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Julie Andresen couldn’t sleep.
She was sweating through her pajamas and sheets each night. She was so exhausted that she considered quitting her job of 30 years as a program manager for the city of Phoenix.
Then came the hot flashes. Her libido felt almost nonexistent. She woke up several times during the night to use the bathroom.
She met with her doctor and her gynecologist. Both told her that this was normal. The diagnosis? Midlife.
She saw nine doctors over five years, sometimes waiting more than three months to get an appointment. She was told to ignore the symptoms, and they eventually would go away.
“My doctor asked me if I wanted night sweats or if I wanted cancer,” says Andresen, 54, despite no family history of breast cancer. “I felt so awful, everything was so bad, and it felt like no one cared.”
She finally turned to a gynecologist at a concierge medical practice who didn’t take health insurance. Within a week, she was told she was in perimenopause and prescribed hormone replacement therapy.
One year later, her symptoms such as night sweats have gone from 87% of the time to 2%.
Many women say they feel gaslit, ignored and dismissed by their own doctors. When they say they feel anxious, they are prescribed an antidepressant. When they complain of achy joints, they are told to stretch more. When they say that sex is painful, they are told to drink a glass of wine. And those itchy ears? It’s all in their head.
At a time when menopause is talked about more than ever before and grown into a $20 billion industry that includes everything from herbal supplements promoted by Drew Barrymore to cooling bamboo robes, women still struggle to find care.
One in five women go a year before a doctor diagnoses her menopause, according to one survey. Another showed that 5% of women seeking help for perimenopause or menopause saw 11 doctors before getting help. Some turn to concierge doctors who don’t take health insurance but specialize in menopause. Othershave found relief with women’s telehealth companies. Women say they often have to beg their own doctors to help them.
While changes are coming, the biggest one with the Food and Drug Administration’s new guidance on hormone replacement therapy, women say it’s still not enough. As more doctors get certified in menopause care and some states look to mandate more education for medical students, women still often are left to advocate for their own health in a way that they say never would happen if they were men.
“I was at my wit’s end,” says Andresen, who pays $3,200 a year for access to her specialist. “I couldn’t find anyone to help me, and I was paying so much money going from doctor to doctor. I needed my health back.”
'The panic was so real'
Melissa Gordon noticed that she was gaining weight no matter what she ate.
Her cholesterol spiked, her blood sugar dropped.
She met with her doctor and her gynecologist. Both told her she was simply aging.
She was 38.
Then came the anxiety, so debilitating she felt her face freeze. One doctor told her it might be multiple sclerosis; another said it was just in her head.
She saw seven doctors over the last few years before trying a women’s telehealth company. That doctor reviewed her medical history, asked questions and diagnosed her with perimenopause this year. Gordon started hormone replacement therapy and now says she rarely experiences symptoms.
“When it was so bad, I felt like I was inside of a video game. The panic was so real,” says Gordon, a marketer and web designer in Los Angeles. “Once someone listened to me, it all changed. It was amazing.”
Finding a doctor who specializes in menopause can be difficult. General practitioners are more likely to prescribe antidepressants than hormone replacement therapy, according to the Menopause Society.
Most doctors – even gynecologists – didn’t receive adequate training on menopause during medical school, according to a study in the Journal of The Menopause Society. Less than one-third of the almost 100 obstetrics and gynecology residency program directors recently surveyed said they received training in their residencies.
The Menopause Society, a nonprofit organization that provides resources for healthcare professionals, certifies providers in menopause care through examsand continuing education. Membership has spiked in the past few years, with more than 4,000 certified physicians to pharmacists, up from 1,000 a decade ago.
It recently launched a $10 million training program to help train more than 25,000 healthcare workers in menopause and perimenopause.
Telehealth, which exploded during COVID, also is stepping in. From Midi to Alloy, Winona to Evernow, women’s telehealth companies are varied, with some companies taking insurance, and others that offer their own medicine and supplements.
Midi began in 2021 when Kathleen Jordan, a physician, hit midlife and saw so many friends struggling to find appropriate care.
She shared the women’s frustration. Their clinicians ignored their concerns. There weren’t menopause specialists near them. And many women couldn’t afford a concierge menopause doctor.
“Every woman should have access to good menopause care,” says Jordan, the chief medical officer and co-founder of Midi, a women’s telehealth company. “The most common comment after a Midi visit is ‘I finally felt heard.’ They’re not being given the time that they deserve.”
