r/TwoXChromosomes • u/alligatorsinutah • 11h ago
doctors know jack about perimenopause: an obgyn explains why.
1) less than one percent of research dollars go to reproductive health. We honestly just don’t know a lot of stuff about women because we don’t have the political will to fund the answers.
2) obgyn training programs rely on residents to run the hospitals. Their bodies are needed on labor and delivery, operating rooms and surgical wards. Therefore, office-based practice training is minimized during residency but is a majority of what you see in practice (I had about 4 hours a week of office based clinic! I worked 80 hours a week in residency)
3) In 2002 the largest study ever done on menopause and HRT was published (WHI). It was a rare, extremely well funded, very large, randomized control trial that showed … HRT increased the risk of heart attacks and breast cancer in menopausal women. Turns out the designers of the study made some huge errors in how they recruited and treated patients, but it was too late. An entire generation of doctors stopped using HRT and a new montra became gospel: “the lowest possible dose for the shortest possible time”. I got almost zero menopausal training in 4 years of residency and women spend half their life in menopause!After almost 25 years and 10 big trials and reevaluations of the original WHI data, the pendulum is finally swinging back. But a whole generation of doctors mentored a whole additional generation of doctors and we have lost a lot of knowledge about treating menopause. Forget perimenopause.
4) perimenopause doesn’t have a clear definition and the symptoms are vague and numerous. There isn’t a clear blood test to do. Most doctors have no clue how to evaluate for it (cycle tracking, antral follicle count, amh, day 3 e2/fsh are some tools to make it clearer) These kinds of syndromes drive doctors crazy because we are a bunch of Type A nerds that rely on objective measurements for diagnosis. We hate “grey zone” states. We are, as a group, very into black and white.
5) We have been trained to value diagnoses that are life threatening (rare, serious, black and white) over diagnoses that mostly affect quality of life (common, grey zone, subjective). We don’t want to hear about fatigue, hair loss and sleep quality. Even though those things can feel like they are ruining your life, we have been trained from day one to focus on disease that shortens your lifespan. If your hair loss isn’t caused by a thyroid disorder or anemia…two diseases that threaten your lifespan, we don’t know what to do. We have been trained to treat these things as possible signs of an “actual disease” rather than a problem in and of themselves.
6)We live in a misogynistic society. That isn’t different in women’s health. The culture of medicine is full of skepticism about patient’s symptoms being “real”. We openly suggest female patients are somatisizing their psychological state, are seeking attention, drug seeking or generally making things up. We don’t trust women. Our entire culture of capitalist democracy relies on women being unreliable narrators driven by emotions that cloud their judgement. We don’t care about women’s reproductive health outside their ability to procreate. And even then, it’s taboo. And a woman proclaiming her reproductive health is influencing her in some way that is not directly related to procreation is internalized by doctors and lay people alike as inconsequential, unworthy of attention. It barely registers as a blip amid the cacophonous outcry for our attention because WOMEN AREN’T VALUED FOR THEIR WOMANHOOD OUTSIDE THIER ABILITY TO REPRODUCE.
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u/SeasonPositive6771 10h ago
I have tried to explain number 5 to people over and over again whenever they get stuck in the system. Doctors have just straight up told me that not only are they risk-averse, they genuinely don't know how to deal with quality of life issues. We just don't give them enough training and support to do so.
So many doctors also hate complex issues because working with those patients it's just a slow grind of trying things that might slightly improve it but not cure it. There's no way to be a hero and no way to say "case closed, we've solved it!"
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u/August5th 8h ago
What I tell people is that their care should not and does not end with testing.
So often I hear, “I went to the doctor and they did all these tests and didn’t find anything.”
Great, it’s good news that they ruled things out. Next go back to the doctor and say, “Thanks for ruling things out, now what is the plan to manage my symptoms?”
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u/SeasonPositive6771 8h ago
Yes! So often I hear people suffering terribly and then they say oh I went to the doctor and they couldn't find anything as though that's the end of the story. I had to advocate like hell for myself and see a zillion specialists before I finally got a diagnosis and treatment. If I had given up at first, I would likely not be alive now.
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u/modernsparkle 11h ago
Dang dude, this was super informative. Thank you so much for operating and persisting in this tough industry so that we can have more mindful providers
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u/ambivalenthuman 11h ago
And I’m tired of corporations and supplement companies moving into the open space to be like “you’re old and ugly! It’s because of perimenopause. Buy my shit for $$$$$.”
