Two years ago, 49-year-old Tina Mulryan, a New York City hair colorist, visited her primary care physician looking for answers. For over a year she had been waking up several times at night, suffering from hot flashes and experiencing brain fog during the day. Mulryan tells Yahoo Life she used to have plenty of energy but recently was feeling depleted.
“I’m just kind of really irritable because I’m tired,” she says, recalling how she felt. “I want to take a nap in the middle of the day and that’s not me. I’ve always had a ton of energy.”
Her doctor offered her Lexapro, an antidepressant. “I said no, I’m not depressed,” she says. Mulryan wanted answers about her symptoms — and didn’t get them. “I was just like, you know what? You’re not the doctor for me anymore. And I just left.”
It turns out that Mulryan was experiencing perimenopausal symptoms. “I felt frustrated,” she says about the lack of help she received from her physician. "I felt let down by the medical community.”
‘We’re not educating providers on menopause’
According to a recent study from Elektra Health, a digital platform that offers menopause-related education and support, only one in five women between the ages of 40 and 60 receive a menopause diagnosis, even though 80% of all women generally experience symptoms.
Dr. Stephanie Faubion, medical director for the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health, tells Yahoo Life that the mentality among her colleagues is, “‘If I just ignore it, these women and this problem will go away.’” But with menopause symptoms lasting on average seven to nine years, “we can't just pat women on the head, tell them it’s going to be fine and not to worry about these symptoms,” she says.
“We’re not educating providers on menopause management anymore,” she says. Faubion is co-author of a 2019 study that found just 6% of residents said they felt comfortable managing menopause and more than a third said they were not prepared at all. On average, they reported having about two hours of education about menopause in medical school — total.
Dr. Anna Barbieri, ob-gyn and founding physician of Elektra Health, tells Yahoo Life: “You’ve got a lack of education. Lack of time as a resource. And just the controversy surrounding treatments of menopause that are still so prevalent, and it’s like a perfect storm of why [doctors] don’t feel comfortable with it.”
‘There’s nothing wrong with you — move on’
When Barbieri was finishing her residency at Mt. Sinai in 2003, she says she barely had any menopause training. It turned out to be a blind spot for her in 2014 when, at 41, she began experiencing brain fog and forgetfulness. “Being a busy ob-gyn with no real experience in the area of menopause, I took myself to a neurologist and had a brain MRI because I thought I had a brain tumor,” she tells Yahoo Life. “Well, I didn’t have a brain tumor. I was actually in early perimenopause, and it was really through my own search that I was able to find ways to feel better.”
Barbieri saw her experience as an opportunity to educate herself on the topic so she could better help her own patients. She says that 80% of her patients now come to her because of menopause. Most of them find her after not getting answers or help from their ob-gyn or primary care physicians, who often don’t know enough about menopause and how to treat it. In some cases, she says women are being flat-out told “‘There’s nothing wrong with you — move on.’”
Adding to the challenge is the fact that few people — both patients and doctors — even talk about menopause. That was the case for Gwen Harris, of Nashville, who, when she was 54, says menopause symptoms, including insomnia, chronic eye problems, hot flashes and anxiety, “descended” on her. She was unsure who to turn to.
“I didn’t know anything. It was not something my mom ever told me,” she tells Yahoo Life. Harris says the doctors she went to “wanted to give me sleep medication and anxiety medications.” Instead, she worked with a naturopath, who practices alternative medicine. “I literally had to go on this journey myself because I felt very alone and frustrated,” she says.
In 2013, Harris organized a menopause support group that has grown to over 124,000 members — the largest of its kind on Facebook. “Suffice it to say, I found out that I’m not alone,” she says.
One of the common threads in the support group is the feeling of frustration, says Harris. “They went to their doctor and their doctor didn’t know what to do for them” is a typical refrain, she says.
Harris now co-runs a menopause support network called Menowave and says in the 10 years since she created the support group, she notices that the younger generations are talking more about menopause and “helping to break the taboo.”
Barbieri agrees that support groups are places of community to share stories about menopause, but cautions not to take medical advice from these groups, since treatment varies for each individual.
