Here’s something most people don’t know that may feel shocking.

In 2022, researchers surveyed OB/GYN medical residency program directors across the country. Only 31% reported having a menopause curriculum at all. And among the programs that did have one, every single one reported five or fewer menopause lectures per year, with 71% reporting two or fewer.[1]

So for most residents, the honest number isn’t even “a handful of lectures.” It’s closer to zero.

Which feels absurd, right? Because when you enter your 40s and your sleep falls apart, your joints ache more than usual, your uterus feels like it has a mind of its own, and your brain feels like it’s buffering, who do you reach out to? You should be able to call your OB/GYN. That’s the person you’ve trusted with your reproductive health for twenty plus years. And more often than not, they just weren’t trained in this and often fall short.

This is absolutely not a knock on OB/GYNs. They are truly the experts in obstetrics and gynecology, including surgery, pregnancy, delivery, cancer screenings, and so much more. Perimenopause just didn’t make it into their curriculum, and the program directors themselves know it. In that same survey, 93% strongly agreed that residents nationwide should have access to a standardized menopause curriculum, and 84% said their own program needed more menopause educational resources.[1] I will write another blog post on the patriarchal history of Obstetrics and Gynecology, but for now just know that there is a reason half the population has been pushed aside, ignored, and gaslit once we reach our 40s.

So, if you’ve walked out of an appointment feeling dismissed, had your provider stare at you like a deer in the headlights when you finally got the courage in the last 5 minutes of your appointment to say “hey, by the way, I don’t have a desire to have sex anymore,” or been told your labs are “normal” and offered an antidepressant, you weren’t imagining it.

You just need a different kind of provider. Here’s how to find one.

Look for four letters: MSCP

The most useful filter in this entire search is a credential called MSCP (Menopause Society Certified Practitioner).

It’s an additional board certification through The Menopause Society. It isn’t a weekend course, and it isn’t something you obtain by putting “hormone specialist” on your Instagram profile.

Surprisingly, it’s not tied to one specific degree. Nurse practitioners, physician assistants, MDs, and DOs can all hold it. So don’t screen by letters after the name, screen by whether menopause is something they actually specialized in.

You can search the official directory at portal.menopause.org by ZIP code.[5]

Once you find a few providers, here are the top questions I recommend asking them.

1. How long is my first visit?

This one is much more revealing than it sounds.

I used to work for a well-known healthcare organization. This was a decent one, with genuinely great community outreach, where the initial visit for menopause was 20-30 minutes (at least for a year or two) in my specific clinic. That feels like a luxurious amount of time in the insurance and private equity-driven healthcare world we currently live in. It IS NOT. Menopause has enormous nuance, and it’s intensely personal. You have a symptom list that spans sleep, mood, cognition, joints, libido, cycles, metabolism, and more. You have a family history. You have goals. Thirty minutes gets you a rushed history, and maybe a prescription.

Fifteen minutes, which is what a lot of insurance-based (and private equity owned) practices are down to, gets you almost nothing. You end up doing the thing everyone does, where you mention the actual reason you came as the provider’s hand is already on the doorknob.

A lot of what gets attributed to perimenopause also isn’t only perimenopause. I’ve seen patients with weight gain, dry skin, and hot flashes who looked like textbook perimenopause, and a full thyroid panel comes back revealing Hashimoto’s thyroiditis. Now we’re treating the thyroid and often also providing estrogen or additional hormone support too. Those things aren’t in competition. But you only find these underlying issues if someone has time to look. In the last two months, I have diagnosed patients with iron deficiency anemia, Hashimoto’s, and celiac disease, all of which were missed by other providers who weren’t able to have enough time to properly assess.

Ask the length. If it’s under 45 minutes for the initial visit, consider going elsewhere.

2. Will they prescribe you testosterone?

This is a fast, necessary, and brutal filter.

There’s a lot of hesitation around prescribing testosterone to cisgender women, nonbinary folks with ovaries, and trans men, even though the evidence base supports its use for distressing low sexual desire after menopause. This has been endorsed in a 2019 Global Consensus Position Statement backed by ten international medical societies, with clinical practice guidance from ISSWSH and The Menopause Society.[3]

Some providers won’t prescribe it because of clinical reasoning about your specific history, which may be reasonable and clinically sound. Others won’t prescribe it because they were just never taught how to, and won’t say so. If the answer is a flat “no” with no explanation, that tells you where the edge of their training and competency is.

There’s no FDA-approved testosterone product for cisgender women in the U.S. currently, so this is prescribed either off-label or through a compounding pharmacy.[2]

3. Can they work with or prescribe compounded medications?

Not everyone needs compounding. But some people really do.

A concrete example: micronized progesterone commonly comes in a peanut oil base, and the FDA labeling lists peanut allergy as a contraindication.[4] If you have a peanut allergy, that’s a hard no, unless your provider can send a specialized compounded formulation to a compounding pharmacy.

Compounded testosterone cream is far easier to dose accurately than measuring out a tenth of a packet of a product designed for cisgender men. Many medical providers aren’t even aware that there is an alternative option to the commonly known testosterone gel packets, which is why seeing an experienced provider who is comfortable with compounding medications is important.

4. Will they be able to recommend treatments for low libido?

The most overlooked area in all of menopause health, in my experience, is libido. I hear the same sentence constantly: no provider has ever asked me about this, or they told me to see a therapist, but didn’t offer any other options.

