SURPRISE EPISODE: Finding Real Perimenopause Care

A little surprise in your AGECRAFT After Dark feed.

This time, I’m not asking the questions. I recently joined Dr. Rachel Pope on Our Womanity to talk about what it’s actually like to navigate perimenopause when the healthcare system isn’t particularly good at recognizing—or treating—it.

We get into my own perimenopause story (including the grocery-store hot flash that made me think I was dying), being repeatedly told I was “fine,” why regular periods don’t mean you’re not in perimenopause, and the exhausting amount of self-advocacy often required to get appropriate care.

We also talk about the bigger problem: gaps in menopause education for healthcare providers, insurance and access, the rise of private and telehealth care, and the increasingly complicated job of separating genuinely helpful resources from people trying to sell vulnerable patients another supplement, test, treatment, or doodad.

And we get into something central to my work now: validate, educate, advocate. Because people shouldn’t have to become amateur medical researchers just to get someone to listen to them.

Also? Being the guest is delightful. No research. No interview prep. No questions to write. I just showed up and talked. Highly recommend.

Originally recorded for Our Womanity with Dr. Kameelah Phillips Pope and shared here as a special AGECRAFT After Dark feed drop.

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Transcript

Dr. Pope 1:15

I hear from women every day how difficult it is to navigate the healthcare system. Whether you're using an insurance model or a private practice or cash pay, whatever, it can take so long to find the right healthcare professional for you and to find someone who's truly listening. Our healthcare system has been, to be honest, not really based around women and not really based around wellcare. It's been about helping to reduce disease, reduce suffering, and kind of putting out fires. We're hoping to change that. We want to work on preventive care. We want to invest in women's health. We want to understand women, do better research on women, and provide better care for women. And so I thought it would be fitting to have a woman who has experienced it all through midlife come and talk on the show today. I feel like listening to women is what it's all about. And I think a lot of what she says is going to resonate with you. And hopefully we'll come up with some good ideas together. Julia Granacchi is a National Board certified health and wellness coach, comprehensive Pilates instructor, and founder of the Agecraft Practice, where she helps people navigate the physical, emotional, and identity shifts that come with midlife and beyond. Her approach brings together evidence-based behavior change, movement, nervous system regulation, and a healthy skepticism of the cultural messages that tell us that aging is something to fear, fight, or fix. She works primarily with women, queer, and gender-expansive people to build resilience, increase capacity, and create a relationship with their bodies rooted in curiosity and agency rather than control. Julia also works with Anna Barbieri Medical, bringing health coaching into the perimenopause and menopause experience as part of Dr. Barbieri's multidisciplinary care team. She trained at the Institute for Integrative Nutrition and Harvard Medical School's Sustainable Nutrition Program and completed her comprehensive Pilates certification through the Keynes School of Core Integration. At the heart of Julia's work is a simple idea. Midlife isn't a problem to solve. It's an opportunity to reconsider what's working, let go of what isn't, and craft the life you want. So, Julia Grunaki, I'm so excited to have you here. You know, I have been a big fan of yours since hearing your podcast Circling the Drain, which was like such a good concept and so relevant and also so shocking every time I listen to the beginning episode, hearing, you know, what people were saying to women in their midlives, like it is just shocking. So this is why I want to have you on. Thank you so much for being here.

Julia 3:47

Of course, such a pleasure. So nice to be interviewed instead of interviewing because it's uh less crap and less pressure. So thank you for that.

Dr. Pope 3:54

Yes, absolutely. You just get to show up and tell us about your experiences. So, you know, basically my idea was to talk to someone who has really been through it. And unfortunately, I think your story is not uncommon. I think it's going to resonate with a lot of people, but I'd love for you to just walk us through sort of what it's been like as you've been trying to find a healthcare provider, as you've been trying to find someone to address needs that you've experienced going through perimenopause and midlife. Sure.

