Why do so many doctors fail patients with menopause?
A sad truth about medicine in America -- and in many countries around the world - is that despite making up half the world’s population, women have been overlooked when it comes to their health. There are numerous notable examples of this. One of the most surprising, however, may be the staggering lack of knowledge around menopause.
Most women will go through menopause, which begins 12 months after their monthly menstrual period has stopped, and can continue for several years. While some will have few or no symptoms, many women struggle with issues like hot flashes, trouble sleeping, pain during sex, and even memory problems.
These and other symptoms can make menopause a time where life becomes upended. According to a recent AARP survey, 84% of women feel their lives are affected by menopause symptoms, with 12% of this group stating that symptoms impact their lives “a great deal” or are debilitating.
And what may be worst of all is that in most cases, this doesn’t have to happen.
Johns Hopkins School of Medicine Department of Gynecology and Obstetrics’ Dr. Wen Shen soberly sums up the situation: “Nearly one-third of this country’s women are postmenopausal….Many of them are needlessly suffering.”
For years, small daily doses of estrogen were used to help with most menopause symptoms. Then, in the 1990’s, a study showed the treatment may cause cancer, and it was avoided or stopped outright. No other major study was performed until years later. Now, doctors have found that hormone therapy doesn’t seem to increase risk of cancer, and in fact appears to be far more beneficial than harmful, since it can prevent serious conditions like osteoporosis, type 2 diabetes, and Alzheimer's disease later in life.
But many practitioners still aren’t prescribing hormone therapy to menopausal patients. One reason, as journalist Meghan Rabbitt cleverly puts it, is that menopause is like “a marathon… with a seriously outdated training manual.” A recent survey conducted by the North American Menopause Society found that only 57% of practitioners were up to date about menopause treatment.
Menopause is at once so complex and so rarely discussed that many doctors aren’t given any kind of training that would help them understand patients who are going through it - or, in many cases, even properly diagnose it.
The AARP survey report cites a study that found that less than a quarter of ob-gyn residency programs include training related to menopause, and even then, these courses are often optional. The result is that nearly 80% of residents feel “barely comfortable” discussing menopause and treatment options.
Some doctors specialize in menopause treatment, but many general practitioners may not even be aware that this speciality exists, and thus may not recommend them to their patients.
Talking about and treating menopause correctly have become a mess. But why? Is there more to this issue than the (sadly) usual neglect that often go hand-in-hand with diagnosing and treating women’s health issues?
When researching the current state of menopause diagnosis and treatment in the US, you’ll come upon five major obstacles to universal understanding of and access to care for this very common condition:
1. Centuries of neglect towards women’s health issues in general.
2. Shame around menopause. Menopause symptoms some women may experience, such as incontinence and vaginal dryness, are often considered shameful, making it hard for many to talk about.
3. The complexity of the condition. You many know women who have gone through menopause with hardly a symptom at all, while others constantly had hot flashes, or complained of brain fog. Maybe you also know someone who had more complex health issues that appeared at this time. That’s because, as menopause specialist Dr. James Woods explains, “Every woman’s ovaries will age and then stop producing estradiol, the body’s most important estrogen. But each person will be different in how she reacts to that loss.” Journalist Jennifer Wolff adds “ menopause management is a highly skilled subspecialty, one that requires a full understanding of how plummeting estrogen affects every system in the body.”
Dr. Bruce Dorr reports that over 30 different symptoms can be linked to menopause.
Some of these can easily be attributed to other conditions. For instance, seven of the eight criteria for diagnosing depression could in fact be the result of perimenopause or menopause. Many doctors don’t make the connection between menopause and even some of its most common physical symptoms, like vaginal dryness and weight gain.
4. Priorities. The World Health Organization considers menopause an important health issue and believes that its treatment should be “an integral part of health care.” But it notes that many governments don’t have policies or funding to put this care in place. In many cases, this is due to not seeing it as a priority compared to many other health conditions.
5. Money. That old saying “follow the money” seems to apply to menopause care as well. While the condition is complex and different for each individual, once you’ve found the right hormone supplement, continued care requires little more than an annual check-up. “The reality is that treating menopause may not be as profitable as delivering babies or doing surgery.” Gynecologist Tara Allmen told the AARP.
Fortunately, there is hope. In addition to menopause organizations, patient advocates, and doctors (including several cited in our article) are starting to make noise about this previously swept-under-the-rug condition. A number of them are calling for changes to medical curricula as well as the establishment of more clinics specifically dedicated to helping patients experiencing menopause.
It will be interesting to see if their voices and influence are powerful enough to break through the obstacles that women around the world have faced and, in a majority of cases still face, when it comes to treating their condition.
It’s a crucial battle; research is increasingly showing us how important preventative care during menopause truly is. Managing this condition is about more than just improving someone’s daily life (not that this isn’t a noble goal on its own). If we can manage menopause for a majority of women, we may see rates of conditions like osteoporosis, type 2 diabetes, and Alzheimer's disease, fall.
Let’s hope advocates’ voices get even louder.
Contact Our Writer – Alysa Salzberg