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Midi's Approach

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About the Expert

  • Clinicians must understand a woman’s unique experience and health history to effectively manage her challenges at midlife. That requires in-depth conversation, touching on her lifestyle, mental health, sexual wellbeing, and more.
  • Hormone replacement therapy (HRT) will, in many cases, be a safe and extremely effective solution for the symptoms of perimenopause and menopause, and it confers preventative health benefits, as well. But HRT is by no means the only treatment available.
  • Certain supplements and botanicals are well supported by scientific evidence, and can be used instead of HRT, or alongside it for a layered approach to relief.
  • Lifestyle coaching should be an element of treatment for all women, because sleep, nutrition, exercise, social support, and mindset are the pillars of good health at every age.

Every woman’s body is beautifully unique, with its own chemistry, physiology, and history, which means every one of us will react differently to the changes that happen at midlife. The biggest shift: Female hormones start to fluctuate and gradually decline during perimenopause, and then drop off to almost nothing at menopause. In response, each woman will experience her own particular combination of symptoms, varying in severity and timing. Just as there’s no single experience of menopause, there’s also no single treatment to make everything feel better. At Midi, we take a “yes, and” instead of “either/or” approach to the full range of science-backed solutions, because lifestyle changes, supplements and botanicals, and hormone replacement therapy (HRT) can all help. To treat each patient as the extraordinary individual she is, we tap into the entire toolkit, mixing and matching in bespoke combinations. Here’s what that looks like in practice, and why it matters for our patients and clinicians.

A holistic approach begins with listening

Midi starts by getting to know you, deeply and multi-dimensionally, so we can build a Care Plan that’s effective and feels right to you. “I treat the whole person,” says Dr. Erin Conlon, a Midi clinician and licensed naturopathic physician with a doctorate in naturopathic medicine and masters of science in integrative medical research. “That means listening to your story and telling it back to you, as I understand it, to make sure I’m not missing anything. Then I ask questions about the symptoms you came in to discuss as well as a range of related symptoms you may be having, but never thought to mention. We talk about exercise, sleep, and diet, because all of those are interconnected, and may be driving your symptoms. I ask about mood, sex, and issues like loneliness, because they all contribute to quality of life, as well as physical wellbeing.” The reason is simple: The more we learn about you, the better we can help you.

Next, we look at the full spectrum of solutions, not just HRT

If HRT is appropriate given your symptoms, age, medical history, genetics, and personal approach to health, there’s a good chance we’ll recommend it. Why? Because decades of research and clinical data confirm that HRT is the most effective intervention available to improve symptoms of hormone transition. It is FDA approved for the treatment of hot flashes, sleep, depression, and can bring relief in a matter of weeks or even days. And when prescribed according to guidelines (Midi follows those set by the North American Menopause Society, the leading nonprofit organization focused on women’s health in midlife), HRT actually lowers your risk of heart disease, osteoporosis, and all-cause mortality.

Prescribing HRT requires answers to a detailed health questionnaire and in-depth clinician/patient conversation (yes, we’re big on actual human connection at Midi). We screen all patients carefully to weigh the benefits, ruling out hormone therapy altogether for anyone with a history of the following:

  • Stroke or an embolism
  • Certain types of heart or liver problems
  • Cancer that might be stimulated by hormones, including certain kinds of breast or uterine cancer
  • Current unexplained vaginal bleeding

Midi clinicians consider those, and many more factors that inform your personal HRT decision tree. Your personal approach to health matters as well, because some patients want to avoid HRT whether they are good candidates or not. Midi respects and supports that point of view. We want you to feel as comfortable with what’s in your Care Plan as we do, and fortunately, we have a wealth of science-based alternative solutions. That’s the strength of a holistic approach.

Supplements, botanicals, and lifestyle changes

Every patient has options, and many women—including those with a personal or family history of breast cancer—will benefit from supplements, botanical remedies, and wellness therapies. Those can work in place of HRT, or alongside it for a layered approach to relief. Some of the most studied supplements include black cohosh, ashwagandha, soy and red clover. A randomized contolled study published on Menopause, for example, found that valerian improves the quality of sleep for menopausal women experiencing insomnia. There is good science behind wellness therapies, such as acupuncture and cognitive behavior therapy (CBT), which is particularly effective for vasomotor symptoms and insomnia.

In addition, research proves, time and time again, the power of lifestyle changes to counter menopausal symptoms, improve everyday wellbeing, and protect your health for the long haul. “Lifestyle coaching works for literally everyone, and benefits every element of health,” says Midi co-founder Dr. Stephanie McClellan, a gynecologist who has focused on caring for midlife women for more than fifteen years. “We know that the pillars of health are sleep, nutrition, exercise, social support, and mindset. These are the things that modulate the immune and cardiovascular systems, energy metabolism, gut microbiome, and brain pathways. So lifestyle goals and specific, realistic ways to reach them will be part of every Care Plan a Midi patient receives.”

Finally, a number of non-hormonal prescription medications are very effective for hot flashes, mood changes, sleep, and more. They are usually used to treat other conditions, including overactive bladder and nerve pain, but we can prescribe them to relieve menopause symptoms at far lower doses. No hormones plus improved symptoms is a winning combination for some women, especially for breast cancer survivors—a group Midi welcomes. In fact, we specialize in cancer and menopausal symptoms, using protocols created by some of the world’s top experts in survivorship.

Put it all together and you can treat the root cause of symptoms

To explain why Midi uses a wide variety of solutions, Dr. McClellan offers this example: “I might see three different women with the exact same sleep problem—they’re wide awake in the middle of the night and can’t fall back to sleep—but for each of them, the root cause is different. For one, anxiety could be to blame, so we’ll recommend lavender, which is clinically shown to calm the brain, and cognitive behavior therapy, to help her counter anxious thought patterns. Another could be carrying the experience of early life trauma—her Care Plan could include trying a weighted blanket to calm her too-vigilant mind. For the third, the issue could be largely hormonal. If she’s a candidate for HRT, that’s our primary answer.” What Midi won’t do, says Dr. McClellan, is camouflage the problem with sleeping pills without ever addressing the root cause.

For nearly every woman Midi cares for, the solution is multifactorial, meaning that elements from numerous approaches are woven together for maximum relief.  That benefits patients, and clinicians, says Dr. Conlon. “Combining supplements and botanicals with HRT may enable us to give you the lowest effective dose, while layering on more relief,” she says.  “If you’re super sensitive to a pharmaceutical, we can give you something evidence-based but gentler from the botanical realm. When you avail yourself of both conventional and complementary solutions, outcomes are better and options for the clinician are expanded.” The end result is more personalized, thoughtful treatment with recommendations that often improve numerous symptoms simultaneously.

No more do-it-yourself medicine

A final advantage of Midi’s “yes, and” approach to care? Our clinicians are trained to integrate solutions, so you don’t have to. Oftentimes a woman struggling with menopause symptoms sees a traditional doctor for prescription medications and procedures, heads to Google for information on supplements, and turns to friends for advice on wellness therapies. Cobbling together your own care without expert guidance is exhausting, and potentially risky. A Midi clinician comes to your visit armed with an understanding of all the conventional and complementary treatment options out there, ready to curate the safest, most effective regimen for you. All you need to bring is your health story. As we say often at Midi: You know your body. We know the science. Let’s work together to help you feel your best.

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