For women, the change of life comes with a lot of unpleasant symptoms. Menopause symptoms include: hot flashes, night sweats, mood swings, irritability, anxiety, depression, brain fog, memory lapse, difficulty concentrating, insomnia, restless sleep, vaginal dryness, painful intercourse, loss of libido, urinary urgency, urinary incontinence, frequent urinary tract infections, joint and muscle aches, headaches, heart palpitations, fatigue, weight gain (especially in the abdomen), thinning hair, hair loss, skin changes (dryness, loss of elasticity, increased wrinkling), breast tenderness, bloating, gas, constipation, or indigestion, dizziness/vertigo and tinnitus. These symptoms sound unbearable to say the least.
A survey from a few years ago found that many medical residents had not sat through a single lecture on hormone replacement therapy. From the New York Times:
My friends’ reports of their recent doctors’ visits suggested that there was no obvious recourse for these symptoms. When one friend mentioned that she was waking once nightly because of hot flashes, her gynecologist waved it off as hardly worth discussing. A colleague of mine seeking relief from hot flashes was prescribed bee-pollen extract, which she dutifully took with no result. Another friend who expressed concerns about a lower libido and vaginal dryness could tell that her gynecologist was uncomfortable talking about both.
Years ago, I met a middle-aged woman whose (female) doctor referred her to a (female) urologist for vaginal dryness, painful intercourse, urinary urgency, and frequent urinary tract infections. These doctors – both women in early middle-age – did not identify the obvious root cause: hormones. Or perhaps they did but were unwilling to discuss it. The urologist ordered numerous urinalyses, lab cultures, an X-ray, a CT scan and later an MRI. Numerous office visits found nothing physiologically wrong and resulted in no useful therapy. Yet, as the New York Times reported:
…there’s an established treatment. Why aren’t more women offered it?
… in 2002, a single study, its design imperfect, found links between hormone therapy and elevated health risks for women of all ages.
One study upended millions of women’s lives. Within weeks of the study coming out women stopped hormones and doctors began to refuse to prescribe hormone replacement therapy.
The medical community is finally re-evaluating the efficacy hormone replacement for menopause. Former FDA commissioner Marty Makary was a resident when the 2002 study came out. At the time he realized errors in the study and more errors in how the study findings were reported. He wrote about the experience in his book Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health. While he was FDA Commissioner, Makary convened a panel last year to “set the record straight” about hormone replacement therapy. From The New York Times:
“There’s probably no medication that improves the health outcomes of a population more than hormone replacement therapy for women who start it within 10 years of the onset of menopause,” except perhaps antibiotics, Dr. Makary said on a podcast.
“Women live longer, feel better. The benefits are overwhelming.”
The market has responded although health insurance often does not cover it. Numerous telemedicine websites have sprung up to assist menopausal women. The medical journal JAMA claims “Wild West or Gold Rush: How Long-Neglected Menopause Care Has Spawned a Booming Marketplace,” saying:
These days, social media feeds are brimming with influencers touting their personally tested “hacks” to solving menopausal symptoms and celebrities promoting herbal supplements and skincare lines. Telehealth companies promise convenient access to specialists while a growing number of startups market products designed to ease hot flashes, improve sleep, restore libido, and sharpen memory.
For women seeking answers, this explosion of products and providers following decades of neglect represents a long-overdue investment—a gold rush fueled by growing awareness and demand for better care. To others, this surge of attention has created a rocky menopause landscape akin to the lawlessness of the Wild West, in which bold claims often reach patients before clinical evidence does.
JAMA concludes it is about time that medical care for menopause symptoms is being taken seriously. However, not all information is of equal value. Social media influencers tout treatments and health hacks that are often inaccurate. Telemedicine is filing gaps but also outpacing scientific rigor. One public health expert JAMA quoted claimed the rise of telemedicine reflects the broader failure of our health care system, when patients may be referred to numerous specialists because the physician lacks the expertise in menopause to recognize all the symptoms. JAMA welcomes increased awareness but also worries it is proceeding too fast.
Read more at:
Goodman Institute Heath Blog: FDA to Reassess Outdated Recommendations Against Menopause Treatment
Goodman Institute Heath Blog: One Study 20+ Years Ago Condemned Millions of Women to Needless Suffering
JAMA: Wild West or Gold Rush: How Long-Neglected Menopause Care Has Spawned a Booming Marketplace