Perimenopause and menopause care not only can relieve women of symptoms such as brain fog, frozen shoulder and urinary incontinence, but can determine their health in their older years.
“For too long we’ve expected OB/GYNS to do all of women’s health, but they can’t do it alone,” she says.
'I felt like I was going crazy'
Loredana Buonopane didn’t feel like herself.
She was anxious, struggled to sleep and felt as if her emotions were out of control.
She met with her general practitioner and a few gynecologists. Each told her that because she still had a menstrual cycle, she wasn’t in menopause and didn’t need hormone replacement therapy. One told her that taking estrogen was dangerous.
“I felt like I was going crazy,” says Buonopane, 50, a stylist who also owns a vintage shop. “I kept thinking, how can I even keep my job when I feel like this.”
She struggled to find a new doctor that took insurance and finally found one more than an hour from her New Jersey home. That doctor put her on an antidepressant, which while approved to treat some perimenopause symptoms such as hot flashes, isn’t as effective as hormone replacement therapy.
“It helps a little,” says Buonopane, who is in perimenopause, the time preceding menopause. “But it’s not what I need.”
The new FDA guidelines direct drug companies to remove the black box warnings on hormone replacement therapy drugs containing estrogen. This change is monumental in helping more women manage disruptive menopause and perimenopause symptoms, ranging from increased urinary tract infections to night sweats.
For more than 20 years, the warning has kept many women away from hormone replacement therapy after a 2002 Women’s Health Initiative (WHI) study linked it to a higher of breast cancer, heart attacks and strokes in postmenopausal women. The risks, recognized later, were mostly found in women who were older when they started hormone therapy.
The study's ramifications affected millions of women, with the use of hormone replacement therapy dropping from 40% to 5% in the past 20 years as many doctors stopped prescribing it, and even if they did, women were reluctant to take it.
Menopause doctors say removing the label doesn’t change the risk but will help more physicians better understand them.
“It’s like we have to do all of the research ourselves and then try to convince a doctor to listen to us,” Buonopane says. “It’s shocking to me to reach this age and not be able to get help.”
Capitalizing on women's health
Menopause has become big business, with more than 40% of U.S. women in perimenopause, menopause or are postmenopausal. And most women are in worse health during menopause, which can last one-third of women’s lives.
“Everyone is trying to capitalize on it,” says Monica Christmas, a physician and associate medical director of the Menopause Society. “It makes it not only harder for women but practitioners.”
Christmas sees hope in the increased interest with an explosion in menopause books and influencers. But, she says, it also makes some women think that hormone replacement therapy is the answer to all medical issues for women in midlife.
“With many of these things. It’s difficult to untangle what’s due to menopause and what’s due to chronological aging,” she says. “Metabolism changes happen with age. Hormone replacement therapy is not a magic jellybean that is going to make us young again or stave off the aging process.”
'My health is worth it'
As the founder of the Menopause Clinic at Brigham and Women’s Hospital in Boston, physician Heather Hirsch saw around 18 women a day.
There wasn’t enough time to listen to them.
“By the time a woman gets to perimenopause, they want to tell you about endometriosis, their period, having babies and even divorce,” says the author of “The Perimenopause Survival Guide." “The trauma of being a woman encompasses not just reproductive health but so much else.”
That’s because perimenopause and menopause symptoms can be so varied that women often seek advice from a dermatologist for their dry skin, a neurologist for their brain fog, an OB/GYN for vaginal dryness, and a general practitioner for high cholesterol.
Now that she runs The Collaborative, a concierge practice, she sees fewer than half that number a day.
For Andresen, the concierge model just made sense.
“I was spending so much money seeing so many doctors before hitting my deductible,” she said. “This was really my last resort.”
She likes the personal attention from her doctor, noting that her first appointment was more than an hour. But she also likes the education offered. She’s watched more than eight hours of videos on menopause and rattles off statistics like a doctor.
Now she shares this valuable and hard-earned knowledge with friends and even wrote a letter to the FDA this summer to advocate for better treatment options for women.
Her health is worth it.
Laura Trujillo is a national columnist focusing on health and wellness. She is the author of "Stepping Back from the Ledge: A Daughter's Search for Truth and Renewal," and can be reached at ltrujillo@usatoday.com.
This article originally appeared on USA TODAY: Why women in menopause can't find doctors
Reporting by Laura Trujillo, USA TODAY / USA TODAY
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