Why don’t more people know about menopause treatment?

Few phenomena are a better testament to the complexity of the female reproductive system than the complete firework show finale it gives when it stops working. Unlike most other organs, the ovaries and female hormonal systems “die” long before the rest of the body does because they are not technically essential to the rest of the body’s function. When a person who was once fertile has completely lost, by surgical means or otherwise, the ability to reproduce, they have entered menopause. I like to think of menopause as an evolutionary control, preventing risky pregnancies at old age, but in truth, this mechanism is relatively new, as the human lifespan was not always long enough for it to be observed.

It’s hard to believe that menopause is really just a small death, because it causes so many problems for so many people. The whole situation typically begins during perimenopause, which is the era in which someone’s menstrual periods are irregular but not completely absent. Perimenopause can last any number of years before someone is officially menopausal (sigh). There are a variety of symptoms associated with both perimenopause and menopause, and they’re not pretty. Symptoms range from irregular bleeding and premenstrual syndrome, weight changes, headaches, and hot flashes to all the other things that happen when female hormones — especially estrogen — are out of whack (mood changes, forgetfulness, decreased concentration, depression, anxiety, insomnia).

I want to emphasize how significant that parenthetical list is. I'll cover this more later, but society, and subsequently women themselves, tend to downplay the effects of regular hormonal changes. Yes, it is natural for someone’s hormones to fluctuate monthly and throughout life. But if you are someone with estrogen, you probably know how disorienting it can be when you suddenly realize that you have no control over how you are feeling (and sometimes acting) and how debilitating it can be to not be able to do anything about it. For folks who are pre- or non-menopausal, these symptoms come and go because estrogen decreases once in a monthly cycle before increasing again. During perimenopause and menopause, though, they can be constant and accompanied by other, newer symptoms because estrogen is decreasing gradually, and for good. The debilitation becomes a constant part of life for a number of years. You might ask, then, why there are no treatments to help with all of these nasty symptoms. In fact, there are.

For one, estrogen has been packaged as estradiol — a synthetic estrogen derivative — a million times over. It takes the form of birth control and hormonal therapy. There are other hormonal therapies available that administer hormones like progestin as well. Some drugs, like Gabapentin, a seizure treatment, and Clonidine, a high blood pressure medication, have been successfully repurposed to solve hot flashes. Antidepressants and antianxiety medications can also be modified to relieve some mood changes caused by menopause.

Despite the wide array of options, though, it is rare to find anyone who is using any to relieve symptoms. Most don’t even know that options exist. Many tough their way through the hard years — and not for lack of trying. According to a study discussed by AARP, three in four menopausal women who reached out for professional medical help did not receive treatment.

There are a few things that can account for this. One is a lack of menopause education for medical providers. Menopause is not widely taught because it is simultaneously an inevitability of life and also not the same for any two people who experience it. Doctors who do not specialize in this area simply do not have the resources to effectively engage with patients who come to them with concerns. And since patients are rarely more informed than doctors about newer treatments, they do not have the means to advocate for themselves.

For doctors and patients who are aware of some options, specifically hormonal treatments, history is a barrier. During the mid-twentieth century, hormonal therapies were widely used. In the very early 2000’s, though, word began to spread that extended exposure to estrogen could lead to increased risk for some types of cancer and blood clotting. While this is somewhat true and was based on scientific study, it also contributed to an overblown and widespread fear that still prevents some doctors from prescribing hormonal therapy where it is needed, and where the benefits far outweigh the risks. Many studies have been released since the start of the century that prove that estrogen is safe to use for long periods of time, but many patients are never given the chance to try it for themselves.

The way society sees pain in relation to women’s health is likely the most complicated factor that keeps women from being treated. Dr. Rebecca Thurston of The University of Pittsburgh describes this phenomenon as a “high cultural tolerance for women’s suffering.” We take for granted that women can survive anything without outside help, because they almost always are forced to. Women’s struggles with menopause are often viewed as a normal part of aging that is unworthy of serious treatment or insurance costs. And truly, for some, symptoms are mild, but for others they can be completely debilitating. Forcing menopause into a box keeps physicians from fully engaging with it and keeps patients in denial about their own needs. As always, education could be a successful solution to the menopausal misery of many.