Health care visits during perimenopause are challenging for those of us in perimenopause (and for our health care providers)!
When WLB founder, Nina Coslov was 43 she was pretty sure she was experiencing changes associated with hormonal fluctuations. But, she was still getting a period every month. So, neither her PCP nor GYN thought what she was experiencing could be perimenopause.
She soon learned many others were in the same situation: pretty sure something different was happening, but being told, “it can’t be perimenopause, you are too young” or “it can’t be perimenopause, you are still getting a regular period”.
This led her to wonder if it’s not perimenopause, what could it be? Was it the start of something worse? And it left her feeling like her health care providers didn’t really understand her situation and couldn’t help her. She felt alone and afraid.
It’s essential for those of us on the path to menopause to feel like we have the support of our health care providers. Midlife is a time when good habits can lead to the prevention of chronic diseases that arise as we age. So, as part of the WLB survey, we asked participants about their health care experiences so we might be able to shine a light on what optimal health care visits during perimenopause might look like.
PUBLISHED PAPER — Seeking Health Care for Perimenopausal Symptoms: Observations from The Women Living Better Survey
A 6th research paper from the Women Living Better Survey was published online ahead of print (here) as of January 12, 2023, in The Journal of Women’s Health and in the April 2023 Issue.
*** This paper is open access made possible by generous supporters of Women Living Better through a GoFundMe campaign.
The Goal of this Research: To improve health care visits during perimenopause by illustrating what leads to satisfaction or dissatisfaction.
Research methodology
In the Women Living Better Survey of women ages 35-55, we asked participants if they had sought health care for their most bothersome symptom. For those that answered yes, we asked an open-ended question, “How did that go”?
To analyze the responses, the three authors identified themes associated with satisfaction and dissatisfaction.
What we found
There were 5 themes associated with satisfaction
- Validating experiences (e.g., feeling heard and supported, provider normalized or acknowledged a link to perimenopause or age)
- Matching explanatory models (i.e., provider and patient agreed on explanation for symptoms)
- Supported by a team
- Shared decision making
- Symptom addressed
There were 4 Themes associated with dissatisfaction
- Invalidating experiences (e.g., dismissed, too young, regular period, acknowledge perimenopause, but it is “just how it is”.)
- Mismatch in expectations between patient and provider (i.e., disagreement between patient and provider views, the patient seeks root cause or logic of therapy and isn’t given one, patient perceived the information from the provider as incorrect, the patient received conflicting information from various providers)
- Barriers to treatment (e.g., needed to see multiple providers, the expense of treatment)
- Not feeling helped (e.g., the patient has given up, testing was done but not helpful, the patient received no helpful advice, treatment was offered but it didn’t work)
We encourage you to look at the paper itself to see the actual quotes from survey participants associated with each theme. The quotes (i.e. the data) provide the best illustration and context for what we found.
How our findings can help …
Those on the path to menopause
Our recent research in both an English-language and Spanish-Language version of the WLB survey supports the idea that for some people on the path to menopause, symptoms begin before significant menstrual cycle changes.
However, the research about this phase of life is incomplete; understanding of the range of symptom experiences and how those are tied to hormonal fluctuations is limited. In addition, many health care providers have not been taught much, if anything, about the path to menopause.
If you seek healthcare and your provider doesn’t see the possibility of a connection between your symptoms and perimenopause, here is what you can do:
- If you are tracking your cycles and symptoms, share that information at your visit (or ahead of your visit is even better if that’s possible). This tool can help you organize your information so you can convey what is most important to you in the time limits of a visit.
- You can print this paper from the Spanish language survey or this paper from the English language survey to share with your provider. They both support the idea that symptoms start before significant cycle changes.
Health care providers that support midlife women
- Offering “anticipatory guidance,” that gives patients a heads up about what experiences might be coming on the path to menopause is a good strategy. It can reduce confusion, concern, and needless suffering. Knowledge that that symptoms on the path to menopause can begin while periods are still regular and that there are a variety of such symptoms (i.e., more than hot flashes and vaginal dryness) is key to being able to normalize the experience for a symptomatic patient.
- Validation is a powerful and underutilized tool and can go such a long way to relieving cause and concern. Validation can take many forms;
- acknowledging an experience as appropriate or “normal” for their reproductive stage; “many people experience mood or sleep changes during perimenopause”.
- acknowledging an explanatory model for what they are experiencing; “you are correct that your hot flashes or mood or sleep changes can be related to perimenopause”
- acknowledging and educating, “perimenopause happens in the context of midlife and research demonstrates that life stresses can exacerbate some symptoms. So, thinking about which stresses in your life are modifiable is a worthwhile thing to do”.
- While for women, reading the data in the paper (i.e. quotes), can make them feel less alone, for healthcare providers it can offer a window into what comments are seen as positive and (while unintended) sometimes negative, unsupportive, or unhelpful.
