The Perimenopause and Menopause Movement
Perimenopause and menopause are having a moment right now and frankly it is overdue.
The Women’s Health Initiative (WHI) study came out in 2002, and after that, we really left women with few choices about what to take to manager their symptoms in midlife. Not anymore!
It seems like every Instagram account is an expert on menopause care and has the course, supplement or program for you! Proceed with caution -hint -don’t buy the snake oil.
This movement is driven by the women in perimenopause and menopause as we are not willing to suffer in silence. Women are having symptoms that are affecting all aspects of their lives: their relationships, their quality of life, the ability to work or parent. And women are saying, “hey, this isn’t right.” We need to do something, we deserve better!
This isn’t your mother’s menopause.
Very rarely does a women come to see me and say, “ I only have hot flushes, that’s it.” Menopause is not just about hot flashes. Sometimes it starts with night sweats, which is just a hot flashes at night. Then there is sleep disturbance (probably from more than just the night sweats), mood symptoms, sexual symptoms, heart/chest discomfort and joint aches.
We have to remember that estrogen affects every tissue and organ system, EVERY tissue and organ system! And when we lose it, you have effects in pretty much every tissue and organ system in your body.
The way primary care medicine is set up right now is that you are allowed to have one complaint at a time. Fun! This is not the ideal system for midlife care. Women are being misdiagnoses as having a mental health condition, fibromyalgia, dry eye, sexual dysfunction, of being lazy because they’ve gained weight, of having memory loss and cardiovascular disease. You may get 10 different diagnosis or referrals to specialists for what is actually one underlying decline or low hormone problem.
As a clinician who is educated in Menopause Hormone Therapy and midlife care, we have a lot of tools in our toolbox that are evidence based, that really work, and help women in midlife. Hormones are not all good or all bad, all right or all wrong, they require some understanding of when to use them and how to use them and who can safely use them.
We now know who the best candidates are for hormone therapy, and we can minimize the risks. For example, the WHI found that if you have a uterus and you are taking both estrogen and a progestogen (the WHI used conjugated equine estrogen and medroxyprogesterone acetate), the risk of breast cancer was increased slightly(1). “Slightly” increased turns out to be the same risk from drinking 1-2 glasses of wine a night or being overweight or being inactive. We now know this risk is one or few more cases per thousand women per year after 5 years of hormone therapy. The risk of breast cancer was actually less in the estrogen only arm of the WHI, but this didn’t get the same press release. Another example, the risk of blood clots associated with estrogen hormone therapy can be minimized by using transdermal preparations of estrogen in low doses. Overall, we don’t see these small risks of using hormone therapy as prohibitive for most women and if they are having bothersome symptoms, they can often use Menopause Hormone Therapy (MHT) safely and effectively.
Bottom line: find a healthcare practitioner that is educated in midlife care, that will believe you when you come to see them, that will take the time to hear your concerns, validate, educate, then treat you as an individual. Hormone therapy is not a one-size-fits-all. There are lots of options and women deserve to fully understand the risks and benefits to make an informed choice for themselves.
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