Equilibrium Menopause

I had two different people tell me that ‘all the good [healthcare] providers are going that way’. They were both referring to healthcare providers not taking insurance and switching to a direct pay model. Granted, they were both trying to compliment and thank me after spending a full hour completely focused on their health. It just struck me because they both used the same phrasing. This kind of talk used to strike me as sad. I now realize it was because I thought I was being left behind in a broken system.

This time, I was so proud of myself.

I love my job again. I can spend the time I need to spend on complicated problems. I am able to ask probing questions and wait for the answer. I can fully explain WHY I don’t need to write a prescription for X diagnosis. I teach how certain exercises help with Y. I sensitively broach the subject of how Z is actually totally normal, just no one talks about it. And here’s a good article to back it up!
When was the last time you (as a healthcare professional or patient) had the luxury of being seen as a fully fleshed complex human being in a medical setting?

Let’s bring human connection back to the center of healthcare.

Your doctor has 10 minutes for you 6 months from now. I have an hour for you tomorrow.

Come see me at the Allen Library!
Bring your questions! Let's have a conversation.

Perimenopause Unpacked: What You Need to Know (and Why It Matters) Dr. Dani from Equilibrium Menopause will take you on a clear, relatable journey through the ups and downs of perimenopause—what it is, when it often begins, and the common signs...

Why I exited mainstream healthcare economics.

Health insurance dictates so much of the practice of medicine in modern society. What medicine can I take? What pharmacy can I use? Is that specialist in my network? Where and when is my surgery? The care we are allowed to receive is often dictated by a faceless third-party who we’ve never met and may not even be human. At its core, because insurance companies are the main payer, they drive the ‘power of the purse’.

Insurers are at the center of our current healthcare economy.

Health insurance separates people and providers. Because of insurance, I used to spend as much time recording, analyzing, and arguing about the care I was providing as I did actually delivering it.

More intelligent individuals than me are trying to fix this problem. I can’t solve the convoluted economic drivers of healthcare. I can’t control insurance companies. I can exit the system.

Equilibrium Menopause is a direct-pay practice.

Why don’t I take insurance? Because I want YOU to be at the center of your own care.

Come find your new balance at Equilibrium Menopause.

Can I only see you online?

Professionally, yes. I chose this on purpose.

I have seen patients in the clinic and via telemedicine. In the noisy clinic, I struggled getting to the root of the problem quickly. I led with open ended questions and listening. I tried learning communication tactics to guide the conversation. I studied how to connect and build trust faster. I worked to make the clinic more inviting. Nothing changed. My patients were angry at me before meeting me, after waiting with screaming children and coughing adults. Doors were slamming, emotions were high, and my patients were guarded.

Over the years, I noticed a phenomenon: Women are more comfortable talking to me when they are in a setting that’s comfortable for them.

When you are at home, or in your office with a closed door, or even parked in your car, you are more at peace than in any doctor’s clinic. It’s easier to talk about what’s really bothering you. Telemedicine is still a face-to-face conversation, in real-time. We are more alone with fewer distractions. You can grab your medicine from your medicine cabinet or look it up on the device you are currently using without it being rude.

And we have more time.

There is no rush. There is no one outside the door waiting for us to come out. There is no other person in the next room also waiting to be seen. There is no traffic to beat to get back to the office.

I have a full hour to focus just on you.

So, can I only see you online? Professionally, yes. Or catch me on the running trails around Allen!

How do I know if this is perimenopause?!?!?!? (Part 2)

I like to summarize perimenopause as ‘puberty backwards’. It has all the hormonal ups and downs, all the mood swings, and an unpredictable nature. Many of us enter perimenopause at the same time our pre-teens and teens are going through their changes. Ugh! Help!

You have options!

We used to wait until menopause was complete before we would treat the symptoms, but if you’re experiencing this, you know that the worst is usually in the middle of the transition. More research, advocacy, and education has led more healthcare professionals to treat the symptoms earlier, but medicine is slow to change. It figures. It takes a decade just to educate us!

So how do I know if this is perimenopause?!?!?!

It takes time.

Not every skipped period is the sentinel for ‘the change’, but it could be. Heavy periods could be hormonal changes, or fibroids, or both.

Remember: The #1 symptom of perimenopause is “I just don’t feel like myself”.

You need a provider who listens; Someone who takes the time to tease out what is life threatening vs soul crippling. They ask ‘What makes you, YOU?’. The best providers validate your experience, support your goals, and equip you with the tools you need to navigate this journey.

It’s not just about hormones. It’s about YOU. Come find your new balance at Equilibrium Menopause.

How do I know if this is perimenopause?!?!?!?!

