26: I Spent a Year Looking for a Doctor Who Would Believe Me. This Is What I Found.

Okay, I have some breaking news for you today. Women can have babies and be in perimenopause at the same time. I know, I just blew your mind. And honestly, I think I blew the mind of every doctor and fertility specialist on earth too. Who would have thunk? Okay, fine. I’m being a little facetious, but only a little, because this is actually a real problem and it has a fancy name, cognitive dissonance.

Which is just a highbrow way of saying that people’s brains short circuit when they’re asked to hold two contradictory ideas at the same time. Fertility and perimenopause. A vegan and a leather jacket. An environmentalist with a fully loaded SUV. The brain just goes, does not come cute. And when that cognitive dissonance lives inside the medical system, it stops being funny pretty fast.

THE UPHILL BATTLE

Let’s talk about getting support as a woman, just in general. Already an uphill battle. You know this. You have lived this. Being taken seriously, being believed, having someone actually listen, that is work. That is labor that we do every single day just to get basic care. And now, add fertility. I have heard stories from countless women who had to find new doctors, sometimes multiple new doctors, because no one believed them when they said that something was wrong, only to find out that their intuition was exactly right. Something was very wrong.

Women given inaccurate

lead to unnecessary inductions

all women ovulate on day 14. Spoiler, you do not. Now add perimenopause on top of that. That consolation of needs, fertility, perimenopause, and just being woman in a medical system that wasn’t built for you.

Getting support for all of that at the same time is exhausting in a way that is hard to put into words.

MY STORY: A FULL YEAR

It took me a full year to find an OB

or a reproductive endocrinologist who was willing to help me. A full year in New York City. Every other doctor I saw said they couldn’t help me. They did fertility or they did pregnancy or they did perimenopause.

No one did the crossover. And I just kept thinking, how is this possible? How is this not a thing? When I finally found her, I had to wait a month to get in. And when I walked into that appointment, I was prepared. I had mapped out all of my symptoms in clinical language. I had a stack of studies. I was ready to make my case, to prove that what I was experiencing was real, because that is what we learned to do. We learned to come in armed.

She asked me to tell her what my experience was. So I did. And I was on the verge of tears about to pull out my stack of studies when she looked me in the eyes and said, I believe you. I don’t have words for what that moment felt like. It was one of the most pivotal moments of our entire fertility journey. She believed me. She didn’t need my data. She took my word for it and said, I will help you.

FIGURING IT OUT ALONE

Now here’s where it got interesting. She believed me. She wrote the prescription.

And then she said, too much estrogen can push ovulation. Incredibly helpful. And also entirely out of strategic guidance I received. And she was honest with me. She had never prescribed estrogen this way before. She was willing to try. She was open about where her knowledge ended. And she made clear that if something wasn’t working, I could come back. I genuinely appreciated that. It was a we can figure this out together energy. And I was really here for it.

But figuring it out, that was larger than me. I ended up in bodybuilder forums. I ended up reading research on ovarian insufficiency. I was piecing together information from communities that had nothing to do with me specifically, but were the closest thing I could find to people who had worked through similar hormonal territory with no roadmap. And I am genuinely glad I went on that journey. I learned things I never would have learned otherwise. But I shouldn’t have had to. That’s the point. That is not a personal feeling. That is a system’s…

failure.

THE DATA: THIS IS NOT A NICHE SITUATION

So why is there such a big gap? Why in New York City could I not find a single doctor who did the crossover? I have been thinking about this for months and I have a theory. But first let me give you some context on the landscape that we are actually living in because this is not a nice situation. Over the past 20 years, births in women over 40 have increased 193%. Let that sink in.

Birth rates in the US are declining across every age group except women over 40. We are the only group trending up. Births in women over 45 have increased 450% since 1990. Births in women 35 to 39 have doubled. And here is what that actually looks like in real numbers. In 1990, 13% of births were to mothers under 20 and 70% of all births were to mothers under 30.

Mothers between 35 and 40 accounted for only 9% of births, and mothers over 40 were barely a rounded error. Fast forward to 2023. Births to mothers under 20 have dropped to 4%. Births to mothers under 30 have dropped from 70% to 49%. And births to mothers over 35 have jumped to 21%, with mothers over 40 now counting for 4% of all births. That is 147,000.

babies that were born to women over 40 in a single year, 2023. This is not a blip. This is not going away. And as reproductive technology gets better, it is only going to continue.

[THE THEORY: WHY THE GAP EXISTS]

So here is my theory on why this support isn’t there. I think our culture sidelines women after our frugals years in ways that are so normalized we barely notice them. The way we are portrayed in media, the expectations that shift, the subtle and not so subtle message

that a certain kind of woman walks through the door of a fertility clinic and she’s young and she’s not in perimenopause, even though we know that women can start entering perimenopause in their late 30s, even though this overlap happens every single day. We have been taught to downplay what is happening in our bodies, to suck it up, to not bother anyone with it because no one will believe us anyway. And so we do. And this system has never had to reckon with what is missing.

STILL IN IT: THE IVF REALITY

And here’s the thing. I’m not telling you this story from the other side.

I’m in the middle of it right now. I’m currently going to start an IVF cycle. The incredible doctor who believed me, who was willing to figure this out with me, is no longer in my insurance network. So I’m starting over. And because these cycles take time, a lot of time, my estrogen prescription ran out. So I went to the current reproductive endocrinologist who’s managing my current IVF to get refill. She said that she wasn’t comfortable prescribing it, that it was out of her expertise, and she recommended that I go back to my GYN.

I want you to think about that for a second. The reproductive endocrinologists complete, pardon, pause. Reproductive endocrinologists complete three additional years, years of fellowship training beyond an OB or a GYN. Three years studying exclusively hormones, fertility, and reproductive physiology. And my reproductive endocrinologist, with all of that training, felt that hormone therapy

for a perimenopausal woman was above her pay grade and sent me back to a doctor with less hormone training than she has. I’m not blaming her. She should never, ever write a prescription that she doesn’t feel comfortable writing. And I mean that sincerely. But if a doctor with three years of specialized hormone training doesn’t feel equipped to help me, then who does? That is the question I keep coming back to.

and I don’t have a clear answer. I just know that I am still figuring out myself.

LANDING: I SEE YOU

If you are out there listening and you have had to fight to be heard, I see you. If you would have had to come back, pause. If you have to have, pause. If you have had to come into an appointment armed with studies and data just to be taken seriously, I see you. If you have had to become your own researcher, your own advocate, your own citizen scientist because the system didn’t have anything for you, I see you.

It is exhausting, it is frustrating, and it can feel incredibly isolating. But you’re not alone. There are so many of us navigating this quietly without enough support, doing the work because we have to. And someday, I hope our daughters don’t have to do this. I hope the system catches up. I hope that being born with a female body stops becoming a pre-existing condition that requires this much extra labor just to get basic care. Until then, we do it together. I am in it with you.

and I’m sending you the biggest hug.