According to a recent Elektra Health survey, only one in five women between the ages of 40 and 60 receive a diagnosis of menopause, even though 80% of women experience its symptoms. Elektra Health is a digital platform that offers menopause-related support and education.
Medical director for the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health, Dr. Stephanie Faubion, said the mentality among her colleagues is, “If I just ignore it, these women and this problem will go away.” However, with menopause symptoms lasting an average of seven to nine years, “We can’t just pat women on the head, tell them it’s going to be fine, and not worry about these symptoms,” said Faubion.
“We’re not educating providers on menopause management anymore,” she said. Faubion is a co-author of a 2019 study that discovered only 6% of residents said they felt comfortable managing menopause, and over a third said they weren’t prepared at all. An average of the residents reported receiving only about two hours of education about menopause in medical school.
Ob-gyn and founding physician of Elektra Health, Dr. Anna Barbieri, said, “You’ve got a lack of education. Lack of time as a resource. And just the controversy surrounding treatments of menopause that are still so prevalent, and it’s like a perfect storm of why [doctors] don’t feel comfortable with it.”
Women are told, “There’s nothing wrong with you — move on.”
When Dr. Barbieri completed her residency at Mt. Sinai in 2003, she said she had minimal menopause training. It resulted in a blind spot for her in 2014 when she started to experience forgetfulness and brain fog at 41. “Being a busy ob-gyn with no real experience in the area of menopause, I took myself to a neurologist and had a brain MRI because I thought I had a tumor. I was actually in early perimenopause, and it was really through my own search that I was able to find ways to feel better.”
Barbieri viewed her experience as an opportunity to educate herself on the topic to help her patients. She said almost 80% of her patients come to her because of menopause. Most find her after not getting any help or answers from their primary care physicians or ob-gyn, who often don’t know enough information about menopause and how to treat it. In some cases, Barbieri said women are being told flat-out, “There’s nothing wrong with you — move on.”
Barbieri says support groups are places of community to share with others experiences with menopause but cautions not to take medical advice from those groups since treatments vary for each individual.
Some doctors hesitate to prescribe hormone therapy
One barrier to women getting menopause symptoms treatment is the hesitation of some doctors to prescribe hormone therapy treatment (HRT). That typically stems from the Women’s Health Initiative study conducted in 2002, which reported that HRT causes an increased risk of breast cancer, heart disease, and stroke and has more risks than benefits.
However, researchers who critiqued the studies have pointed out that “no distinction was made between users and their age.”
The study also used a type of oral estrogen called Premarin on the women, which contains a mixture of several estrogens found in the urine of pregnant horses. “We don’t typically use this type of hormone therapy anymore. We mainly use estradiol today, which is what the ovary used to produce before menopause,” said Faubion. It is available in several forms, including skin patches, that doctors believe are safer than taking estrogen orally because it bypasses the liver.
Before the report’s release, Faubion said about 40% of postmenopausal women used hormone therapy. The number dropped to 6% after its release and has not changed. “So, it dropped by orders of magnitude and has not rebounded,” said Faubion. “And it’s because providers and women aren’t educated, and they’re afraid of it.”
Women need to educate themselves
According to Faubion, many women don’t even realize they’re in menopause, and many doctors don’t either. She says she has seen several women come into her clinic with many perimenopausal symptoms without realizing what they’re experiencing. “It was like, I’m sweating, I’m gaining weight, I’m losing hair, I have palpitations, I’m anxious. And all of it, they’re thinking, “Oh my God, I’m dying.” And I look looking at them and them going, “Oh my God, you’re in menopause.”
However, if a doctor isn’t tuned into menopausal symptoms, it can lead to unnecessary testing. “Women are seeing a urologist for urinary frequency and maybe some incontinence. They’re seeing a cardiologist for palpitations; they’re seeing a psychiatrist for mood changes,” Faubion said. “And all of it is really just related to menopause.”
Barbieri says that women can’t wait for the changes needed for doctors to get educated about the management of menopause. Instead, she encourages women to self-advocate and self-educate.
How to advocate for your menopause health
If you think your symptoms could be related to menopause, Barbieri suggests preparing for your doctor’s visit specifically to advocate for yourself.
Spend a few minutes identifying all of your symptoms and writing them down. “In my practice, I will often spend a good hour with a new patient, but many people don’t have that luxury of time with their doctor,” says Barbieri. Instead of telling your doctor, “I just don’t feel myself,” knowing your specific symptoms — waking up multiple times per night, hot flashes, struggling to focus, etc. — helps.
Prepare ahead of time what you are planning on saying. Barbieri advises saying, “I think I’m having symptoms of perimenopause including…” and list your symptoms, adding, “Do you think that’s what it is? Can these symptoms be attributed to something else, and do we need to address that and rule those out?”
Ask questions about how symptoms can be managed. Barbieri says that some physicians are open to their lack of background and experience with menopause and make a referral. Another question can be asked is, “Do I qualify for hormone therapy?” If the doctor responds, “No, I think hormones are dangerous, and nobody should be doing it,” she says the patient should ask, “Why or why not? What’s the data to support it?” If the physician responds, “Yes,” then ask, “What am I looking at in terms of risks and benefits? What are some alternatives? What is the next step?”
Barbieri cautions against doctors with extreme responses or absolutes like “hormones are dangerous.” She says the field requires a nuanced understanding of the individual patient and is complex.
Faubion wants women to understand that “menopause is not a disease. It’s a normal life transition that 100% of [women] are going to go through.” However, that doesn’t mean navigating treatment options or putting up with symptoms on your own.