Interview with Dr. Janet Choi, Chief Medical Officer at Progyny — Redefining Menopause Care

Menopause touches every woman, yet care for it remains fragmented, misunderstood, and often stigmatized. Dr. Thais Aliabadi and Mary Alice Haney sat down with Dr. Janet Choi, a double board-certified reproductive endocrinologist and OB/GYN, Menopause Society Certified Practitioner, and Chief Medical Officer at Progyny, to discuss what modern menopause care should look like. Our conversation covers practical clinical guidance, workplace advocacy, and how an integrated benefits model can keep women healthy and productive throughout their lives.

Table of Contents

• Why this matters: the missed decade and the cost to individuals and organizations
• Interview
• How to take action now
• FAQ
• Final note

Why this matters: the missed decade and the cost to individuals and organizations

The average age of natural menopause is about 51.5, but the transition often begins years earlier. Perimenopausal symptoms can start seven to ten years before the final menstrual period and sometimes even in a woman’s 30s. These symptoms are not just “annoyances.” They can disrupt sleep, cognition, mood, relationships, and long-term health, including heart disease, bone loss, and metabolic changes. Employers lose productivity and talent; women lose career momentum and quality of life.

Interview

Can you describe Progyny’s mission in one sentence?

Our mission is to empower individuals on their personalized health journeys with a whole-woman approach that spans family building and comprehensive women’s health benefits. We center care on the person and the life stage, not on a single diagnosis or episode of treatment. That means guidance and intervention from menstrual health through fertility, pregnancy, postpartum, perimenopause, and menopause.

How does a person engage with Progyny? What does the member journey look like?

Progyny is typically available through an employer-sponsored benefit. Once an employer offers Progyny, members sign up and are immediately connected with a dedicated Progeny Care Advocate, or PCA. The PCA is a trained, licensed professional—nurses, social workers, genetic counselors, embryologists—who becomes the member’s point person. They do real navigation work: triage symptoms, provide education, coordinate appointments, and connect members to vetted specialists in Progyny’s network when clinical care is needed.

The relationship is human first. Members tell us they develop strong trust with their PCAs; some even name their babies after them. The PCA is not an AI bot. The PCA listens, explains options, triages urgency, and, if indicated, arranges same-day or timely virtual consults with a reproductive endocrinologist, menopause specialist, or other clinicians in our network.

How do you handle the range of needs—from painful periods and PCOS to infertility and menopause—within the same benefit?

We designed care to follow a person across decades. A woman with heavy, painful periods enters the same continuum as a woman freezing eggs, trying to conceive, navigating pregnancy loss, postpartum recovery, and later, perimenopause and menopause. The PCA documents symptoms and life goals, provides education on next steps, and escalates to the right specialist when needed. For example, a 33-year-old with heavy bleeding and fertility concerns can be connected to reproductive endocrinology and pelvic specialists; a 45-year-old executive with cognitive fog, palpitations, and night sweats can be fast-tracked to a menopause specialist.

Who are the PCAs and what training do they receive?

PCAs are full-time Progyny employees with professional licensure or specialized training. Their backgrounds include licensed clinical social workers, nurses with maternity and fertility experience, genetic counselors, embryologists, and adoption specialists. Progyny provides structured onboarding and ongoing clinical training. Our clinical team—medical leadership, the medical advisory board, and provider network—writes the scripting and educational content. We also use quality assurance, quality improvement, and AI-generated summaries to monitor calls and continuously refine training and workflows.

How do you ensure your network clinicians are qualified to treat menopause?

We vet providers who request entry to our network. Criteria include relevant training, demonstrated clinical interest, and adherence to evidence-based guidelines from major professional societies. We look for providers who prioritize individualized care and who understand the wide-ranging effects of perimenopause and menopause beyond hot flashes. Some clinicians in our network have Menopause Society certification, but the focus is on demonstrated competence and good outcomes rather than titles alone.

What is Menopause Hormone Therapy (MHT) and when is it appropriate?

Menopause Hormone Therapy, or MHT, refers to estrogen therapy often paired with progesterone if the uterus is intact. Estrogen relieves vasomotor symptoms like hot flashes and night sweats and helps prevent bone loss. Progesterone protects the uterine lining from estrogen-driven overgrowth and can be delivered by pill, vaginal formulation, or a hormonal IUD.

We favor transdermal (patch) estrogen for many patients because it bypasses the liver and has a favorable metabolic profile. Patches are simple to use and typically changed weekly or twice weekly. Oral estrogens, topical creams, and gels are also options depending on symptoms and patient preference.

How do clinicians choose dose and formulation?

Dosing is individualized. For younger women with premature ovarian insufficiency, hormone replacement often uses higher estrogen doses similar to those given during normal reproductive years. For typical perimenopausal or menopausal presentations in the late 40s and 50s, we start at the lowest effective dose and titrate based on symptom response. We do not generally recommend routine measurement of serum estrogen levels to guide dosing; clinical response is the most useful signal.