My friend’s first sign of perimenopause was ear tingling. I have another friend who developed vertigo. Several people tell me they never had a sign and just stopped having periods one day. Lucky buggers!

Everyone’s experience with perimenopause is different, so how do you know?

Well…my answer isn’t sexy…nor am I selling a quick fix. The truth is, it's often difficult. We have to tease out whether the sleep disruptions are from increased stress, or the night sweats from a broken thermostat. Are we really this angry at our coworker, or is this a mood swing? Many of the symptoms of perimenopause also overlap with other medical conditions, such as thyroid disease, anemia, and autoimmune disorders.

So where to start?

Begin with a timeline. Do the symptoms have a pattern? Are they associated with a certain activity? Has period timing changed? Then take that to a healthcare provider who listens. Labs may need to be checked, or preventative screenings brought up to date to ensure nothing scary is causing these symptoms. Perimenopause may not be the only thing going on. We can still have stress AND thyroid disease AND perimenopause at the same time.

This is why it is so vital that your healthcare provider gets to know YOU.

My goal is to maintain your high-functioning quality of life during the perimenopausal transition. To do this, I need to know YOUR goals. I need to know what symptoms are bothering YOU the most; What is preventing you from living your best life.

I have an hour for you tomorrow. Come see me. eqmeno.com

“I need to get my hormones checked.” How many of us have said this?

There is so much in that sentence:
The implication that I need to address the issue. Good on you! Yes! Take care of yourself!
The acknowledgement that something might be ‘off’ or different from before. Recognition is the first step! Yay!
A hint that validation may be necessary; that ‘getting checked’ will lead to more information, and may be a diagnosis.
I only object to the idea that lab values deepen our knowledge on this journey of self-discovery. They won’t.

Estrogen and progesterone, even when working completely in sync within their feedback loop with FSH and LH, vary widely within the average 28 day cycle. Anyone remember this picture from health class!?!?!?!

Anytime we check these female hormone levels, it's usually just a spot check. Lab values only tell me, your doctor, what your hormones were doing that moment in time. It doesn’t tell me how your brain receptors are responding to feedback or how efficiently your ovaries are functioning.

Only listening to your symptoms and their timeline tells me where your body is in the perimenopausal transition.

That’s why I have an hour for you tomorrow. Come see me. eqmeno.com/schedule

Evidence-based medicine used to be a buzz word in the 90s. By the time I went to medical school in 2007-2011, it was the aspirational standard of care. Our job as new medical students was to learn as much of the mainstream research that was available and digest it into the practice of medicine. Some older mentors would speak about ‘Art’ of practicing medicine, but that wasn’t on the multiple choice test, so this was difficult to cram into the study schedule.

After having cancer myself, I appreciate the room that the ‘Art’ of medicine holds for the unknowns in science.

Evidence can only get us so far. My oncology friends practice this every day. They treat the person in front of them. We can only reference the science we have available today. If there isn’t a study that applies to this specific circumstance, we have to rely on the standard of care, treatment availability, ethics, partnership with our patients, and our own wisdom. For perimenopausal medicine, that wealth of knowledge is lagging far behind.

Treating perimenopausal symptoms is the ‘Art’ of medicine.

I view myself as a personal healthcare consultant. It is my imperative to be the expert on the current body of knowledge. In addition, I have the wisdom of experience as I’ve journeyed with numerous women down this path. But do I have the ‘Right’ answer? No!
As your consultant, I listen to your goals, what is currently affecting your quality of life, and what you’ve already tried, then we discuss your options. Then you choose what direction you want to head next.

Find your new balance at Equilibrium Menopause.

Menopause is the end of a woman’s reproductive life. Simple. Ovaries stop releasing viable eggs. That’s it. Women have been going through menopause for as long as we have lived beyond our reproductive years. Menopause itself has never killed anyone. It’s a natural process. It’s puberty backwards.

So why is it so hard?

The changes that come with perimenopause affect every cell in our body. They are as diverse as people are. One woman has ringing in her ears; Another has a new itch on her elbow; Still more experience sweating, fatigue, difficulty sleeping, and mood swings, but not all. The most common perimenopausal symptom is “I just don’t feel like myself”. How do we treat that?

We start with listening.

Solving complex problems begins with truly understanding them. How does estrogen affect my tendons and skin? Where does testosterone come from in women? What is the hypothalamus and why does it connect my ovaries and my body temperature?
Menopause is complicated. It is a multifaceted process that takes years, with many phases, that usually requires a multipronged approach. Navigating the mid-life transition necessitates an understanding of the whole person. What are my goals? What is most important to me?

This takes time.
Your doctor has 10 minutes for you 6 months from now.
I have an hour for you tomorrow.

Come find your new balance at Equilibrium Menopause.