Title: Menopause Health Care: Addressing the Gap in Knowledge and Treatment Options
Introduction:
Menopause is a significant life transition that impacts countless women in the United States. However, persistent myths surrounding hormone replacement therapy (HRT) and inadequate training for new doctors have resulted in women struggling with the physical and emotional challenges of this stage. The lack of proper healthcare support has led to the rise of virtual startups focusing on women’s health issues, offering simple yet effective treatments such as vaginal creams containing low doses of estrogen. This article explores the alarming breach in menopause health care, uncovers the root causes, and delves into the importance of addressing this gap for the well-being of women across the nation.
I. Deficient Information and Misconceptions:
1. Faulty Data from Women’s Health Initiative (WHI):
– WHI initially indicated increased risks associated with HRT.
– Subsequent research and analysis demonstrated the positive effects of hormone therapies.
– Despite evidence disproving the risks, misinformation persists.
2. Lack of Public Knowledge:
– Society’s deficient understanding of managing menopause.
– Stephanie Faubion, MD, highlights the complexity of hormone therapy, which contributes to misunderstandings.
II. Insufficient Training of Doctors:
1. The Role of Vaginal Estrogen in Urinary Problems:
– Doctors, including urologists, lack knowledge of using vaginal estrogen for urinary symptoms.
– Incomplete training during medical residencies hinders comprehensive patient care.
2. Inadequate Education within OB/GYN Residencies:
– OB/GYN residency programs often do not provide extensive menopause treatment knowledge.
– Patients actively transitioning through menopause may be overlooked due to healthcare system limitations.
III. Bridging the Gap in Menopause Healthcare:
1. The Rise of Digital Women’s Health Startups:
– Traditional healthcare fails to address menopause adequately, leading to the emergence of virtual clinics.
– Companies filling the menopause healthcare gap are helping women with unresolved issues.
2. Importance of Low-Dose Estrogen Treatment:
– Vaginal creams with low doses of estrogen offer effective relief for menopause symptoms.
– Ashley Winter, MD, emphasizes the significant impact of these interventions on patients’ lives.
3. Overcoming Treatment Doubts and Non-Compliance:
– Lingering doubts due to early investigations continue to affect patient compliance.
– Andrea Rapkin, MD, observes patients’ concerns with estrogen products but notes the growing interest in vaginal hormones.
Conclusion:
The alarming breach in menopause healthcare in the United States necessitates urgent action. Persistent myths about hormone replacement therapy and the lack of training among doctors have left countless women struggling with the physical and emotional toll of menopause. However, virtual startups focusing on women’s health issues are beginning to bridge the gap by offering simple yet effective treatments, such as vaginal creams containing low doses of estrogen. To ensure better menopause healthcare, it is crucial for medical professionals and the public to dispel misconceptions, educate themselves, and embrace the benefits of appropriate hormone therapies. By doing so, we can create a healthcare system that supports women in navigating this significant life transition with ease and confidence.
Summary:
Addressing the alarming breach in menopause health care, this article explores the persistence of myths about hormone replacement therapy and the lack of training among doctors. It highlights the rise of virtual startups that provide women with relief from unresolved menopause symptoms. The article dives deeper into the importance of low-dose estrogen treatment and the need to dispel doubts and misconceptions. It emphasizes the lack of knowledge both among the public and healthcare professionals and offers insights into the intricacies of hormone therapy. By bridging the gap in menopause health care, we can enhance the well-being of women across the United States.
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September 1, 2023: An alarming breach haunts menopause health care in the United States, thanks to persistent myths about hormone replacement therapy and failures in the way new doctors are trained. The result: Countless women are struggling with the physical and emotional cost of this life transition.
These shortcomings have led to an influx of doctors moving from traditional practice to virtual startups that focus on women’s health issues, treating patients who come to them desperate and frustrated after years of unresolved issues.
The solution is often so simple it’s almost insane, say specialists: vaginal creams containing low doses of estrogen, which can address the problem menopause symptoms from vaginal dryness to recurrent urinary tract infections.
