Chapter 1: The Appointment Dilemma

Prepare yourself for a saga filled with frustrating doctor visits, unexpected betrayals, and the art of extreme couponing.

Start by scheduling an appointment with your gynecologist. Be ready to wait several weeks or even months while pondering why you’re sweating profusely every day and gaining weight. If you happen to have an earlier annual exam, you can mention your distressing perimenopausal symptoms, but expect an additional fee for this consultation. Remember, checkups are merely for routine assessments!

It’s a common understanding that “women’s health” primarily involves awkward and sometimes uncomfortable screenings for breast and cervical cancer. Unfortunately, it rarely addresses the uncomfortable and often embarrassing bodily changes that accompany the onset of perimenopause or the mental health challenges tied to these changes.

Upon arriving for your appointment, brace yourself for at least a 34-minute wait in the reception area, even if you arrive a staggering 179 minutes early, have the first slot of the day, and graciously hold the door for the receptionist.

Once your name is called, you’ll be ushered into a restroom where you’ve been conditioned to relieve yourself at every opportunity, regardless of whether you’ve had anything to drink for a day or just experienced a bout of nausea.

Following this, you will step onto a scale that mysteriously adds an extra 19 pounds to your weight, in addition to the weight of your clothing, shoes, and purse.

While you contemplate the number you’ve just seen, your blood pressure will be checked. If it’s normal, your name will be immortalized on a gold plaque in the waiting room.

Next, you’ll be instructed to undress and don a pink short-sleeved top devoid of buttons along with a half paper skirt, and take a seat on butcher paper in a chilly, windowless room—an ideal setting to reflect on life choices you wish you could change.

After a span of 16 to 711 minutes, there will be a knock on the door. With your appointment only scheduled for 6⅓ minutes, your doctor will enter and casually inquire about your sleep the previous night to gauge whether your complaints stem from sleep deprivation.

The silver lining? If you convincingly express your struggles with perimenopausal symptoms, you might walk away with a prescription for Hormone Replacement Therapy. Tears of frustration are not only acceptable but may even be encouraged.

Be aware, however, that your prescribing doctor is likely unaware of your insurance details or the actual cost of the medication. And you might be in the dark as well!

Later that day, during your lunch break rush to the pharmacy, you may find that the medication is out of stock. That night, you’ll attempt to sleep in your tank top, on moisture-wicking sheets, with a fan blowing on you, your husband relegated to the guest room, and ice cubes tucked into your underwear in a desperate attempt to stay cool. You’ll cling to the hope that tomorrow will finally bring a change!

But alas, tomorrow comes, and nothing has changed. This continues for several more days. Eventually, the pharmacy will call to inform you that your prescription is ready. You go to pick it up, only to discover it costs $647.45 per month. This shocking news will trigger another hot flash. The upside is that you won’t have to pay, but the downside is walking out empty-handed yet again.

As you share your frustrations with friends, you learn about an app that could unlock better pricing and a treasure trove of coupons hidden somewhere online.

Rumor has it that additional discounts may be lurking in Pokémon locations throughout Philadelphia, and your nephew might be willing to help you track them down—provided you promise him a cheesesteak.

Moreover, a colleague of your friend Beth will advise you that visiting the pharmacy on a Tuesday grants you an extra 10% discount, but only if you show up precisely between 10 am and 10:10 am and navigate to aisle 6¼ to find the pharmacist’s station.

You'll soon discover the importance of bringing your AAA card, five non-perishable canned goods set to last until 2027, and your voter registration card. Learning the secret handshake of the pharmacist (which, spoiler alert, doesn’t actually involve handshakes) could also yield the best price.

Once you successfully navigate this labyrinth, you might find yourself paying only $401.05 annually for hormone replacement therapy. If you’re fortunate, the pharmacist might even throw in some Fluoxetine, recognizing that you’re likely feeling quite down by this point.

Ultimately, the more inventive you are in your search for savings and the more determined you become to avoid being overcharged, the better deal you’ll secure. This phenomenon can be aptly described as Darwin’s “Discount of the Stubbornest.”

For those unable to go through this exhausting process, the alternatives involve maxing out credit cards or waiting 4 to 10 years for the sweating, hair loss, sore feet, relentless PMS, and brain fog to potentially cease.

However, the relentless desire to maintain control over one’s body will linger indefinitely.

Chapter 2: Seeking Solutions

In this insightful video, Dr. Mary Claire Haver discusses how to navigate the complexities of menopause and perimenopause to maximize health and vitality.

Chapter 3: The Cost of Hormone Therapy

In this episode of The Dr. Louise Newson Podcast, the discussion centers around determining the appropriate dosage of hormone replacement therapy for individuals with POI.