specialist?
Getting these answers, she said, is one step toward making sure “that our system is able to deliver the care to women in midlife that they need and to make sure that they can thrive throughout these transitions. Because if we don’t — it’s so unfair. It’s unfair to us as women.”