Imagine a medical condition that disrupts people’s sleep, impacts their mental health and interferes with their work. It’s also associated with a range of uncomfortable symptoms, including night sweats, brain fog, joint aches, fatigue, weight gain, decreased libido and heart palpitations — all of which can last more than a decade.
Now imagine this condition affects half of the world’s middle-aged adults. Yet fewer than 1 in 10 physicians treating these individuals feel prepared to do so.
The condition, of course, is menopause, which approximately 2 million American women will reach every year. For such a ubiquitous experience, it’s shocking how little it is discussed by the medical profession and the public at large.
Last week, lawmakers led by Sen. Patty Murray (D-Wash.) introduced bipartisan legislation that would fund additional clinician training, menopause-related research and public education campaign. This is a crucial effort that will help women access the care they need for this sorely neglected part of their life.
Menopause is typically diagnosed after a woman has gone 12 months without a menstrual period. Most women experience it between the ages of 40 and 58, with the average age being 51. (People who have both ovaries removed go through surgical menopause after the procedure, regardless of age.)
As many as 90 percent of women experience menopausal symptoms. Hot flashes are the most common manifestation, and about 25 percent experience such severe symptoms that they seek relief from a clinician. In one study, about 10 percent of women ages 45 to 60 reported missed work in the preceding year due to menopausal symptoms.
Because menopause is diagnosed retrospectively, women also need to know about the transition phase before their last menstrual period, known as perimenopause, which typically lasts four to eight years. JoAnn Pinkerton, an OB/GYN at the University of Virginia and executive director emeritus of the North American Menopause Society, said someone reaches this phase when they have missed periods for three months or have shortenings in cycles.
“I’m seeing more and more women in perimenopause who feel that their symptoms are being dismissed,” Pinkerton told me. Clinicians might not recognize the symptoms, and even if they do, women are often told it’s just life and that there is nothing to be done.
As a result, women are often unaware of the many medications, both hormonal and non-hormonal, that can alleviate symptoms. Health-care providers also fail to mention “even lifestyle changes that could help, like healthier eating, avoiding alcohol, regular exercise and stress reduction,” Pinkerton said.
Stephanie Faubion, director of the Mayo Clinic’s Women’s Health Clinic, said she has seen women travel to her facility to be evaluated for “a whole host of things that together sound really scary,” but in the end, they were all related to menopause. These patients are sent to various specialists, when it probably “could be managed by one person,” she said, if only the physicians recognized it for what it was.
Faubion was the senior author of a 2019 study that uncovered a huge knowledge gap in menopause care among physicians. It surveyed resident physicians in family medicine, internal medicine, and obstetrics and gynecology and found that nearly two-thirds gave the wrong response to a basic question about treatment. One in 5 reported not receiving any lectures on menopause during residency. Less than 7 percent said they felt adequately prepared to manage women experiencing menopause.
I asked Fabion whether medical training has improved since her study was published. “I don’t think we are making a lot of progress,” she replied. She is looking into ways artificial intelligence can aid clinicians by identifying menopausal symptoms in patients’ medical records. The technology can then “cue the doctor and say, ‘Your patient is probably menopausal. Here’s what you do.’”
In an ideal world, every clinician who treats women should ask them, starting age 40 or earlier, a series of questions to screen for perimenopause. They should then discuss treatment options to reduce current symptoms and talk about what to expect in the years ahead.
This is far from reality. Currently, women must proactively bring up concerns themselves. Those who do not have receptive clinicians should consider looking through the North American Menopause Society’s searchable database to find a provider certified to care for women in perimenopause and beyond.
Hopefully, efforts in Congress might make this database unnecessary, though what we need is wholesale change in how our society perceives menopause. It’s normal for parents to talk to girls about their first period. Virtually everyone has some idea of what to expect during puberty. We should have similar conversations to normalize and increase awareness of perimenopause and menopause.
I plan to write more on menopause both for my column and newsletter, “The Checkup With Dr. Wen.” Do you have questions about how to manage menopause symptoms? Please submit them here.