It’s not just about desire, inability to orgasm, or painful sex. It’s asking about your sleep, your stress load, your thyroid, your family history, your cardiac health status, and your other joint symptoms (and then connecting them), instead of treating each one as an unrelated complaint.

Your Colorado options, honestly assessed

Large national telehealth platforms. Convenient and often affordable up front, as many take insurance for a portion of their platform. Usually 15–30-minute (max) intake, a narrower formulary, frequently a membership model that is often not covered by insurance, and you may not see the same provider twice. Fine for a straightforward case or someone on an existing regimen who is feeling great already. Frustrating if you’re new, not sure if you’re in perimenopause, complicated, or already on a regimen that isn’t working well for you.

Your existing OB/GYN. Absolutely worth asking. Some are outstanding at this and have pursued the training themselves. Ask directly whether they hold the MSCP credential or not. One important note here is that most OBGYN visits covered by insurance are 15 minute appointment slots. This is worth asking, because even the best of us can’t thoroughly cover all of your perimenopause related concerns in 15 minutes.

Functional medicine and naturopathic practices. Often generous with time and genuinely holistic, but not always evidence-based. Scope of practice varies significantly by license, and pellet therapy in particular is worth researching carefully before you commit, as dosing is difficult to adjust once implanted, and highly variable in both efficacy and safety. This isn’t just my opinion — ACOG specifically recommends preparations other than pellet therapy for delivering testosterone, citing the lack of safety data and the inability to remove the pellet once it’s in.[2]

A specialized cash-pay practice with a Menopause Society Certified Practitioner (this is where Terra Share Health sits). No insurance billing, which is exactly what buys the 60-minute visit. Superbill can be provided for HSA/FSA or reimbursement. You keep using your insurance for prescriptions and labs as well.

There’s no universally correct answer here. There’s a correct answer for you, and it depends on your complexity, your budget, and how much time you need.

Where I fit

I’m Terra, a board-certified Family Nurse Practitioner (FNP-C) and Menopause Society Certified Practitioner (MSCP). I’ve been in healthcare for well over a decade. I’ve worked with tens of thousands of patients across 11 states, both in-person and via telehealth.

Terra Share Health is 100% virtual, which matters a lot in a state like this one. I’ve lived in Steamboat Springs, CO and Missoula, Montana. I know exactly how hard it is to get specialized care when you’re not on the Front Range, or near larger cities.

I offer full-service perimenopause, menopause, and gender-affirming hormone care throughout Colorado, plus GYN urgent care in several other states. My goal is to be a friend who happens to have a lot of expertise in this field. Someone who hears you, works through what’s actually going on in your body, and helps you step into this next phase feeling like the best version of yourself.

Why Cash Pay?

The reason I can spend a full hour with you on your first visit and message you is that I don’t bill insurance, and I am not owned by a VC group. What I’d point out is that in practice, most patients use their insurance for the parts where it works well: prescriptions and lab work. If you’re uninsured, I have multiple resources for discounted labs and self pay discount coupons for prescriptions. And I can provide a detailed superbill you’re welcome to submit for reimbursement, or run through HSA or FSA.

The frustrating reality with insurance-based menopause care right now is that you’re often either booked out months, or you finally get in and have fifteen minutes. That isn’t really a solution to begin with. Compared to the other online platforms, I offer very competitive pricing. In addition, I provide discounts for educators (teachers) and healthcare workers (nurses, doctors, therapists, chiropractors, etc).

The Takeaway

Go to portal.menopause.org. Search your ZIP. Ask about visit length, testosterone, compounds, certifications, and if they treat low libido.

You don’t have to white-knuckle what should be the best years of your life because the medical system decided this wasn’t worth teaching.

Whether you work with me or with someone else entirely: you deserve a provider who was actually trained in this!

Wondering if we’re a fit? Book a free 15-minute intro call — we’ll talk through what’s going on, what your goals are, and whether I’m the right person to help you get there. No pressure, no obligation.

Sources

1. Allen JT, Laks S, Zahler-Miller C, et al. “Needs assessment of menopause education in United States obstetrics and gynecology residency training programs.” Menopause (The Journal of The Menopause Society), 2023. Survey distributed to 145 U.S. OB/GYN residency program directors in 2022; 99 responded (68.3%). 31.3% reported having a menopause curriculum; among those, all reported five or fewer menopause lectures per year and 71% reported two or fewer; 92.9% strongly agreed residents nationwide should have access to a standardized curriculum; 83.8% agreed their program needed more menopause educational resources.

2. American College of Obstetricians and Gynecologists. Compounded Bioidentical Menopausal Hormone Therapy. Clinical Consensus, November 2023. States that there is no FDA-approved testosterone formulation for the management of menopausal symptoms, recommends a shared decision-making framework for compounded testosterone, and recommends preparations other than pellet therapy for testosterone delivery based on the lack of safety data and the inability to remove the pellet.

3. Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019), endorsed by ten international medical societies and published simultaneously across four journals; ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women (2021); The Menopause Society Practice Pearl on testosterone for postmenopausal HSDD (Menopause, 2023).

4. Progesterone Capsules, USP — FDA prescribing information (DailyMed). Labeling states the product contains peanut oil and is contraindicated in patients allergic to peanuts.

5. The Menopause Society certified practitioner directory: portal.menopause.org