Patients with menopausal syndrome are flocking to infomercial doctors. They find them online, referred by lists of bio-identical practitioners in lists of popular books referred by compounding pharmacies, or referred by female friends who have found that a practitioner is willing to give them hormonal medication that will ease their suffering.
I know patients who travel across the country to have their blood and saliva tested, and to have compounded hormone preparations created "just for them" yet the "unique prescription" requires more money and more time each visit in order to create "just the right dosage for each patient".
These same patients often end up in my office with enlarged breasts, heavy bleeding, weight gain and water retention and often with the well recognized and more serious complications of hormone use. Their hot flashes, insomnia and fatigue may be controlled, but they are suffering debilitating side effects. And many of these women have been told clearly that "natural hormones" carry no side effects. The patients choose to believe that with this form of hormone therapy that there is no risk of breast cancer, endometrial cancer, blood clots, heart attack or stroke.
Other women see doctors, in New York City and elsewhere, who are not board-certified in gynecology or endocrinology, and given anti-aging compounded creams and potions, again "created just for them." These doctors generally have no hospital affiliation nor do they know how to monitor the complications of the hormones they are prescribing. Once again and predictably, the patients show up in trouble in a gynecological office.
These patients are in this trouble because highly educated, board-certified, responsible doctors have become reluctant to prescribe hormone therapy.
The question that doctors who are specialists in women's health need to answer is: "What did we forget, in our quest to follow the results of the latest study on the bad outcomes in some women who choose to use hormone therapy?" We forgot to listen to our patients and to help each patient understand her risk/benefit from the use of medication that could restore the quality of her life.
Menopausal syndrome is indeed unique to each patient but universal in a description of its devastating symptoms. Women who are significantly affected have more than hot flashes and some night sweats. These women may have temperature dysregulation many times every hour -- these episodes are often accompanied by racing heart beat, palpitations, fuzzy thinking, volatility. No wonder that even after a short period of this torture, no sleep and days and days of feeling unable to function, women in the throes of menopausal syndrome will do almost anything to feel better.
Gynecologists are the primary care doctors for women in mid-life. We need to prepare our patients at age 40 for the reproductive transition ahead. The New Menopause supports the idea that this is the time of greatest opportunity to prevent ignorance, shame and denial. We need to counsel these patients about normal physiologic change but also let them know that at some point they will need to prepare for symptom management. Preparation and education are the foundation. We must also let patients know that hormonal support in a low controlled dose is available for them if the quality of their lives becomes affected by symptoms.
I hear stories so often of women at the peak of their game falling apart at menopause, losing their nerve and self confidence and often leaving work they loved because they feared they would never recover their energy, their focus, their self-esteem and self-respect.
We who have chosen to be of service to women in this important period of life must do more and do it now. We have allowed the bio-identical charlatans to offer promises of never aging when all we need to do is offer each woman in crisis the hope of becoming herself again.
Menopausal syndrome does not last forever. That is why the North American Menopause Society and the American College of Obstetrics and Gynecology advise that patients begin with the lowest hormonal dose possible to control systemic symptoms and plan to take a hormone holiday in 2-3 years, once the storm of hormonal transition has passed.
Women who struggle with the very real physical, cognitive and emotional consequences of hormonal disruption without medical support and guidance often never recover. They lose the future they deserved and expected and their families, companies and communities lose a woman with so much to contribute. We all see those who didn't make it through the transition to post-menopausal zest and wisdom, visibility and vitality. They are often marginalized and seem almost invisible. They retreat to the home, and to places and friends where little is expected.
It is time for doctors to have the courage to listen to each woman's concerns and fears, to become engaged in the individual management of each patient's symptoms, with her as a full partner, and to offer what is necessary for her to remain fully herself. The difficulties that some women experience during this reproductive stage will provide the fuel for transformation. Suffering, however, is not required for a woman to become the fully realized person she had always hoped to become.