A menopause knowledge gap leaves many women with few answers

(InvestigateTV) — Up to 2 million women in the United States go through menopause every year, according to the Mayo Clinic.

For some, the transition brings symptoms that can make daily life difficult, including hot flashes, sleep problems, anxiety, fatigue and joint pain.

Despite being universal, experts say too many patients run into confusion and limited options because training and treatment have not kept pace.

A years-long search for answers

Katie Christensen remembers a time in her mid-40s when her life started changing.

“My tolerance for anything was non-existent,” Christensen said.

Not only was she irritable and quick to lose her temper, but she was gaining weight despite eating well and exercising. She struggled with brain fog and what she described as “bone crushing fatigue.”

“I would drive home at night and be fearful for driving home because I was so tired, and I would get home and I would immediately lay down and I would nap for two hours,” Christensen said.

“And what I’ve learned now is indeed, I had been in menopause for a long time.”

Menopause is defined as 12 months with no menstrual cycle. The symptoms result from the ovaries producing less estrogen and progesterone.

It took years for Christensen and her doctors to connect the dots, in part because she had a hysterectomy after her son was born.

Even though she still had her ovaries, she did not have a uterus, meaning she had not had a period for years because she could not.

“The word menopause was never even brought up,” Christensen said. “It wasn’t on his radar. It wasn’t touched upon.”

She believes menopause should have been part of the conversation with her doctor.

Many women, regardless of hysterectomy, struggle to get properly diagnosed or treated, according to the Menopause Society.

The organization calls it “one of the most overlooked and underserved areas in medicine.”

Doctors describe a gap in training

Dr. Carrie Wieneke is an OB-GYN at the University of Kansas Health System and a Menopause Society Certified Practitioner, meaning she has advanced training on the topic.

“I hear some patients that I’m their third or fourth person that they might have seen,” Wieneke said. “And so they feel like misheard, and they feel just really relieved to tell a story.”

Nationwide, there are more than 49,000 OB-GYNs. When it comes to Menopause Society Certified Practitioners, that number is just under 4,500.

“We have a deficit in education,” Wieneke said. “There are large knowledge gaps of multiple parts of medicine, especially in women’s health or OB-GYN. I think that menopause is one of them.”

Wieneke said part of the problem is there is no nationwide standard curriculum around menopause for doctors.

Fewer than one-third of OB-GYN program directors surveyed have standardized curriculum in their residency program.

“Some residents might spend a lot of time in a menopausal clinic or might spend a lot of time seeing women of the midlife age, and other residents might not. There’s no set requirement,” Wieneke said.

Perimenopause symptoms often dismissed

Quality of care can vary, and if doctors are not learning about menopause, they also are not familiar with its precursor, perimenopause, which can come with just as many symptoms.

“The irritability, the rage, the weight gain,” said Sloane Heller, who struggled with perimenopause. “There’s just so many symptoms that you’re dealing with that you’ve never had before.”

Unlike menopause, women in perimenopause still have periods, so there is nothing to indicate if they are in it. There is no test and no bloodwork.

It can start in women as early as their mid-30s or as late as their 50s, with symptoms being the only sign. Heller said her doctor dismissed her symptoms.

“And he said, ‘No, you’re just, you’re probably really stressed. You know, talk to me a little bit about the stress in your life.’ And I said, ‘Doctor, I’ve been stressed since the day I was born.’ I said, ‘This is a different level,’” Heller said.

A survey of roughly 1,000 perimenopausal women found more than 50% were provided treatment for anxiety, depression, panic attacks or mood swings, and 46% experiencing symptoms were not offered any treatment at all, according to the survey.

Hormone replacement therapy

For both menopause and perimenopause, hormone replacement is a viable treatment.

For decades, it was discouraged because of a study that warned it was dangerous and increased a woman’s risk for breast cancer. Wieneke said new research found that is not the case.

The FDA has lifted warnings on the treatment, but experts say some doctors and some women are hesitant to use hormones because of fears sparked from that earlier study.

Heller and Christensen had no hesitation.

“I would say overall being on hormones has made a huge difference,” Heller said.

Both women tracked down doctors specializing in menopause to get hormone replacement. Christensen went to Wieneke and described her current treatment as “all the estrogen.”

“This is not the way that you’re supposed to live for the next couple decades of your life, and there are really, really great providers out there. You probably need to advocate for yourself. You need to do some research and find physicians that specialize that have had additional training,” Christensen said.

Women can search the Menopause Society’s website, menopause.org, to find a list of certified menopause practitioners, which includes doctors and physician assistants.

The organization is also working on an initiative to transform education in menopause. Over the next three years, it aims to reach 25,000 healthcare professionals.