This reality is that evidence of the current health-care system is failing vulva owners. “You wouldn’t let a kid go into puberty and not instruct and support them,” says Suzanne Gilberg-Lenz, MD, an OB/GYN who has been practicing for 21 years in the Los Angeles area. “It’d be actually cruel, and yet that’s what’s happening [to] midlife women with menopause.”
Susan Hardwick-Smith, MD, who graduated from medical school in 1995, can attest to the reality of this situation. She says that she received "no education whatsoever" about menopause during her traditional OB/GYN training. “I was advising patients about menopause based on what I had thought that I knew from reading a paragraph or two in a book,” says the Houston-based doctor, who opened a practice dedicated entirely to midlife health and wellness in July 2020.
“Medical schools and residencies are teaching doctors to take care of sickness. We weren’t trained at all how to create wellness…[but] menopausal medicine is all about that.” —Susan Hardwick-Smith, MD
According to Stephanie Faubion, MD, North American Menopause Society (NAMS) medical director and director of the Mayo Clinic Center for Women’s Health, there is still no specific training for menopause, but NAMS does offer a certification in menopause management. Currently, she says, there are over 1,000 certified NAMS practitioners in the U.S. "But that's not a board certification or anything like that," she adds. "It is a recognition that our society gives practitioners who have passed this test...it's an additional commitment to educating yourself on menopause."
While there may be more than 1,000 NAMS-certified practitioners, keep in mind that as of May 2020, there were nearly 19,000 practicing OB/GYNs—and that discrepancy is a problem. “Medical schools and residencies are teaching doctors to take care of sickness,” says Dr. Hardwick-Smith. “We weren’t trained at all how to create wellness…[but] menopausal medicine is all about that.”
Why does it matter if your OB/GYN isn't trained in the symptoms of menopause?
Considering how many humans experience menopause and its related symptoms, it seems obvious that training for care should be necessary: An estimated 75 percent of people with ovaries experience symptoms of menopause, 20 percent of whom say their symptoms are severe enough to interfere in their day-to-day lives, impacting their quality of sleep, work focus, relationships, and more. But, given the stigma that still surrounds menopause, patients often avoid mentioning it. And if they're seeing health-care providers who aren't trained to provide adequate care anyway (which, it bears mentioning, is evidence itself of the medical community stigmatizing the reality of menopause), why venture out of their comfort zone to broach the subject?
While this silence and lack of disclosure to a doctor is understandable, it doesn't do any favors for the person going through menopause. "If the patient doesn’t bring [menopause] up because of lack of knowledge, shame, or fear—and [their doctors] don’t bring it up—[the patient] is not getting the information they need, or they’re getting it from random sources that are not necessarily reliable,” Dr. Gilberg-Lenz says.
Even when patients do initiate conversations about menopause with their doctor, it doesn’t necessarily lead to an adequate or appropriate quality of care. A 2014 study of insurance claims found that although 60 percent of patients with hot flashes seek medical attention, 75 percent of them are not receiving the treatment that's available. In some cases, the severity of their untreated symptoms leads them to leave the workforce earlier than they may have planned.
“I’d been giving the most stupid advice to women for many, many years when they came to me with issues about midlife,” Dr. Hardwick-Smith says of her experience before seeking further training. “I wish I could get all their numbers and I could call them and say sorry. I’d been sending people away feeling very invalidated and with no answers.”
In fact, the doctor adds, it wasn't until she went through menopause herself a few years ago that she truly realized how big the knowledge gap is. “In Houston, there was not one single place that specialized in taking care of menopausal women,” says. That is, until she opened her own practice.
So should you consider a new doctor who is trained in menopause?
If a doctor didn’t receive training in the ins and outs of menopause, they “may not be entirely up to date on some of the information that’s available regarding management of menopause,” says Dr. Faubion. “If your doctor is not up to date on the things that they're trying to manage, that's never a good thing for your overall health.”
“If your doctor is not up to date on the things that they're trying to manage, that's never a good thing for your overall health.” —Stephanie Faubion, MD
That's why she encourages patients with menopause symptoms to seek out a doctor who specializes in this stage of life. “Any one doctor is probably not going to be right for them for everything for their entire life," Dr. Faubion says. "If they feel like they're not getting the answers that they need, then they should be getting care from another person.”
It's important for your doctor to monitor menopause symptoms, as they often go hand-in-hand with other health risks: A 2017 study found that the more severe and longer-lasting hot flashes or night sweats are, the greater a person's risk for developing type 2 diabetes. A 2013 study found that menopause is a risk factor for developing cardiovascular disease. And another 2017 study suggests that menopause could trigger metabolic changes in the brain that make a person more vulnerable to brain aging and Alzheimer’s disease.
Of course, even without those specific and severe-leaning risks, patients deserve to understand what is happening with their body, and a doctor who isn’t adequately trained in menopause may be more likely to dismiss those concerns. If you feel like your doctor is brushing off your questions or rushing through your appointment, Dr. Gilberg-Lenz says it’s probably time to look for someone who is trained in menopause.
3 ways to find a menopause-focused doctor
The good news: It's getting easier to find doctors who focus on menopause—or at least have extra training to provide better care to menopausal patients. Here are three ways to search for one.
1. Look for an OB/GYN with continuing education in menopause
“The North American Menopause Society...certifies practitioners in menopause management,” says Dr. Faubion. “[It’s] not a board certification, but it is a recognition that our society gives practitioners who have passed a test.” You can search for certified doctors in your area using the physician finder on the NAMS website.
In addition, Dr. Faubion says, there’s a women’s health fellowship at the Mayo Clinic that, while also not a board certification, gives doctors specialized training in menopause. Plus some residency programs, like Mayo’s, require OB/GYNs, as well as endocrinology and family medicine residents, to go through mandatory women's health rotations and clinics. You can research your provider's accreditations to cross-reference.
2. Seek out a provider who specializes in menopause
Some, Dr. Hardwick-Smith, choose to specialize exclusively in midlife care—or make menopause a large part of their work, like Dr. Gilberg-Lenz. Patient reviews can also be a helpful way to narrow down your options, says Dr. Hardwick-Smith. “If patients are saying that a doctor spends a lot of time and listens well and treats you like an individual, that’s important information.”
It’s also a good idea to interview your prospective doctor to find out if they’re the right fit for you. Look for a provider who makes you feel comfortable so you aren’t afraid to speak up. Admittedly, this can be difficult if you’ve been dismissed before, but the right doctor will take the time to help you open up.
3. Explore telemedicine options
If you can’t find a menopause specialist near you, look into telemedicine options, which have grown over the last year, amid COVID-19 conditions. It is now possible to find a remote menopause care provider through platforms such as Gennev.
It's also crucial to realize that breaking up with your longtime OB/GYN is okay if they aren't well-versed in treating symptoms of menopause (or for any other reason you deem necessary). “There’s no reason to suffer in midlife, and so many of us are because we’re seeing a doctor who’s just not taking care of [us],” says Dr. Hardwick-Smith. “You deserve to be heard and you can feel great in this time of life.”
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