Women are receiving false or delayed treatment as medical schools still do not provide adequate training during menopause. Misinformation about estrogen therapy also contributes.
It’s time to talk about menopause and menopause
Hormonal and physical changes associated with menopause are rarely openly discussed. Why is it not good?
Leslie Anne McDonald was so tired that he often lifted weights.
She dropped her daughter at school and returned to bed. Her body hurts. She had a hard time sleeping. Her brain felt mist.
Her doctors prescribed antidepressants, despite the 36-year-old claiming she wasn’t depressed. She even went for treatment.
It took ten years to get the correct diagnosis: perimenopause. Online personal trainers and coaches needed hormone therapy.
More than a third of women who are experiencing menopause or menopause are prescribed Zoloft, Prozac, Wellbutrin, or other common antidepressants. Use among women during these years. Now more women’s health experts say the majority didn’t need women. Antidepressants can treat symptoms rather than causes and make things worse.
“I don’t feel depressed, but I did feel terrifying,” says McDonald, 46, an online fitness coach in the Philadelphia area. “I was miserable and I tried anything, even if I didn’t think it was necessary.”
Women are receiving false or delayed treatment as medical schools still do not provide adequate training during menopause. Misinformation about estrogen therapy also contributes.
Last week, a new push by doctors and researchers in a Food and Drug Administration committee pushed the agency to remove what they say is an outdated warning about topical menopause treatments, including estrogens. Currently, such drugs include warnings about the possibility of breast cancer and should not be used to prevent cardiovascular disease or dementia, but may increase the risk of stroke, clots and potential dementia.
The FDA has not yet dominated change, but supporters say the delay will lead to more women losing the treatment they need.
“These women are not mentally unstable and not depressed,” says Maryne Stewart, who surveyed more than 1,000 women in the UK about their experience of menopause. She also leads Femmar Corp, a company that drives lifestyle changes to support menopause. “It’s tragic for women to try to feel better.”
Promoting better perimenopause treatment
When women describe symptoms during menopause, including anxiety, fatigue, and increased brain fog, doctors often prescribe antidepressants first.
This is because most doctors, even gynaecologists, did not receive adequate training in menopause during medical school, according to a study in the Journal of the Menopause Society. Less than a third of the 100 obstetric and gynecological residency program directors surveyed recently reported having received residency training.
This is also because the 2002 Women’s Health Initiative (WHI) associated hormone therapy with a slightly higher risk of breast cancer, heart attacks and stroke in postmenopausal women. It was later found that the risk was mostly discovered in older women when they began hormone therapy.
According to the Journal of the American Medical Association, use of hormone therapy has declined from about 40% in 1999 to about 5% in 2020.
Hormonal therapy is the most effective treatment for menopause, and is the first recommendation, according to the North American Menopause Society.
“Clinicians are defensive and women can be misdiagnosed with gaslit,” said Heidi Flagg, an OB-Gyn, menopause specialist and clinical assistant professor at NYU’s Grossman School of Medicine. “In the perimenopause, the initial strain must always be hormone therapy. There are major changes in women with improved brain fog and depression emotions and hot flashes and other symptoms.”
Flag and other doctors say if you have major depressive symptoms, they will work with psychiatrists to see if antidepressants are useful in addition to hormone therapy during menopause. For a small number of women who are unable to take estrogen due to breast cancer or other reasons, doctors recommend antidepressants as a treatment option.
“We are hurting women by not talking about natural hormones that improve women’s mood and sexual function,” Flag says.
Peri-menopause symptoms can also reflect symptoms of anxiety, and depression says Dr. Sameena Rahman, OB-gyn and sex and menopause expert in Chicago.
“You have this hormone roller coaster that’s happening in middle age where a lot of other things are going on,” says Rahman. “It can be confusing for clinicians and patients.”
How Doctors Change Permeabil Treatment
As X and older millennial women begin menopause and menopause, they share their stories and demand better treatment. They are not ok to go through it like their mothers. Menopause has also become a large company, with over 40% of women in the US being in menopause, menopause, or postmenopausal. And most women may have poor health during menopause, which can last a third of their lives.
“We have a gender health gap,” says Dr. Mary Claire Haver, author of “The New Menopause.” “Women are ready to become their own advocates. They want and embrace better choices than their mothers.”
Recently, three states have passed menopause laws ranging from continuing education requirements to mandatory insurance coverage. And one in four states introduced menopause care and education laws.
The Menopause Society recently launched a $10 million training program that will help train more than 25,000 healthcare workers during menopause and menopause.
What women in menopause should do
From general practitioners to gynecologists, from more physicians to educate themselves, experts say women need to educate themselves and become their own advocates.
“I felt very miserable, I was falling asleep for dinner,” McDonald said. “They tested me for Lyme disease. I went to the doctors many times and complained about it.
McDonald spent several years on antidepressants before seeking assessments of hormone levels. She later took a low dose of estrogen and within two weeks she felt better.
“You really have to be your own advocate,” she says.
Treatment methods for permenopause
Find a provider specializing in menopause or menopause. The Menopause Society to prove them provides a list.
Find a provider quickly. Women often experience menopause at age 35, so many people end up in menopause, half of their lives, Stewart says.
Educate yourself before you meet with your provider, Flag says.
According to Stewart, combine medication with lifestyle changes such as nutrition and exercise to alleviate symptoms.
Tell other women about it. Share your experience with your provider.
“Our job is to educate mothers and daughters now,” says McDonald. “We’ve gone through this and they don’t have to.”
Laura Trujillo is a national columnist focused on health and wellness. She is the author of “Back from the Shelf: A Daughter’s Truth and the Exploration of Updates” and can be contacted at ltrujillo@usatoday.com.