Julia 4:24

Yeah, happy to tell this story. I tell it often. Because I think, yeah, most people can relate to it. It's why I got into this work. It's why I had started that podcast, because I started my perimenopause, well, I should say I became aware of my perimenopausal journey during COVID, which was a terrible time to go through or start perimenopause, especially when we weren't sure what COVID was. And so I recall very specifically going to the grocery store in the middle of summer. I was masked up and gloved up, and I was waiting in the deli line to get some turkey meat. And I just started sweating. And it was this heat wave, and we've all, well, most of you have experienced this, that came up kind of like from my pelvic floor up through my body, through the top of my head. I turned bright red and just started to melt. And I thought I was dying. And I thought again I was wearing a mask. So everything is more complicated. You know, the hands are sweating in the gloves, the face is sweating behind the mask. And I thought this was an onset of like some crazy fever. I had gotten COVID. I I'm I'm dying. I'm dying. I wasn't dying. I was having a hot flash. And that was the beginning of my awareness of perimenopause. Yeah.

Dr. Pope 5:42

Yeah. That's so common too, right? Because sometimes it's like that obvious sort of knock you off your feet symptom that lets people in on what's been happening. But do you feel like there were other symptoms that predated that that maybe you just so many.

Julia 5:57

Where do we have how much time do you have? It's limited. I mean, let me get I mean, at that point, I think I gosh, how I think I was like 43, I want to say, or 44. You know, COVID just seems like so long ago, and yet it also feels like yesterday. So I think I was 43 or 44, and I was definitely one of these people who had a very athletic build most of my life. I am a comprehensively certified Pilates instructor. I have been a Pilates client starting in the year of 2006. So I have been in this practice doing it, teaching it later, but in, you know, practicing it for many, many years. So I've considered myself a person with a lot of strength. You're healthy, physically, yeah, very healthy, uh, very athletic build. And my body just sort of started to look weird, you know. And we've heard this before. And as a doctor, you hear this, right? It was like fat in strange places that I'd never had before. It was weight I couldn't shed, even though I was just, can I curse on this show?

Dr. Pope 6:56

Yeah, absolutely.

Julia 6:57

Okay. I was working my ass off. Like, and not only working my ass off at my crazy corporate real estate development job, but then going to Pilates afterward, I was getting up at like five in the morning to strength train like twice a week. I was doing so much and I was so burnt out and I was so tired and like nothing was changing, and I had so much anxiety and I wasn't sleeping, and I kept going to the doctor. And this is the story we've all heard. I kept going to the doctor, I kept being told I was fine. I'm having doctors prescribe, you know, sleeping pills and all of these other things. You know, I'm in this place where I like I don't want to get addicted to any kind of sleeping pill or colanopin or anything like that. Not that there's anything wrong with these pills, I want to clarify. Yeah, there's a time and a place. You know, and at a certain point I had just kind of given up, I think. And that all culminated in having that hot flash because that was very clear evidence of what was happening. There was no doubt. Yeah. And so, you know, I reached out to my my OBGYN at that time. And this is a story I think I'm sure that you hear, that I hear from patients all the time. Yeah. Is that I went to my current OBGYN who I knew longer than my husband. Okay. I mean, I had been going to her. I am a child-free person by choice, but this doctor had seen me through polyps and fibroids and surgeries and had been like in my corner for so many years. And I got into telehealth with her and was dismissed essentially for these symptoms. I was prescribed the birth control pill, which has never gone well for me. I tried it, it did not work. Again, birth control is fantastic. It is great for so many people, not for everyone, not for me. And that just, you know, from there went into a series of seeing different specialists, different doctors, finally seeing a, you know, a functional city, right? Like I, you were like, I should be able to throw a rock out my window and hit a specialist. Not true. So to make a very long story short, I ended up with a functional medicine doctor, like in a membership program, which was financially not sustainable and absolutely ridiculous. And the only positive about it was that I did start menopause hormone therapy. I became very educated. I went through Electra Health, which was also fantastic. So the kind of a series of different providers ended up at New York Langone once they opened their menopause care wing, which was like groundbreaking. I want to say this was four years ago or something. And to this day, like you can't even get in. I mean, I am so lucky that I got through the door basically the day they opened because you can't even get this is New York City. You cannot get an appointment there. And Mount Sinai is just, I think, now opening their kind of version of that. That is all to say, it's been a bumpy road. Yeah. But because of that experience, that's why I do what I do. You know, that's why I left this cushy six-figure job in real estate development and became a Pilates instructor and health coach specializing in this work because there is a gap that has to be filled. Exactly.