“Without question, this is one of the most meaningful interventions I’ve ever offered a patient, and yet it’s underused,” said Ashley Winter, MD, chief medical officer and urologist at Odela Health, a digital women’s health clinic. “A lot of companies are flourishing in this menopause space because it’s underserved by traditional healthcare: Your gynecologist typically takes care of reproduction, and typically when women are done with childbearing, they’re released from their gynecologist’s care. “
More than 1 million women in the United States go through menopause every year. According to a 2022 survey4in 10 women report menopausal symptoms that have been disruptive enough to interfere with their work performance at least weekly.
And yet, many women do not receive adequate treatment.
Doctors say part of the blame is the damaging legacy of faulty data. Early results from the federally funded Women’s Health Initiative (WHI) published in 2002 showed that Hormone replacement therapy led to increased risks of heart attacks, strokes, and breast cancer. But a more detailed analysis showed the opposite: Hormone therapies have a useful effect on cardiovascular and bone health and generally reduce the risk of death in younger women or in the early postmenopausal period.
Hormone replacement therapy (HRT) offers estrogen, sometimes with progesterone, into the body through gels, creams, patches, pills, suppositories, or a device placed inside the uterus. Systemic HRT sends hormones into the bloodstream, while local HRT (such as vaginal estrogen cream) specifically treats vaginal symptoms of menopause.
Myths about the health risks associated with systemic and topical HRT have long been debunked, and research on topical HRT in particular shows that it poses no health risk. cancer or another chronic diseases.
Yet even though it’s been two decades since misinformation began to spread, people remain woefully uninformed about hormone treatments.
The FDA still requires estrogen products to carry a black box warning in early data, even though they have since been proven false.
“In my opinion, this is one of the most damaging public relations misadventures in modern medicine,” Winter said. “He has literally killed women. And that has made them miserable.”
The public has a clear lack of knowledge about managing menopause, said Stephanie Faubion, MD, medical director of the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health.
Low-dose estrogen treatment is not a radical approach; in fact, it’s the standard of care for women experiencing many symptoms of menopause, Faubion said. But the subject is nuanced and some people get lost in the details.
“I don’t think there’s a lot of knowledge about the risks and benefits of hormone therapy in general,” Faubion said. “New information appears so frequently that it is difficult to follow it. The answer is complicated and depends on the dose, length of treatment, and the formulation you are taking. It’s hard for a lot of people to understand.”
But Winter said the lack of public awareness reflects a larger problem: Knowledge gaps also exist among doctors, stemming from insufficient training on issues related to menopause.
During her six-year urology residency, she never learned the role of vaginal estrogen in urinary problems, Winter said. It was only during a year-long fellowship on sexual dysfunction that she learned of the treatment.
“Despite dealing with urinary problems, incontinence, blood in the urine (training to handle all those concerns), the role of local hormones “Use of the vagina to control them was never taught or discussed,” Winter said. “I never prescribed any of that.”
A year ago, Winter left her job at Kaiser Permanente to join Odela. After years of prescribing overactive bladder medications with little or no results, she said, she now uses the knowledge she gained during her fellowship to help women who have spent years battling debilitating symptoms.
Urologists aren’t the only doctors who lack proper training. OB/GYN residencies offer little knowledge about menopause treatments, she said Ghazaleh Moayedi, DO, an OB/GYN and complex family planning specialist at the Texas-based Pegasus Health Justice Center.
The problem is partly down to the systems, he said. Training programs often direct patients who are uninsured or covered by public insurance to resident physicians. Patients who qualify for Medicaid or Medicare are often pregnant or over the age of 65, Moayedi said, so women who are actively transitioning may go under the radar.
“What that means in a state like Texas where I live, where it’s hard to qualify for Medicaid, is that the people we see who qualify are pregnant,” he said. “And you’re not on Medicare until age 65. So most OB/GYN residents don’t graduate with extensive menopausal experience.”
According Medicaid.gov80% of the nation’s Medicaid-covered population is age 45 or younger.
When doctors are properly trained and prescribe local hormones, patients don’t always follow the treatment plan, said Andrea Rapkin, MD, professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA.
That non-compliance with treatment is yet another example of doubts lingering because of misinformation spread through early investigations, Rapkin said.
“I’ll prescribe an estrogen product and find out they didn’t take it, though I’ll reassure them,” he said. “I think there are still some concerns, but I’m glad to see that there’s a growing interest in vaginal hormones.”
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