V is for Variables
Over about two years, I asked six different medical providers about hormone therapy — asking each of them to factor in my own medical history and genetic nuances.
I got six different answers.
Not six versions of the same answer. Six different frameworks, six different comfort levels, six different amounts of hedging. One preferred not to discuss it at all.
I'm Julie Kaminski, a National Board-Certified Health & Wellness Coach. I know how to ask a clinical question. And I still left most of those appointments with less clarity than I walked in with.
If that's been your experience too, here's why. Because it isn't you — and it isn't entirely them, either.
What are Variables in the SAVOR Method?
Variables is the V in the SAVOR Method, my five-pillar framework for midlife women (Sustenance, Activity, Variables, Organization, Refuelment). Variables covers the hormonal, medical, and genetic factors that shape how you feel and whether you get to thrive.
Some of them you can change. Some you can't. All of them are worth understanding — because you can't work with a variable you don't know exists.
Are doctors trained in menopause care?
Most receive very little formal training. A national survey of OB/GYN residency program directors published in the journal Menopause found that fewer than a third of programs had a menopause curriculum at all. An earlier survey of residents across family medicine, internal medicine, and OB/GYN found that under 7% felt adequately prepared to care for menopausal patients.
Read that again.
Your doctor may be excellent. Genuinely, deeply excellent. And may have received almost no formal training in the thing you came in to talk about.
That is not a reason to distrust her. It's not a reason to distrust medicine. It's a reason to stop assuming that walking into an appointment is the same thing as getting answers.
How do I prepare for a menopause appointment?
Write down your symptoms before you go — all of them, including the ones that feel unrelated or embarrassing. Sleep. Joints. Mood. Brain fog. Libido. The 3am wake-up.
Then ask directly: What are my options, including hormone therapy? What are the risks for someone with my history specifically?
If you don't get a real answer, ask for a referral or find a Menopause Society Certified Practitioner. That credential exists precisely because of the gap above.
Second opinions are not disloyalty. They're due diligence.
Is what I learned about hormone therapy still accurate?
Probably not, if your understanding was formed a decade or more ago. This field is moving fast, and the fear-based story many women absorbed about hormone therapy has been substantially revisited in the years since.
If your understanding of your options was formed in 2015 — or formed by something your mother was told — it's out of date.
That doesn't mean hormone therapy is right for you. It means the question deserves a current conversation, not an inherited assumption.
Who are the best menopause experts to follow?
You don't have to read the journals yourself. These clinicians and researchers are doing it and translating it:
- Dr. Rachel Rubin — urologist and sexual medicine specialist, relentless on vaginal estrogen and the genitourinary symptoms nobody wants to name out loud
- Dr. Stacy Sims — exercise physiologist whose entire thesis is that women are not small men, and that midlife training needs its own rules
- Dr. Vonda Wright — orthopedic surgeon behind the framing of musculoskeletal syndrome of menopause: the joint pain, the lost strength, the recovery that isn't recovering
- Dr. Mary Claire Haver — OB/GYN who has done more than almost anyone to move this conversation into the mainstream
- Dr. Kelly Casperson — urologist, refreshingly direct about libido, pleasure, and the things we were taught to just live with
- Dr. Lisa Mosconi — neuroscientist on what actually happens in the midlife brain, including the fog you were told to ignore
Follow two. Not all of them. The goal is better information, not another source of overwhelm.
What options exist for managing menopause symptoms?
Hormone therapy. Non-hormonal medications. Sleep. Protein. Stress load. Strength training.
You don't have to choose all of them, and you certainly don't have to fix all of them at once.
But you should know what exists before you decide what you're ordering — because the most common reason women stay stuck isn't that they picked wrong. It's that nobody showed them the full menu.
The whole point
You are not going to out-discipline a system that changed the rules on you.
But you can become the most informed person in the room about your own body.
That's not a consolation prize. In midlife, that's the whole strategy.
If this resonates, this is the work I do.
Coaching with me isn't another plan to follow. It's space to step back, understand what your body is actually asking for, and build a strategy that supports the life you're living now.
👉 Book a complimentary call and let's map out what thriving looks like for you.
Thriving isn't accidental. Thriving is intentional.
With warmth,
Julie
Julie Kaminski MA, NBC-HWC is a Board-Certified Health Coach and Founder of the SAVOR Method based in Charleston, South Carolina.
She holds a master’s degree with distinction in counseling psychology, is a graduate of the University of Pennsylvania’s Foundations of Positive Psychology certification, is NBC-HWC Certified, and maintains ACE Certifications in Group Fitness, Personal Training, and Fitness Nutrition. Whether coaching one-on-one, leading workshops, or designing group challenges, Julie’s mission is to help clients uncover their unique Blueprint to Thrive.
Answers to Frequently Asked Questions
What is a Menopause Society Certified Practitioner?
A clinician who has passed a competency examination administered by The Menopause Society, indicating specific training in menopause care. The Society maintains a searchable directory of certified practitioners.
Should I get a second opinion about hormone therapy?
Seeking a second opinion is reasonable, particularly if your provider declined to discuss options or you left without clarity on the risks specific to your history. It reflects due diligence rather than distrust.
Why do doctors give different answers about HRT?
Some variation is legitimate — hormone therapy is an individualized decision and reasonable clinicians can weigh risk differently. Some variation reflects the training gap: most residency programs do not include a menopause curriculum.
What questions should I ask my doctor about menopause?
Ask what your full range of options is, including hormone therapy; what the risks are for someone with your specific medical and family history; and what would need to be true for their recommendation to change.
Is hormone therapy safe?
This is an individualized medical decision that depends on your health history, timing, and symptoms, and it should be made with a qualified provider. The evidence base has been substantially revisited since the early 2000s.