Why doctors hesitate to prescribe hormone therapy
One of the barriers to women getting treatment for menopause symptoms is the reluctance some doctors have to prescribe hormone replacement therapy (HRT). That typically stems from the 2002 Women’s Health Initiative study, which reported that HRT causes an increased risk of heart disease, breast cancer and stroke, and had more risks than benefits.
However, researchers critiquing the studies have pointed out that “no distinction was made between users and their age.”
The study also used a kind of oral estrogen called Premarin on the women, which contains a mixture of multiple estrogens found in the urine of pregnant horses. “We don’t typically use this type of hormone therapy anymore. We mainly use estradiol today, which is what the ovary used to produce before menopause,” says Faubion. It’s available in multiple forms, including skin patches, which doctors believe to be safer than taking estrogen orally because it bypasses the liver.
Before the report was released, Faubion says about 40% of postmenopausal women were using hormone therapy. After the report was released, that number dropped to 6% and hasn’t changed. “So it dropped by orders of magnitude and has not rebounded,” says Faubion. “And it’s because providers and women are not educated and they’re afraid of it.”
Women need to educate themselves: ‘I found my voice’
Adding to the challenge is that many women don't even realize they’re in menopause — nor do the doctors they’re working with.
Faubion says she's seen many women come into her clinic with a slew of perimenopausal symptoms without realizing that’s what they’re experiencing. “It was like, I’m sweating, I’m gaining weight, I’m losing hair, I have palpitations, I’m anxious. And all of it, they’re thinking, ‘Oh my God, I’m dying.’ And I’m like looking at them going, ‘Oh my God, you’re in menopause.’”
But if a doctor isn’t tuned into menopausal symptoms, it can lead to a slew of unnecessary testing. “Women are seeing a urologist for urinary frequency and maybe some incontinence. They’re seeing a cardiologist for palpitations, they’re seeing a psychiatrist for mood changes,” says Faubion. “And all of it is really just related to menopause.”
Barbieri says women can’t wait for the changes that need to happen for doctors to become educated about menopause management. Instead, she encourages women self-educate and self-advocate.
That’s what Colorado resident Christen [last name withheld] had to do when she turned 46 and was dealing with numerous perimenopause symptoms. “I thought I was terminally ill,” she recalls. Her journey began when the first doctor she visited wanted to put her on Premarin, the conjugated equine estrogen. She had learned about the possible side effects and instead asked her doctor for an estrogen patch. He agreed.
“I did find in menopause that I found my voice,” Christen says. “I learned I could be so clear and direct. That it’s OK to say, ‘This is not enough for me. This is what I want to do. If you can’t help me, I’ll find it somewhere else.’”
How to advocate for yourself
Think your symptoms might be related to menopause? Barbieri suggests preparing for your doctor’s visit in specific ways so you can advocate for yourself.
Organize your symptoms. Spend a few minutes identifying all of your symptoms and writing them down. “In my practice, I will often spend a good hour with a new patient, but a lot of people don’t have that luxury of time with their doctor,” Barbieri says. Instead of telling your doctor, “I just don’t feel myself,” knowing your specific symptoms — struggling to focus, waking up multiple times per night, hot flashes, etc. — helps.
Prepare what you’re going to say. Barbieri advises saying to your doctor, “‘I think I’m having symptoms of perimenopause including…’” and list out your symptoms, adding: “‘Do you think that’s what it is? Can these symptoms be attributed to something else and do we need to address that and rule those out?’”
Ask questions about how to manage symptoms. Ask the doctor if they can help. Barbieri says some doctors will be open about their lack of background and make a referral. Another question to ask: Do I qualify for hormone therapy? “If the provider says, ‘No, I think hormones are dangerous and nobody should be doing it,’” she says, then ask: “Why or why not? What’s the data to support it?” If the provider says yes, then ask, “What am I looking at in terms of risks and benefits? What are some alternatives? What is the next step?”
Barbieri cautions against any doctors with extreme responses or absolutes like “hormones are dangerous.” She says the field is complex and requires a nuanced understanding of the individual patient.
For Faubion, she wants women to understand that “menopause is not a disease. It’s a normal life transition that 100% of [women] are going to go through.” But that doesn’t mean having to put up with symptoms or navigating treatment options on your own.