Dr. Pope 9:59

There's a gap that has to be filled. You know, as you're describing this scenario, the thing that I think a lot of people basically have it wrong in medicine. And this is just my hypothesis from what I hear from my colleagues and from patients, is that even the research criteria for perimenopause is menstrual changes, like starting to have menstrual changes. And I think that could not be further from the truth of when perimenopause starts. And yet I sit on committees where we're reviewing grants, and I still hear people say, but they didn't include the menstrual changes. They're not using menstrual changes as the criteria. And I'm like, this criteria, I think, is what has to change. Because I'm imagining your doctor that you have a great relationship with on the other end and saying she's having all these things, but she's probably still having regular periods. So it's not perimenopause, right? And that is like, I think, where people just get it so wrong.

Julia 10:57

There's such a disconnect there. I mean, I'm a great example. I just turned 50 in November. And up until the age of literally a 50, I want to say, let's see, I turned 50 in November. I skipped my period for two months after that. So I think December, January, I skipped my period and I thought, finally, the relief is coming. I've made it. Uh only to have it come back. And I actually just got it this morning. You're welcome. Um but up to that point, 28 days to the number, like every single time. So my menstrual cycle had never changed. It had been just completely normal for years and years and years. I was clearly in peri-menopausal. I'm clearly in the menopausal stage or getting into it and regular periods most of the time. Yeah.

Dr. Pope 11:43

Yeah, exactly. I I had a patient earlier this week who's 52 and she's like, When are these periods gonna stop? Like, why can't they stop? And you know, aging. Like you can you can tell the rest of her body is aging and she's still having regular periods. You just could never say that she's not in perimenopause. But if you talk to her and you base everything on her menstrual period, she wouldn't be by the straw criteria.

Julia 12:06

Correct. Yeah, and to your point, you know, I would add also, I am still in shock. You know, I work with a clinical practice. Yeah. We specialize in menopause care, that is what we do. And I am still shocked every day when I meet patients who tell me when I say, what brings you here today? And they say the same story that I had. I have seen my OB. She has delivered all four of my children. I went to her with these issues. She drew labs. I'm getting my period regularly and told me I was fine. And I am shocked every single time. I'm still amazed because there is an organization called the Menopause Society that exists that can tell you that this is not the criteria. Yeah. I mean, you literally can look it up on the internet.

Dr. Pope 12:50

I know right there.

Julia 12:52

It's just, yeah, gobsmacked every single time.

Dr. Pope 12:55

And so there's definitely a gap in education for healthcare professionals. Absolutely. And I feel like it starts in medical school, you know, where the emphasis is not really put on what is normal. We are really taught about like look for the pathologies, look for what's abnormal, look for the disease states. And even when, you know, in residency for OBGYN, I kind of came into it from a really holistic perspective. I was really into like natural childbirth and I had trained as a doula before I was a resident. So I kind of came in with some skepticism. I realized, like, yes, we do pathologize everything, but to provide care for the vast numbers of women who are going through, you know, I don't want to pathologize menopause, but there really is suffering associated with it. So why are we not learning how to relieve that kind of suffering?

