Photo by Erin Nelson.
Dr. Gretchen McCreless, a gynecologist and certified menopause practitioner, speaks with a patient about her symptoms during an office visit at St. Vincent’s Women’s Health in Birmingham.
“I feel like myself again.”
Dr. Gretchen McCreless said she hears that comment over and over from patients at her practice.
And she’s grateful to be able to help —McCreless said she feels like perimenopause and menopause are often overlooked, even though half of the population experiences them at some point, often with significant symptoms in the process.
“I feel like we hear a lot about adolescence and puberty because it’s such a huge change in our children’s lives,” said McCreless, a Mountain Brook resident. “Menopause is just like puberty, but it’s on the opposite end of a woman’s life span. You go through this crazy change in your hormones and your body, and it literally affects every part of your body.”
But by the time women reach perimenopause, they’re focused on other things — like taking care of children, spouses or aging parents — and not thinking about taking care of themselves, she said.
“So I think a lot of the attention gets turned away from women and some of the things we experience later in life,” she said. “But every single woman is going to go through menopause. I just think there’s a lot we can do better in that area, so I’m trying to do that.”
McCreless, a gynecologist with Ascension St. Vincent's Women’s Health in Birmingham, said her interest in menopause care started when her mom was experiencing some menopausal issues and couldn’t get the help she needed.
“I looked in her local area to see if she had anyone that I thought would be a good fit, and that’s when I realized they have a whole menopause center at the academic center where she lives,” McCreless said.
Not only that, McCreless saw that all of their providers were certified menopause practitioners. That nudged her to look into the certification, since it was a niche that she felt wasn’t filled in Birmingham.
“I cannot even tell you how many patients find me because of that and come to seek me specifically,” she said, noting that about half of the patients she sees are in their 40s and wondering what they can do to make the transition smoother. “And then I see many people who are beyond menopause in their 50s and are saying, ‘I still don’t feel good; I don’t feel like myself. What can I do?’”
McCreless said a variety of treatment options are available for both stages of life, and if someone is starting to experience some symptoms, it’s never too early to have that conversation.
“I have seen a really big increase in the number of women in their 40s coming to see me as they start to realize their body is changing a little bit,” she said, noting that those symptoms can include anxiety, weight gain, poor sleep or irritability.
For some women, going back on birth control may be a good option, McCreless said. “I have a lot of 40-something-year-olds who are taking birth control pills again because that helps stabilize your hormones in that transition period and it makes it a little bit easier to transition.”
But some of her patients are “absolutely adamant” about not taking birth control, and another option is hormone replacement therapy.
“We can do a cyclic patterning of estrogen and progesterone just to kind of help level and stabilize their hormones,” McCreless said, noting that this helps through the transitional years when a woman is still having bleeding but moods start to change and night sweats and sleep difficulties may start.
She said hormone replacement therapy has had “kind of a negative reputation” in the past, but that stems from research conducted more than 20 years ago. She noted that as the years have gone on, results have shown that any negative outcomes were limited to women over 60.
“In fact, women who were just going through the transition in the early years of menopause did not have the same complication and risk of the hormones, and they actually had a lot more benefit from taking hormone replacement,” McCreless said.
She noted that in 2022, the North American Menopause Society released a statement saying that in the first 10 years of menopause, hormone replacement therapy should be considered because it improves bone and heart health and general well-being.
“It’s kind of an attitude change in the gynecology world; I’ve had to change my own way of thinking,” she said. “I think for so long the attitude has been, ‘Hormones are bad, I don’t want hormones, I can get through this, I’m just going to grit my teeth and get through it.’ And you don’t have to do that.”
As women get beyond menopause, she prescribes testosterone for low energy and low libido.
And McCreless said she’s careful about what she gives her patients.
“There are certain progesterones that, when they’re given in combination with estrogen, can increase your breast cancer risk, so I try to just be very mindful of which progesterone we prescribe and have patients taking,” she said.
McCreless said she can prescribe bio-identical hormones, which have the same chemical makeup as what the body produces.
For women who can’t take hormones because of underlying health conditions, there are “a lot of other options” ranging from over-the-counter supplements to medications that help with hot flashes.
McCreless said all the way around, her goal is to make women’s lives better — women who, like her mother, have issues and need help getting some relief.
“One of the more rewarding things I experience is just hearing people say it literally changed their life,” she said.
And she’s glad she gets to do it in her new hometown. McCreless moved to Birmingham from Ohio to do her residency at UAB Hospital, then decided to make Mountain Brook home after getting married in 2016.
“We just loved Crestline,” she said of herself and her husband. “He’s a runner and spent a lot of time running the sidewalks and the streets of Mountain Brook. We just spent so much time there, it was a community that we loved, so that’s where we decided to stay.”
For more information about McCreless’s practice, call 205-939-7800.