If symptoms persist after a trial of low-dose estrogen, clinicians increase the dose or change the formulation. Common starting transdermal doses include 0.025 to 0.05 mg equivalents. Progesterone is added if the uterus is present to protect the endometrium.

Are there signs of too much estrogen?

Yes. Common indicators include breast tenderness, spotting, or breakthrough bleeding. When initiating therapy, irregular bleeding during the first three to four months is often acceptable as the body adjusts. Persistent bleeding beyond that window should prompt further evaluation—pelvic ultrasound, endometrial biopsy, or other investigations to exclude pathology.

What about progesterone IUDs? How are they used in perimenopause?

Progesterone IUDs are powerful tools. For perimenopausal women with heavy or painful periods—often due to fibroids or adenomyosis—a levonorgestrel IUD can dramatically reduce bleeding and pain. That symptomatic control can improve quality of life immediately.

In women who continue to experience vasomotor symptoms or sleep disruption despite an IUD, clinicians can layer a transdermal estrogen patch. Because the IUD provides endometrial protection, the addition of estrogen addresses hot flashes and bone health without a second systemic progestin, though oral micronized progesterone at night may still be useful for sleep and mood in some cases.

Can oral micronized progesterone help sleep and mood?

Yes. Micronized progesterone is a more physiologic, plant-derived formulation that has sedating effects when taken at night. For perimenopausal patients who struggle with sleep or nighttime anxiety, a low dose of oral micronized progesterone can improve sleep architecture and mood. It is distinct from some synthetic progestins and is often well tolerated.

What about testosterone therapies for women?

We strongly caution against routine testosterone injections or pellets for women. There are significant risks and potential for long-term adverse effects. Evidence for benefit in most midlife women is limited, and off-label testosterone can lead to irreversible virilization and other complications. Testosterone should be considered only in very specific, carefully monitored cases, under the supervision of an expert who follows current evidence and safety protocols.

Menopause is often reduced to hot flashes. What are the other important issues?

The narrative that menopause equals hot flashes is narrow and harmful. Menopause and perimenopause can include:

• Sleep disturbance and insomnia, which affects up to 60 percent of women in transition.
• Cognitive symptoms such as memory lapses and difficulty finding words can be frightening.
• Mood changes, including anxiety and irritability, that affect relationships and work functioning.
• Sexual health changes—vaginal dryness, dyspareunia, low libido—that are treatable and should be addressed directly.
• Metabolic shifts: increased abdominal weight, rising cholesterol, and insulin resistance that raise cardiovascular risk.
• Bone density loss leading to osteoporosis risk later in life.

These changes are not inevitable outcomes without options. Many are preventable or manageable with early recognition, lifestyle interventions, and targeted therapies.

How should someone advocate for help at work if symptoms are affecting performance?

Start by normalizing the conversation with trusted peers or friends. Many women find the first step is admitting the issue to themselves and to those close to them. Armed with that confidence, gather practical resources: symptom documentation, information about possible accommodations, and a care plan. Approaching HR with concrete materials—sample accommodations, references, and, if available, a Progyny-style benefit—makes the discussion easier and more actionable.

Employers often underestimate how many employees are affected. Some jurisdictions and employers are already developing menopause-friendly policies and accommodations. Reasonable adjustments such as flexible schedules, access to private spaces for temperature control, permission for brief medical appointments during the workday, or remote work options can keep experienced women engaged and productive.

What are the most common myths about menopause you want to bust?

Myth 1: Menopause only affects older, retired women. Not true. Perimenopause can begin in a woman’s 30s or even earlier in some cases, and symptoms can last a decade or more.

Myth 2: Menopause means inevitable weight gain and decline. While metabolic changes can make weight management harder, targeted lifestyle interventions, medical evaluation, and therapies can prevent or reverse many effects.

Myth 3: Life ends at menopause. The opposite is true. With appropriate support, this transition can be a period of renewal, greater sexual health, and focused prevention of long-term disease.

How does Progyny approach conditions often missed in early adulthood, like endometriosis and PCOS?

These conditions are underdiagnosed and undertreated. Progyny aims to close gaps in access and expertise. Early diagnosis matters: identifying endometriosis or PCOS in a woman’s 20s can preserve fertility, prevent long-term complications, and improve quality of life. Through PCAs and a curated specialist network, Progyny provides education, screening, and timely referral to subspecialists who can offer surgical, medical, or reproductive options.

Is Progyny only available through employers? Can individuals sign up directly?

Progyny is primarily an employer-sponsored benefit. We partner with a range of employers—small, mid-sized, large, and even labor unions—using a fully insured model where appropriate. If you are interested and your employer does not currently offer Progyny, the best first step is to speak with HR. Many employees discover existing benefits they did not know about simply by asking. If your employer does not offer comprehensive women’s health benefits, you can advocate for them to add such a program.