Julia 13:43

Yeah, I want to acknowledge, I think, I think it's really important not to vilify doctors and the medical system because this is me as such a coach, like this is not your fault. This is not your fault, right? One in five US OBGYNs report formal menopause training. That's not a lot. 80% of OBGYN residents report little or no formal training and menopause management. So it starts in education. And then you know this if you want more, you have to seek that out on your own. And my God, you're busy. You already have to get continuing education and other things. This may not be the thing. So that is all to say that it starts in the education system. And I would even add it starts even earlier with educating kids in their health classes. We learn about birth, we learn about puberty. Why aren't we discussing menopause? Why didn't I learn about menopause when I was 14? Yeah.

Dr. Pope 14:37

Sometimes I don't know if anybody's listening. Is anybody out there? But then I hear that people are enjoying the podcast episodes I'm putting together. If you are one of those people, please like and subscribe. So I know that there are people out there listening. That keeps me continuing on. And then you'll get notifications when there's a new episode. Also, if you know someone who could use the information that I'm putting out there, please feel free to share and forward. I love your support. Thank you. Yeah, I agree. No, I I love that I try to teach my kids about menopause. And it's funny because even this morning my daughter was asking some questions and I started going straight to the hot flash thing. And then I had to tell myself, okay, but it's not just hot flashes, you know. So I'm like, I feel like there's a constant education that we all are are needing to do. And I I follow that with there has to be incentivization in the healthcare system too. Because I love what Melinda Gates is doing by trying to bring more education, but like we are lifelong learners in medicine. We're expected to learn more information as like new research comes out all of the time. But if people are not incentivized to actually provide that care or held accountable for providing that care, like the needle's not gonna move. And you know, I feel like one of the things I've heard you guys talk about on circling the drain was, you know, finding someone who would take insurance. And then again, like hearing about the program at NYU, like getting in, right? Like, right, how are we serving the millions of women that are going through menopause all around the country if we don't have people who will take insurance and many of them who will provide this care?

Julia 16:18

Yeah, I mean, that's such a great point. And I think naming that is really important because again, it's not the doctor's fault. You know, here in this particular case, when it comes to talking about insurance, look, I work for a membership-based practice because the people that I work for want to provide a very specific kind of care. And we cannot do that within the insurance system. And I'm sure you know this better than anybody. And you you've talked about this previously on your show. First of all, insurance companies don't reimburse for seeing lady parts the way that they do for seeing dude parts. So there's a discrepancy in reimbursement. But then also, if you want to spend more than 15 minutes with someone, you are not gonna get paid for that. So it starts with the insurance companies first. Reimbursement has to be better, it has to be easier. Yeah. Otherwise, back to incentivizing, they're not incentivized to take insurance. Yeah. I mean, this is a bigger, a bigger conversation politically, but it starts with government oversight. I mean, right? Insurance companies, my God, it's uh to quote Dr. Rachel Rubin, it is a dumpster fire of brokenness.

Dr. Pope 17:23

It is, it is.

Julia 17:24

Yeah, I know.

Dr. Pope 17:25

So, how do we help the women not like navigate around and out of the dumpster fire? Because this is what I know, like you and I both really want to do.

Julia 17:33

Yeah, I mean, my God, it's so difficult. Okay, from a more systemic point of view, it is calling, it's calling your congressperson, it's getting in touch with organizations where we can actually start with the government oversight, calling your insurance company, asking them why they're not covering certain things. So this is this bigger picture. And if you, if you can, if you are capable contributing financially to groups that can help with that, from a patient standpoint, unfortunately, the whole responsibility falls on your shoulders for advocacy, finding the right provider who can meet that criteria. So with a place like Newark Lingo, and again, just as an example, it might be getting on a waiting list and just coming to terms with the fact that you're gonna have to wait quite a while. But when you get seen, you're really gonna get taken care of. And then it's like menopause.org. Again, educating women so they know that these resources exist. Every single patient I see, they've already come to us. We've already won. We've got the patient, they're doing the thing. I always tell them to go to menopause.org just to be aware that it exists, so that it's there as a resource. So knowing that you can go there and find your provider, likely, hopefully, a provider that takes your insurance who is listed on menopause.org. And, you know, these telehealth companies, there's the good and the bad, right? But they they really are very helpful in the way that there's more access for people in these sort of dry zones of America where they don't have access to this kind of care. They can barely even see a gynecologist or a general practitioner because of the area that they're located. So these telehealth companies are making a huge difference. We've got some, you know, that do take insurance, some that don't. There's some good ones. There's good actors, bad actors. We all know some of them are not so uh savory, but I think in general, the telehealth approach is not bad because most back to your point, most of what is going on with women doesn't require a physical examination.

