When doctors fail women
IN popular culture, it’s often a joke.
At the doctor’s office, its symptoms might be written off as something that will pass in a few months or a year.
But to millions of women, menopause is no joke. And it can last almost a decade, say experts.
“The main duration is seven to nine years,” said Dr Stephanie Faubion, medical director of the North American Menopause Society and director of the Center for Women’s Health at the Mayo Clinic in Minnesota in the United States.
“A good many women have hot flushes and night sweats for a decade. It’s not a small burden of symptoms we’re talking about here, and telling women to tough it out or wait a year or two is not a good solution.”
That’s why there are ongoing efforts to train doctors and other care providers on how to understand menopausal symptoms and care for the women who have them.
Menopause is defined as no menstrual cycle for a year, though symptoms can start years before a woman loses her period, Faubion said. The typical age that menopause starts for American women is 51 or 52, but anything older than 45 is considered to be normal, she said.
Symptoms vary but can include hot flushes, insomnia, night sweats, brain fog, irritability and heart palpitations.
In America, the AARP (a non-profit organisation focusing on issues for the eldely) estimates that 6,000 women in the country reach menopause each day, and about 1.3 million women become menopausal annually, according to a 2019 study by two doctors at Firelands Regional Medical Center in Sandusky in Ohio.
Despite the amount of women reaching menopause, some doctors aren’t properly trained or educated to offer patients relief for their symptoms or peace of mind, experts say.
Menopause education, in general, has dropped off because medical schools have so much material to cover, Faubion said.
“It’s mentioned in a 30-minute lecture at best,” she said. “There’s a huge gap there in menopause education.”
The North American Menopause Society, based in Pepper Pike, a Cleveland suburb, has created a menopause guidebook for providers. After reading the book, they can take a test and get a certification showing that they have the knowledge to treat menopausal women.
There’s also a searchable database on the society’s website, www.menopause.com, where women can go to find one of 1,200 providers in the world, with most in the United States and Canada, the organisation has certified.
The certification isn’t just for OB-GYNS because family doctors are often the first to treat women with menopausal symptoms, Faubion said.
To broaden access to menopause care for women, Dr Leslie Meserve began Curiemd, a private practice in Newport Beach, California, that can treat women using telemedicine.
Last year, Meserve, a primary-care physician, decided she really wanted to focus on middle-aged women’s care.
“There are many areas of the country where women are underserved,” she said.
Meserve talked to one patient who said she had asked her doctor about perimenopause, or the start of menopause when ovaries are working intermittently, and the gynecologist responded that it isn’t a thing.
Another told a patient to take Metamucil, a medication for constipation, for hot flashes.
“What I hear a lot is, ‘I just feel different’,” Meserve said. “Women know their bodies well ... and many of them know what they’re feeling is hormonal. They’re just not sure what to do about it.”
To some, the symptoms of menopause might not be all that dramatic, said Dr Cynthia Evans, director of the Menopause Clinic at Ohio
State University’s Wexner Medical Center, but they can be very disruptive. For example, a woman could have a hot flush in a business meeting and sweat might soak right through her shirt, making the hot flush noticeable to others and often embarrassing, Evans said.
Menopause education is important because “it will affect every woman if she lives long enough,” Evans said.
A small amount of medical residents do learn about menopause during their training to be doctors.
Evans works with a few residents at the Ohio State clinic, training them in menopause treatment and care. “I don’t think it’s well-taught in residency,” Evans said. “There are so many things to learn in those number of years ... it is something people could pick up after they graduate.”
Going through menopause and coming out on the other side can be great, Meserve said, as women are often more confident and happy in that stage of their lives.
“I would like for women to look at it as kind of a new beginning,” she said. “Talking about all the positive aspects of life and the confidence we can gain just by being in our skin for over 50 years – I think that’s what we need to celebrate.”