How do different countries handle menopause? Are there lessons to learn?

There is a wide international variation. Some countries have advanced workplace protections and proactive public health campaigns. The United Kingdom, for instance, has seen growing legislative attention to menopause accommodations. Other nations are farther along in provider training and integrated community-based support. The United States shows growing awareness at the state and employer level, but there remains a patchwork of access. The lesson is clear: policy and benefit design can materially improve outcomes and keep women engaged in the workforce.

What would you do if you had a magic wand for workplace change?

We would require workplace accommodations and ensure meaningful implementation. That means visible, enforced policies that let women take brief medical breaks, have flexible scheduling, access to climate-controlled spaces, and confidential pathways to request ergonomic or schedule adjustments without stigma. We would also ensure every company provides access to a validated women’s health navigation platform so employees can book a consultation and receive clinical guidance in half an hour without massive disruption to their workday.

Please give your five key takeaways for readers.

1. Every woman is likely to experience menopause; symptoms can start well before the average age and even in the 30s for some.

2. Menopause does not have to be endured silently; there are evidence-based treatments and support systems that improve symptoms and long-term health.

3. Awareness and education are expanding. Women should expect individualized care and be prepared to advocate for it when necessary.

4. Menopause is not an end. With proper care, it can be a powerful stage of life with renewed intimacy, focus, and health prevention.

5. Sexual and relationship health remain vital and treatable during and after the transition; resources are available to help restore intimacy and sexual function.

How to take action now

If you are experiencing symptoms:

1. Document what you notice—sleep, mood, cognition, bleeding patterns, and how your daily functioning is affected.
2. Ask your employer about available women’s health benefits or bring the need to HR with concrete examples and possible accommodations.
3. If you have access to a navigation benefit like Progyny, connect with a care advocate who can triage and arrange timely specialist access.
4. Seek a clinician who will listen and individualize care; do not accept dismissal of real symptoms.
5. Keep preventive health on your radar: cardiovascular risk, bone density, diabetes screening, and mental health support are all part of good midlife care.

FAQs

What exactly is perimenopause, and how long does it last?

Perimenopause is the transition period before menopause when ovarian function fluctuates. It can begin several years before the final menstrual period and commonly lasts anywhere from a few months to a decade. Symptoms include cycle irregularity, hot flashes, night sweats, sleep disturbance, and mood changes. We treat according to symptoms and goals, not solely by age.

Is hormone therapy safe for everyone?

Hormone therapy is effective for many, but not everyone. Safety depends on individual medical history, including cardiovascular risk, thromboembolic history, breast cancer history, and other factors. Transdermal estrogen often has a better metabolic profile than oral estrogen. Decisions about MHT should be individualized, balancing symptom relief and preventive benefits against risks. Consult a clinician experienced in menopause care for personalized recommendations.

If I have heavy bleeding during perimenopause, what are my options?

Options include hormonal management with combined oral contraceptives for cycle control, levonorgestrel IUD placement to reduce bleeding and pain, and surgical interventions for specific conditions such as large fibroids. A targeted diagnostic workup should precede major interventions to rule out structural causes or other pathologies.

Will menopause cause permanent cognitive decline?

Cognitive complaints are common during perimenopause, usually involving attention and memory. For most women, these symptoms are transient and improve with proper management of sleep, mood, and vasomotor symptoms. Persistent or progressive cognitive decline should be evaluated by a clinician to exclude other causes.

How can employers make workplaces menopause-friendly?

Employers can implement clear policies for flexible work, provide private and temperature-controlled spaces, normalize brief medical appointments during the workday, and offer benefits that include clinical navigation and evidence-based treatment options. Training HR and managers to recognize and respond compassionately is also crucial.

Can I get Progyny if my employer does not offer it?

Progyny is employer-sponsored. If your employer does not offer it, the most effective route is to present the business case to HR. Many organizations are open to adding benefits that reduce turnover and lost productivity. Resources and sample materials can help make that case.

Final note

Menopause is a major life transition that deserves the same clinical rigor and cultural support we offer for other stages of life. With improved education, navigation, and evidence-based treatment, women can move through midlife empowered to preserve health, relationships, and careers. If symptoms are disrupting your life—find a clinician who listens, document what you experience, and seek integrated support that treats you as a whole person.

For more resources on menopause support, consider visiting programs that offer navigation and specialist networks as part of their benefits. If your workplace lacks a women’s health benefit, advocate for change—this is a tangible way to protect careers, wellbeing, and organizational performance.

This article was created from the video Why Menopause Deserves Better Care ft. Dr. Janet Choi & Progyny | SHE MD for Dr. Thais Aliabadi’s website.