Dr. Pope 19:23

Exactly. And I see a lot of women who tell me unfortunately they had to wait like three to four months to get in with me, but then they found a teleprovider who was able to get them started. And that's awesome. That saves me a step, right? And helps me to kind of get them moving, to really sort of personalize or customize or tweak. I think that's a really nice combination. So many more resources are out there than there used to be. I wonder what you think about like what needs to change. Like, what would be the single most impactful way to change the healthcare system right now? If you think back to yourself at that time where you are experiencing that hot flash and like looking for help, like I guess what would have made it so much better is if your healthcare provider was like, oh yeah, you're not too young. You don't you didn't do well on birth control pills. Here's some other options. Like, is that where the crux lies?

Julia 20:14

Or I don't know. That's a good question. I think, I think it's really resources. You know, if we're gonna ask that specifically, what would have helped me in that moment? And what I do think is improving, if I'm being honest, is the amount of resources we have out there for people going through this transition. Because at that time, I was taking the deepest dive into PubMed and was like, oh, look, there is one singular paper about how micronized progesterone can help with sleep. I want some of that. And I would ask people and they'd be like, What? Like progesterone? And I'm like, you're a doctor. Like, why am I, why is this news to you? And I would print out the paper and bring it with me and be like, it's cited. So we're we're way past that. I mean, there's so many resources. But again, I still get patients through the door who this is new to them. They've never heard of it. And it's like there's a desert out there, even though there is not. We know that there's a lot going on in what I call the metaverse. So, you know, there are a lot of resources. So I think continuing to build resources, shine a light, you know, we've got a lot of celebrities talking about it. You've got Halle Berry and, you know, a number of other people. So all of that is helpful. But I just want to say that one of the problems we run into with more exposure is this idea of people preying upon this community and a very vulnerable population with supplements and, you know, doodads and all these other things. So while that information is very helpful, I feel like we're more in a spot where it's difficult to be discerning of what is to be trusted and what should not be trusted. So now there's a whole other layer of complication.

Dr. Pope 21:51

You're right. It just gives me heart sync because I saw a patient last week who was telling me, you know, I got into this beautiful private practice. It was like very, you know, beautifully decorated. It was curated for women. It was just so appealing in so many ways. They listened to me, which is huge, right? And they started her on compounding hormone therapy, which was fine for her. There were some tweaks that we decided to make sure that her uterus was getting properly protected. But she's like, I just had this feeling that I was being upsold. She's like, I was so grateful for what they were starting me on. And then, you know, they wanted me to do this thing for that, or they started talking to me about aesthetic treatments for this. And I just felt like I was being upsold. And she just kind of like, we talked about how it was like her spidey sense of like, okay, take what you feel like is right and then leave the rest of it. But I was appreciative that she shared the experience with me because you're right, like there are people who are trying to make money off of this situation of there not being enough people out there to help and the desperacy of how I'm sorry to say shitty perimetopods and menopause women feel. And say it, it's shitty. It's pretty, it's so shitty. And it's uh it's even more shitty to take advantage of someone in that situation. It just bothers me.

