Which Doctor?

May 29, 2023 8:27 AM

YANMD. But I need some advice. I think I have finally figured out why I’ve been having so many asthma flare-ups over the past three years. But which doctor should I enlist to help me address this issue?

In early 2019 I had to switch my controller inhaler medication. The new inhaler worked OK for about 18 months (not as well as the old medication, but good enough). Since 2020 I’ve been having an increasing number of asthma flare-ups. I also started experiencing mild symptoms of perimenopause in 2020. But I never connected the flare-ups to perimenopause.

We initially chalked the flare-ups to the increasingly terrible air quality in our area. I’ve made four trips to the ER in the past three years. I realized in the annuals of asthma this is probably nothing, but as a 49 year old woman I am frankly risking no longer being taken seriously.

Until a couple of weeks ago. While researching, I came across two NIMH studies suggesting that the increased flare-ups are a thing that happens and can be treated with patch/gel HRT, even for individuals that cannot take the combo pill. And I’m willing to try it.

I have an allergy/asthma doctor. I have an NP. I have a gynecologist. I have appointments with the NP and the allergy/asthma doc coming up in the next few weeks (and I will be asking for a medication switch) and while the wait for the gyno will probably be longer, I can schedule with them as well.

Which doctor do I enlist to help me? Or do I ask them all and see if any say yes? I’m at a bit of a loss because I’m experiencing an issue that sits at the intersection of two areas of expertise and I could easily get bounced around if none of them want to take a risk.

posted by theBigRedKittyPurrs to Health & Fitness (5 answers total)

Is the NP your primary care provider? I’d ask either your primary care provider or your gyn about menopausal hormone therapy, since they’re likely to be the most informed about current hormone treatment options. I might talk to the allergist about whether hormones / menopause are likely to be a factor in what’s going on, but even if the allergist says that they are, I’d rather have primary care or gyn manage the prescription since they do a lot more of it.
posted by maleficent at 9:46 AM on May 29, 2023 [6 favorites]

Best answer: This could be tricky, because even if your issue didn't sit "at the intersection of two areas of expertise," lots of providers -- even GYNs -- avoid ever prescribing HRT. There was a pretty stunning article in the NYT Sunday Magazine (here's a Wayback non-paywalled version) this past February that attributes that reluctance to a flawed and miscommunicated 2002 study:

"Medical schools, in response to the [study], were quick to abandon menopausal education... About half of all practicing gynecologists are under 50, which means that they... might never have received meaningful education about menopause... Education on a stage of life that affects half the world’s population is still wildly overlooked at medical schools. A 2017 survey sent to residents across the country found that 20 percent of them had not heard a single lecture on the subject of menopause, and a third of the respondents said they would not prescribe hormone therapy to a symptomatic woman, even if she had no clear medical conditions that would elevate the risk of doing so."

My PCP falls into that third -- he never prescribes it. He suggested that I see a GYN if I wanted to discuss it, and left it to me to find one who'd be good for that. (Was I thrilled about that? I was not.) I looked GYNs up online, and called around to area medical groups, asking who it'd be good to see about HRT. I ended up picking one in NAMS' directory of "Menopause Practitioners" because I found NAMS' position papers on HRT to be thorough, evidence-rich, and clearly thought-out.

In your shoes, I'd go with your idea of bringing it up with each of the providers you're about to see anyway, and if they don't prescribe it themselves, ask if they have an idea of who you should see. If not, I'd probably call your GYN's office to ask about their HRT-prescribing tendencies before deciding whether to schedule an appointment. If it sounds like they don't frequently recommend HRT, I'd try to find someone either on the NAMS list or someone whose openness to HRT I could check ahead of time, on line or on the phone with their office.

I hope you're able to get the help you need!
posted by daisyace at 3:55 PM on May 29, 2023 [1 favorite]

Everybody* I know is on HRT (or menopausal hormone therapy - MHT - as it is known these days). It is very ordinary and commonly prescribed. See your GP or other primary care provider and they can sort you out and see if it is appropriate for you given certain contraindications.

I don't think you need to frame it as a solution to your asthma, just get a prescription for your perimenopausal symptoms. Then you can see for yourself if it makes any difference to your asthma.

* hyperbole
IANAD IANYD.
posted by lulu68 at 6:24 PM on May 29, 2023

Best answer: honestly i would bring it up with every single one of them. you have the best chance of getting help that way.
posted by misanthropicsarah at 10:23 AM on May 30, 2023 [1 favorite]

Response by poster: Thanks all. I'll start with the gyno and work my way through from there. The good news is I was able to get an appointment next week.
posted by theBigRedKittyPurrs at 12:07 PM on May 30, 2023