New York Times Magazine: Women Have Been Misled About Menopause
Feb 1, 2023
By Susan Dominus
Kudos to Susan Dominus for a very thorough piece on a complicated and nuanced topic.
I’ll share what I think are some real gems from the very long article for those that don’t have access. Scroll to the bottom for A FREE GIFT link to the article.
For those that do it’s worth a read.
Excerpts
On what women are dealing with:
One friend endured weeklong stretches of menstrual bleeding so heavy that she had to miss work. Another friend was plagued by as many as 10 hot flashes a day; a third was so troubled by her flights of anger, their intensity new to her, that she sat her 12-year-old son down to explain that she was not feeling right — that there was this thing called menopause and that she was going through it.
— Susan Dominus
Even the most resourceful women I know, the kind of people you call when you desperately need something done fast and well, described themselves as “baffled” by this stage of their lives.
— Susan Dominus
About a lack of women’s health research to better understand the path to menopause:
About 85 percent of women experience menopausal symptoms. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes that, in general, menopausal women have been underserved — an oversight that she considers one of the great blind spots of medicine. “It suggests that we have a high cultural tolerance for women’s suffering,” Thurston says. “It’s not regarded as important.”
— Rebecca Thurston, PhD
Pittsburgh Foundation Chair in Women’s Health and Dementia
Professor of Psychiatry, Clinical and Translational Science, Epidemiology and Psychology
Understanding what health care providers are up against:
Even with new information, doctors still find themselves in a difficult position. If they rely on the W.H.I., they have the benefit of a gold-standard trial, but one that focused on mostly older women and relied on higher doses and different formulations of hormones from those most often prescribed today. New formulations more closely mimic the natural hormones in a woman’s body. There are also new methods of delivery: Taking hormones via transdermal patch, rather than a pill, allows the medication to bypass the liver, which seems to eliminate the risk of clots. But the studies supporting the safety of newer options are observational; they have not been studied in long-term, randomized, controlled trials. — Susan Dominus
Conversations about the risks and benefits of these various treatments often require more time than the usual 15-minute slot that health insurance will typically reimburse for a routine medical visit. “If I weren’t my own chair, I would be called to task for not doing stuff that would make more money, like delivering babies and I.V.F.,” says Santoro, now the department chair of obstetrics and gynecology at the University of Colorado School of Medicine, who frequently takes on complex cases of menopausal women. “Family medicine generally doesn’t want to deal with this, because who wants to have a 45-minute-long conversation with somebody about the risks and benefits of hormone therapy? Because it’s nuanced and complicated.”
— Nanette Santoro, MD
University Of Colorado School of Medicine
Chair, Department of Obstetrics and Gynecology
Professor, Division of Reproductive Endocrinology
In thinking about hormone therapy to manage hot flashes and vaginal dryness:
At highest risk from hormone use are women who have already had a heart attack, breast cancer or a stroke or a blood clot, or women with a cluster of significant health problems. “For everyone else,” Faubion says, “the decision has to do with the severity of symptoms as well as personal preferences and level of risk tolerance.”
— Stetphanie Faubion, MD, MBA
Professor and Chair of the Department of Medicine at Mayo Clinic
Director, Mayo Clinic Center for Women’s Health
Medical Director, The North American Menopause Society
P.S. It seems as though I am able to “gift” copies of the article for a while. I hope it continues to work.
About estrogen and cognitive performance:
In the past 15 years, four randomized, controlled trials found that taking estrogen had no effect on cognitive performance. But those four studies, Maki points out, did not look specifically at women with moderate to severe hot flashes. She believes that might be the key factor: Treat the hot flashes with estrogen, Maki theorizes, and researchers might see an improvement in cognitive health. In one small trial Maki conducted of about 36 women, all of whom had moderate to severe hot flashes, half of the group received a kind of anesthesia procedure that reduced their hot flashes, and the other half received a placebo treatment. She measured the cognitive function of both groups before the treatment and then three months after and found that as hot flashes improved, memory improved. The trial was small but “hypothesis generating,” she says.
— Pauline Maki, PhD
University of Illinois College of Medicine
Professor of Psychiatry, Psychology and OB/GYN
Senior Director of Research, Center for Research on Women & Gender
Associate Dean for Faculty Affairs