Julia 23:07

And to your point, I think patients they start to feel it. They know when they're being sold to, and they may not know it initially, but even for me, like I said, I To this functional medicine doctor I was working with in this membership. And like you said, it got me started on this journey, and I'm grateful for that. But it came to a point where I was like, I don't really need this amount of like blood work and I don't need a Dutch test. I don't need any of this stuff. I think I will change course in this moment.

Dr. Pope 23:34

But you were so PubMed and you were so proactive in like learning this yourself. You know, I I don't know how you help the woman who, you know, doesn't do that or doesn't know how to get started. And I hate that people have to learn medicine in order to get help for themselves.

Julia 23:49

Like, you know. So true. I mean, as a coach, for example, you know, I work with a clinical practice. I also have a practice of my own. Yeah. And I have a particular thing that you can book, which is essentially you get 30 minutes with me to ask me anything that you want. And to tell you the truth, a lot of people spend 30 minutes asking me everything about perimenopause and menopause. And then eventually the last thing we usually cover is how to find a doctor, where to go. Just to clarify, you know, I am board certified. There are ethical guardrails to what I do. I do not prescribe, I do not diagnose. So I simply spend 30 minutes giving verified information to people. So I myself am a resource in that moment. But most of the time that's exactly what we do. It's I spend a lot of time validating people's symptoms. I would say it's validate, educate, advocate. So I spend time validating their symptoms. Everything that's happening to is real, it's not made up. I'm sorry you've been gaslit. I'm glad you're here. I spend some time educating, which is just basic information that you can find on the Mounta Society website. And then advocating, I am handing the reins over and reminding the patient that they have agency and that there are resources available to them to see a specialist.

Dr. Pope 25:02

Yeah. And that's what's needed, right? Like you are a midlife doula. You know, speaking of doula, this was like, this is what we needed in the childbirth community to help women advocate for themselves and not like be passive individuals in their birthing and pregnancy experiences. And this is exactly what we need for validating and advocating for women in midlife.

Julia 25:22

Yeah, I think that agency is so important. I think that often women come to, I mean, even in with this clinical practice, them seeing us is the first step in this journey of agency and self-advocacy. And it's the first step they may have taken in their entire life.

Dr. Pope 25:38

Yeah.

Julia 25:39

When it comes to their own healthcare.

Dr. Pope 25:40

That's huge. That's life changing. So how can people find you?

Julia 25:45

You can find me very easily at juliagwellness.com. That is juliagwellness.com. And then honestly, if you just punch my name into Google, Julia Granacki, I will come up in many different places. You'll find all my uh handles for all the social links and all of the things. Yeah.

Dr. Pope 26:02

That's awesome. And you have your new podcast now. Can you tell us a little bit about that?

Julia 26:07

Sure. I have a new podcast called Agecraft After Dark, where we talk about the things essentially that keep us up at night. So I would say there's a little bit of residual vibe from circling the drain that has carried over. So there's definitely things about health care and that health and wellness approach. But then we cover some things that are not related to that. And, you know, my first guest was my tattoo artist. So it varies across the board. It's a little bit witchy because I am there is a woo-woo aspect. I'm very grounded in science, but there is a woo-woo aspect to what I do. Yeah. And so, and there's also some storytelling that occurs on that too. Every guest is uh tasked with telling us a spooky story at the end. So I think it's a fun time, it's a good hang, and also you might learn something. So yeah, H craft after dark.

Dr. Pope 26:56

Great. Well, I've got a great story to tell you. I'm gonna pin it down to remember to tell you. Yeah. It is a little, a little witchy and a little woo-woo. So I think it'll end. But thank you so much for your time. I hate that you had such a hard time, but I love that you turned this into helping other women and helping other women find themselves, find their voice, and get help that they deserve. So thanks for everything that you do, and thanks for all of the work that you're doing, you know, outside of just your one on one work.

Julia 27:26

I appreciate that. I'm also glad that it brought me here and I love what I do. For the first time in my life, I absolutely love what I do. So yeah, it was a good thing.

Dr. Pope 27:33

Awesome.