Why I Built OpExMD

By Hanah Polotsky, MD | Board-Certified Endocrinologist | OpExMD

I was sitting at a table with senior healthcare executives when I lost the thread.

Not completely. Just enough. A pause that ran a fraction too long. A sentence that didn't land. My thinking felt delayed in a way I recognized immediately, the way you recognize a symptom in someone else before you are willing to name it in yourself.

I kept going. I always keep going.

But driving home that night, I sat with a question I already knew the answer to.

Perimenopause.

I am an endocrinologist. I trained at Albert Einstein, completed a fellowship at New York-Presbyterian with rotations at Memorial Sloan Kettering and Hospital for Special Surgery, and spent over a decade at Kaiser Permanente Colorado before moving into an executive role at CommonSpirit. I hold a Master's in Operational Excellence from Ohio State, I'm a Lean Six Sigma Black Belt, and I co-authored a book on physician leadership. I have spent years treating metabolic disease and hormonal transitions.

I am also a mother of five. I cared for aging parents with complex medical needs. I moved through perimenopause while leading hundreds of physicians in roles that allowed no margin of error.

None of that protected me from feeling exactly what my patients describe.

Alone with a body they no longer recognize. Being told their labs are normal.

These women, executives, physicians, and attorneys carrying significant responsibility, were experiencing real, not imagined, symptoms. They reported a diminished ability to think, sleep that no longer restored them, and bodies that stopped responding even to intense, consistent lifestyle routines. Yet, the typical clinical advice they received was, in essence, to "push through."

That answer is wrong. Clinically wrong.

The labs, by the way, often are normal. Menopause is a clinical diagnosis, not a laboratory one. Age, menstrual pattern, symptoms. That is how it is made. The lab is not a failure. The failure is what happens after the lab comes back, when a woman describing a measurable physiologic transition is told she is fine because a reference range says so.

What is actually happening is measurable. Shifts in insulin sensitivity. Changes in body composition, specifically visceral fat. Sleep architecture disruption. Neurocognitive effects tied to estrogen variability. Bone loss that accelerates before anyone screens for it. Cardiovascular risk curves that begin bending years before we call it disease.

We have the data. We apply it poorly.

It's vital to note that perimenopausal cognitive changes often improve postmenopause; the "fog" is usually temporary. Midlife experiences aren't solely menopausal; factors like aging, poor sleep, caregiving, and chronic stress overlap, and their precise contributions are still being determined. I emphasize this not to minimize symptoms, but because overstating certainty over-simplifies the experience. What is not in question: these changes are real, they are consequential, and they are landing on women at the exact decade when companies are built, decisions are made, and teams are led.

The workforce data is unambiguous. Menopause symptoms drive measurable losses in productivity, absenteeism, and attrition, enough that large employers are beginning to take notice. Most women never report symptoms to a clinician at all. They push through until something else forces the conversation.

Our healthcare system is very good at treating disease once it declares itself. We are much less good at recognizing functional decline in real time, especially in high-performing women who don't present as sick. They present as still functioning. Just not at the level they are capable of reaching.

That difference is the whole problem. That is not just a clinical gap. That is a choice we keep making as a healthcare system.

OpExMD was born from a critical need for a different approach. I was determined to build a practice that moves beyond simply managing symptoms. I envisioned a model that addresses the entire system: metabolic, hormonal, cognitive, and behavioral. It examines how these systems interact, how they evolve during midlife, and how to reconstruct them, enabling women to meet the high demands of their lives and careers with renewed vitality.

The women I see are surgeons, founders, judges, executives, teachers, and mothers. They are not fragile. They have run on discipline and grit for decades. What they need is not another person telling them to try harder. What they need is a clinician willing to consider the whole physiology and treat them holistically, incorporating all the internal and external variables that affect their personal and professional lives.

That is the practice I have built.

Here is where we start.

The Physician's Guide to The Midlife Brain

This is my gift to help you on your journey. Get your copy now.

Dr. Hanah Polotsky is a board-certified endocrinologist and founder of OpExMD, a concierge clinical practice focused on menopause, metabolism, and midlife health optimization for high-performing women. Based in Colorado. Telemedicine consultations for women who live in CO, NY, and NJ at opexmd.com.

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References

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