I’ve been blessed to enjoy good health for most of my life. I had three healthy pregnancies and went through my 30s and 40s feeling good, if tired. Then, suddenly, as I approached 50, my sleep fell apart. I could not make it through the night. I was constantly up around 2am for at least an hour, with my thoughts racing. I tried every sleep hygiene suggestion: going to bed and waking up at the same time, keeping the room dark and quiet, avoiding blue light and screens before bed. Nothing worked and I was pretty desperate.
I made an appointment with my primary care doctor. When I described my symptoms, she suggested a low dose of Trazodone, a SARI anti-depressant. Even though I was clearly approaching the average age of menopause, which is 51, she didn’t ask me a single question about the menopause transition or suggest hormone replacement therapy, which includes progesterone that has a proven calming effect known to help sleep. Since I was using a hormonal IUD, which suppressed my periods, I didn’t have any indicators from my menstrual cycle that might have helped identify hormonal changes in my body.
I hated taking Trazodone. It made me feel loopy in the morning. Trazodone is also known to have a drug tolerance effect where, over time, you need a higher dose to get the same benefit — something my doctor didn’t explain and that only increased my feeling that my health was slipping away from me.
Increasingly exhausted and out of sorts, I was hiking with an Australian friend who said, “You have to try HRT! Why you Yanks don’t get menopause care is crazy; all my friends and my sister in Australia are on HRT.” She recommended a well-known women’s health practitioner in our town, so I joined the six-month wait list. By the time I saw this menopause expert, I was experiencing occasional hot flashes. When the clinician asked if they were debilitating, I said no. I was raised to view hard things as challenges to overcome, so even though my sleep was terrible and my hot flashes uncomfortable, I felt like I was supposed to deal with them. Based on my answers and the fact that my IUD was still in, she suggested I come back in a year to see if my symptoms were worse.
So, I waited. But at my next annual visit with my primary care doctor, I advocated for myself and asked specifically about starting HRT. My doctor suggested removing my IUD to see what was happening with my periods since she was reluctant to prescribe HRT until it was clear they had stopped for good. Without my IUD, I entered a roller coaster of bizarre periods. I was lucky not to experience the very heavy bleeding many women do, but my cycles were all over the place, with lots of spotting in between. This was during a difficult chapter in my life and everything felt pretty chaotic.
Finally, close to three years into this health journey, after my periods had stopped for nearly a year, my physician prescribed the lowest dose of progesterone capsule (100 mg) and estrogen patch (0.025 mg). Within a week, I was sleeping better and my hot flashes improved. After a few months, she agreed to increase my prescription to a 200 mg progesterone capsule and a 0.0375 mg estrogen patch. Within days, I felt like I was back to my real self. My hot flashes disappeared, I slept through the night for the first time in years, and I felt calmer and more hopeful. My body, and my life, weren’t what they had been in my 30s and 40s — HRT is not an elixir of youth — but I felt dramatically better.
I am generally a private person and didn’t share much of what I had been going through with friends or family. But then I started hearing very similar stories from friends struggling with perimenopause, and as I read more about the menopause transition and midlife women’s health, I realized just how common my story was. Sadly, partially losing three years to symptoms that could have been treated more effectively and safely was not unique.
It turns out many women experiencing menopause symptoms are prescribed antidepressants or sleep medications rather than HRT. When I researched this issue, I discovered that women ages 40–64 are prescribed antidepressants at the highest rate (27.7%) of any gender or age cohort. This stands in stark contrast to the current HRT prescription rate of about 5%.
And my experience of being told to come back later also wasn’t unusual. Many women are told to return after symptoms worsen, as though there is a threshold of suffering that must be reached before HRT is worth discussing. After starting Inflexxion Health, we conducted a survey of more than a thousand women ages 40–60 in the Mountain West and found that one in four had been told to return later if symptoms worsened or when periods had stopped for a year.
I also noticed that my friends and neighbors in Utah seemed to have an even harder time accessing expert menopause care than friends and family back East. The Mountain West’s ratio of primary care physicians to population is below the national average. In Utah, the ratio is 114 people to each PCP, placing the state about 45th in the country.
Changes in clinical practice often happen first in large academic medical centers and then spread slowly. It can take years for doctors to adopt new approaches, especially when there isn’t a strong financial incentive to do so.
At a point in my life and career where I wanted my gender, healthcare experience, leadership expertise, and age to be positive attributes, I realized I was well positioned to help address the menopause care gap I experienced personally and witnessed around me. It was the type of problem I felt passionate about tackling. And the care gap represented a significant market opportunity — one big enough for many high-quality telehealth providers, not just a few national brands. I wanted to serve women in the Mountain West, where I live, and I didn’t see anyone else focused on our region, which is often dismissed as “flyover country.”
So, I took a deep breath and started Inflexxion Health to help women at a critical inflection point when hormonal changes can profoundly affect their lives. Inflexxion Health is a video-based telehealth service that guides women through the menopause transition with personalized care plans that include hormone replacement therapy, sexual health treatments including custom-formulated low-dose testosterone cream, and other prescriptions. I am deeply grateful to everyone who encouraged and helped us get started and feel honored every day to earn the trust of women in my community.
The more women share their experiences, the harder it becomes to dismiss menopause symptoms as something we should simply “push through.” Inflexxion Health is committed to being part of this needed change in menopause treatment for women in the Mountain West.