How the Undertreatment of Menopause Hurts Us All
Doctors need more training
Mention the word menopause in public, and you will likely hear a snicker somewhere. Women themselves joke about needing a fan as a way of deflecting their discomfort, but menopause is not a laughing matter. It is a medical issue that needs to be discussed without laughter or reproach. After all, more than half of the population on Earth will encounter menopause and need information about how to stay healthy and comfortable.
I don’t know about other women, but when I have approached my doctors about symptoms, including women doctors, I have had little luck in getting any helpful feedback or advice. And, I am the one who has to bring up the topic. Doesn’t it seem like your doctor should be asking you questions about your menstrual cycles and reproductive system regularly? It is, after all, an important part of your overall physical and psychological health.
Some Data
An AARP survey of over 1500 women found that nearly one-third of women over 40 do not receive information on menopause from their primary care provider. Only 50% of the women in the survey had ever discussed menopause with their doctor, and for those aged 40-49, that percentage dropped to 35%.
The top symptoms that women reported as interfering with their lives were hot flashes, night sweats, vaginal dryness, insomnia, and mood swings. Of course, many of these symptoms affect those around them as well. The inability to control your body temperature leads to arguments over thermostat settings. Vaginal dryness can lead to painful sex and therefore a reduction of sexual pleasure and intimacy with your partner. Insomnia contributes to weight gain and difficulty concentrating. And of course, mood swings affect your behavior with others, usually not in a positive direction. Put it all together, and it is obvious that women need treatment options and support during this time rather than giggles.
Doctors need more training
According to the 2010 census, over 50 million women will be of the average age of menopause of 51 in 2020. These women will likely live to age 85 meaning that one-third of their lives will be in menopause. In a survey by Johns Hopkins of Ob/Gyn training programs, only twenty percent address menopause specifically, and those courses are electives! Seventy percent of the Ob/Gyn residents said they wanted more training in menopause and its relationship to cardiovascular disease, Alzheimer’s, cognitive decline, and osteoporosis. These are all serious conditions associated with menopause.
And then there is the mixed messaging around hormone replacement therapy (HRT). While initially, HRT was lauded as the best way to deal with menopause. But, when the Women’s Health Initiative study came out in1998 suggesting that the HRT can cause breast cancer, HRT was relegated to the ashbin. However, the study has been reviewed many times since then and found to be problematic. In the meantime, many other studies have shown that HRT is both safe and effective for women just entering menopause up to age 60. Of course, women need to speak with their doctors to find out if HRT is the right move for them. As a breast cancer survivor, I have received very little guidance from my doctors and been told that HRT would be a gamble. But no one seems to be able to give me the odds.
Resources
If you are someone getting close to or already in menopause, you may be looking for some good resources. I would recommend the sites listed below. They all keep up with the latest research and are patient-centered. I will be contacting a menopause specialist to see if I can get a straight answer as to whether HRT is safe for me, maybe you should too!
American College of Obstetrics and Gynecology
The North American Menopause Society - On this site, you can find a certified menopause practitioner near you. Also, lots of good information.
Dr. Jen Gunter - I follow her on Twitter and think you should too! Last year, she published The Vagina Bible, a must-read for all women (and men, too).
Thanks for this very important conversation, Anna!