Heather Hirsch

Heather Hirsch will lead the new Menopause and Midlife Clinic at the Fish Center for Women’s Health.

During her fellowship training in women’s health, internist Heather Hirsch, MD, MS, NCMP, started to notice a gap in the health care system that seemed to defy logic. Menopause — despite being a condition that ultimately affects nearly half of the world’s population — was woefully misunderstood and, from Hirsch’s perspective, patients were often inappropriately treated or did not receive the comprehensive approach to care they deserved.

Meeting with patients at her former clinic in Ohio, she would listen as women described how they felt: dismissed, confused and frustrated.

“I really feel this is the most underserved area of women’s health,” said Hirsch, a passionate advocate for patient education who hosts and produces her own podcast, Women’s Health by Heather Hirsch. “I’ve made it my mission to care for women in menopause, an area that is often ignored or forgotten.”

Meanwhile, here at the Brigham, Kathryn Rexrode, MD, MPH, chief of the Division of Women’s Health, had come to a similar conclusion in recent years.

“We recognized that there was not a focused center of care at the Brigham for this very common condition in women,” said Rexrode. So, she tapped Hirsch to lead the Brigham’s new Menopause and Midlife Clinic, which will begin seeing patients in the coming weeks.

Located in the Fish Center for Women’s Health — a multispecialty practice at Brigham and Women’s Health Care Center, Chestnut Hill, at 850 Boylston St. — the new clinic will care for women experiencing perimenopause, menopause, conditions that can mimic menopause symptoms (also called pseudo-menopause) and other midlife women’s health issues.

“We hope to meet the needs of female patients at the Brigham as well as throughout the region with comprehensive care for menopausal symptoms,” Rexrode said.

Empowering Patients

The average woman enters menopause at age 51, and the symptoms she might experience are varied and often change over time, Hirsch explained.

“I always tell my patients that no one’s menopause transition is the same,” she said. “Menopause is not just hot flashes; women experience so many symptoms during this time of their lives. They can start seeing hair loss, weight gain, changing libido, brain fog, insomnia, vertigo and chronic diseases like diabetes. I also counsel patients about osteoporosis, breast cancer risk and mood disorders.”

Hirsch emphasized that so many of these symptoms can be safely and effectively treated, something she hopes to raise awareness about.

“We teach women a lot about puberty, preconception and pregnancy, and now postpartum is a very hot topic. But after that, women just fall off the map in terms of patient education,” she said.

“Mix in all the ways the media portrays women’s health at the end of their reproductive life, and no wonder it’s a time when many patients feel lost, frustrated and fearful — and a lot of that is unnecessary. Education and myth-busting have become big parts of my job.”

During a typical, 40-minute new patient visit, Hirsch will consult with patients to understand their symptoms and goals for care.

“For most of the time, I just listen — and that’s really the important part. I want patients to feel they are being treated with respect and autonomy,” she said. “Then I usually spend 10 to 15 minutes providing some education, and we’ll come up with a plan based on their top symptoms, priorities and medical history. We continue to meet and adjust that plan until we find whatever has achieved their health goals.”

In addition to looking forward to delivering this specialized care to patients, Hirsch, who joined the Brigham last fall, said she is excited to embrace the many opportunities for collaboration across Brigham Health.

“What I love about this field is that it’s so multidisciplinary,” she said. “It makes it so easy to collaborate on research, break down silos and interact with so many different types of clinicians. There’s almost no specialty in adult medicine that menopause doesn’t touch.”

For questions or to book an appointment at the Menopause and Midlife Clinic, call 617-732-9300, ext. 3, or email menopause@bwh.harvard.edu.