“We have ‘the floor’ before we start our period towards the end of primary school, but no one gives you ‘the floor’ when you’re about to go into perimenopause.”
– Dr. Stephanie S. Faubion, Medical Director of the North American Menopause Society
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Around the age of 40, the changes begin.
Maybe frizz. Maybe the nails are getting brittle. The belly can push an extra layer of fat. Periods can become shorter, longer, heavier or lighter, or can become extremely unpredictable. There could be vaginal dryness. Or brain fog. Sullen mood. Anxiety.
Some people talk about the changes associated with aging – which they are, in a way. Others focus on individual symptoms, not realizing that they could all be related. Still others fear the worst.
But in most cases, it’s something as ordinary as it gets – perimenopause or the onset of menopause.
“Women come to the Mayo Clinic and say, ‘Dear God, something is wrong at all. I put on 30 kilos, I am losing my hair, I am anxious. I’m a mess. I have palpitations, ”said Dr. Stephanie S. Faubion, director of the Center for Women’s Health at the Mayo Clinic and medical director of the North American Menopause Society. “Literally, they think they are dying.”
There are at least 34 symptoms of perimenopause – a period that can last from a few months to 14 years, when the body goes through menopause. (Menopause – literally: the cessation of menstruation – occurs when it’s been a year since the last period.) These symptoms include hair loss, allergies, or even a burning mouth.
But the medical industry hasn’t figured out how to provide proper care during or after this transition, or even what kind of doctor should be doing it, says Dr Faubion. The North American Menopause Society, or NAMS, has certified 1,025 clinicians in the United States as menopause specialists, from pharmacists to midwives, who take training courses through the society in menopause medicine; 720 of them are doctors of different specialties.
“If you don’t even look at the 55-year-old woman in front of you as being postmenopausal, then you are missing a whole part of who she is,” said Dr Faubion. “It is not an illness; it is a natural process, but we have to make sure that women are not incapacitated by the symptoms.
How did this phase of life become so neglected?
In Her Words asked Dr Faubion to explain. Our conversation has been slightly edited and condensed for clarity.
Let’s start from the beginning. What is the current state of perimenopause and menopause medications?
I have to laugh because my answer is: in what condition? There is no state. There is a huge gap in terms of educating providers and patients about perimenopause and menopause.
We have “the floor” before we start our period towards the end of grade school, but no one gives you “the floor” when you are about to go into perimenopause.
There are many reasons. Providers do not have the information to give, but women also enter menopause at different times. Anything after 45 is considered normal, but some women may not enter until 55. And 7 percent of women enter it before age 45.
When do you catch everyone to give them the basic information they need? And what are you covering? There are so many topics: weight changes and changes in skin and hair and heart risks and bone health and sexual health. It is not a simple thing.
You have mentioned in the past a “menopause management vacuum”. Can you explain?
When you say “menopause management” nobody in the medical field really has that space. It used to be squarely in the domain of a gynecologist, but now gynecology specializes more in procedural areas such as infertility or treating fibroids as this is how they can support each other and procedures are required. There is less emphasis on the woman who comes to the office to report vaginal dryness or hot flashes.
I think it belongs to the area of family medicine and internal medicine because it covers so many different areas of health. But neither are these regions.
Is it also because there are no lucrative procedures associated with menopause medication?
Not really. The barrier is that they have never been in this space and they don’t know how to get there. There is a bit of provider discomfort about menstruation, uncomfortable sex, and hot flashes.
Until internists and family physicians see menopause as a threat to overall health, they won’t take it seriously. They’re going to say, “It’s one of those feminine things that will go away.” This has contributed to this lack of knowledge in terms of doctors and other practitioners and to this “menopause management vacuum”.
What are medical students learning about menopause in school and in residence?
This could be covered in an hour in medical school.
When we surveyed the residency programs, among residents in internal medicine, family medicine, and gynecology, they had maybe a total of one or two hours of education on menopause in total. About 20% said they had no training on menopause, and only about 7% felt ready to treat postmenopausal women.
Are There Any Health Risks Associated With Menopause?
Everyone thinks hot flashes are mild. We now understand that hot flashes may be associated with a risk of heart disease in some women. And menopause itself increases the risk of heart disease, which is the # 1 killer of women.
It is also an economic problem. There is a loss of productivity at work. There are women who drop out of the workforce or reduce their working hours due to menopause symptoms like hot flashes. On average, women spend more than $ 2,000 per year on excess health care expenses related to symptoms.
If we could just recognize it, then we take it as, “Oh, it’s nothing. Do not worry. This will go ”to“ How can we use this time in a woman’s life to optimize her health so that she can lead a better life? I just don’t think we’ve taken that leap yet.
What will it take to make this leap?
It is a matter of awareness. Many of the internal medicine and family medicine residents we surveyed said they did not take care of postmenopausal women, which is absolutely not true. More than half of their patients will be women and the majority of them will be postmenopausal, as we have an aging population. It just tells you that these residents didn’t even see the women in front of them as being postmenopausal, which is part of the problem.
I think women as consumers will help move things forward. The pressure of the postmenopausal woman to get something better has done more in recent years than anything else.
There are a lot of small menopause telehealth companies popping up to try and manage it, some better than others.
But the ideal situation would be for every woman to have a provider who is knowledgeable and can talk about the transition to menopause, and you have educated the patients and everyone is working together.
I know we can do better. It’s just about making our systems work.
Resources? Start here
The Mayo Clinic has information on menopause and perimenopause. The Office of Women’s Health also has information on the basics of menopause. Or read the National Institute’s Guide on Aging: What Is Menopause? The American College of Obstetricians and Gynecologists has a page on menopause and symptom management.
Women Living Better is an education and support group for perimenopausal women.
And this North American Menopause Society search tool can help you find a menopause practitioner near you.