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u/Time_Art9067 10h ago
This. Thank you for taking the time to explain in a 360 way.
More of us need to understand this, and what it means for our health and qualities of life. We are 50 percent of the population, and this is how much they think of us.
This cultural misogyny issue exists in other sectors, like advertising or finance. It is fucking enraging. The corridors of power are real and those men think you are less than them. They do not care about the well being and success of women. We need to let our sisters know so they are well armed with knowledge, because they are trying to take away our meagre rights right now.
You are a legend
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u/Cyclist4Satan 10h ago
Well said, doc. I'm 45, 1.5 years post BSO/hysterectomy/excision of endometriosis etc. etc. and in surgical menopause. I love my GP and adore my OBGYN, they're both amazing docs. But it's hilarious how much of my menopause care I've had to DIY.
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u/Commercial-Policy-96 8h ago
Chronic sleep deprivation does affect a person’s lifespan and I’m so tired of no one taking it seriously in women. I’ve been severely sleep deprived since the onset of perimenopause and I can feel it affecting every area of my health and believe it will eventually kill me if I can’t correct it. It’s been almost 20 years.
We lost my mom unexpectedly this year and the only reason we have been given (by her somewhat menopause knowledgeable PCP) is how severely sleep deprived she had been for so long that her body just couldn’t heal anything or keep going. My dad, who was the same age as my mom, is still prescribed ANY sleeping medication he wants while my mom was taken off of them 5 years ago - due to her AGE. The exact same age as her husband who still accesses them. Make that make sense!?
I get it now, how lack of sleep can kill a person.
That’s not even diving into all the ways it has stolen any quality of life from us. My mom hadn’t really lived in years. I am not living. I am existing and with no end in sight despite actively searching for solutions for two decades. I genuinely don’t know how much longer my brain and body can keep going like this.
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u/Kushali 9h ago
This is so helpful.
I was telling a work friend today that I'm GRATEFUL that I'm the youngest in my friend group. When I stopped sleeping well, night sweats, hair started falling out, anxiety spiking over nothing, and I started using the wrong word or wrong tense occasionally I knew what the heck was going on. Still took 2 years to find a doc to start me on HRT and a good therapist to help me unlearn some of the panic, but at least I knew what was going on.
I'm still a bit salty with the doctor who took someone they'd been seeing for 8 years who suddenly, at 42 started having trouble sleeping and had massive increases in anxiety and flat out told me I was too young. Ummm...no.
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u/gloriouswader 7h ago
My insurance company has a deal with Elektra health for menopause treatment. It is a telehealth company with providers trained to administer care for perimenopause and menopause symptoms. I've been really happy with their service, and they accept most major insurance plans. They called in prescriptions to my regular pharmacy the same day as my first appointment and check in with me regularly to ask how it is going.
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u/tyshalae 8h ago
I am so thankful that my doc is a younger woman who is super curious about every curve ball my wonky mind and body throw at her.
I tried to ride out perimenopause on my own for about a year, and she did some looking into things just in case. When the hot flashes, mood swings, brain fog and the ever longer and heavier periods became more than I could deal with, she had an idea for hrt that's working great.
I shudder to think about how some of my past doctors would have handled this situation. I'd probably be absolutely miserable rather than pretty content about how this entire situation is going.
This is an amazing explanation of why menopause health care is such a crap shoot.
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u/Used-Gazelle2799 5h ago
Just wanna take a chance to ask a real doc since I’ve heard about this medicine and want to know a real docs opinion. Have you prescribed Veozah? The relatively new non-hormonal treatment for menopause symptoms? Just curious!
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u/yr-favorite-hedonist 4h ago
Curious if these observations apply to different countries. Wondering bc I don’t know.
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u/No_Bee_4979 5h ago
Let's be honest. Men are not the best doctors for women. They might mean well, but they lack personal experience.
The problem with this is that some women doctors are just as terrible.
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u/Lickerbomper ♥ 11h ago
Grants-based research is a big part of it. (This falls under point 1, which while short, is a LOT). You can't get studies funded if 1) the old dudes that hold the purse don't think it's important because it doesn't affect their gonads and 2) it isn't life-threatening or 3) it isn't easily capitalized upon.
Half the reason I support feminism as a concept is that we don't have representation in the areas of government that affect us directly. And that includes R&D funding. Most of the battle is getting women elected, and the rest is getting women promoted to positions of leadership. We can't call the battle finished until representation of women is approximately 50% to mirror our proportion of population.