Menopause and the Art of Medicine

The foundation of practicing sound medicine is and should be sound science.  “Evidence based medicine” is the discipline of relying upon scientific data in order to ensure proper care for our patients.  Unfortunately, science is not always clear when it comes to a number of healthcare concerns. Often there is a lack of good research or there is conflicting data. As a Board Certified Gynecologist, I would place the management of the menopausal patient as one of the most controversial areas in healthcare today.

From a purely scientific approach, the loss of ovarian function is unique to our species.  So, while many people would say it is a ‘natural’ process, others can argue that the absence of hormones is not at all natural.  Additionally, the extension of a woman’s average life expectancy from 58 at the start of the 20th century to 78 at the start of the 21st century, has made menopause management a very important healthcare issue.  The average woman will spend nearly one-third of her life without the hormones that were essential during the first two-thirds of her life.  This loss impacts every system of a woman’s body.  Yet, there are a significant number of women who manage to live many healthy years past menopause without the help of physicians. Others, however, suffer from menopause related issues like heart disease, osteoporosis, urinary incontinence, sleep disturbances, and memory loss to name a few. This is why menopause management is so controversial for both patients and physicians.

 

There are entire books written about menopause but in an attempt to be concise, I have identified a few suggestions which may help women navigate through menopause:

  1. Menopause is no sweat for you?  Even if you seem to be doing fine through menopause, educate yourself about what healthcare risks you are facing and take a preventive approach. For example, make sure you are having the recommended screening exams such as mammograms, pap tests, bone-density scans, and colonoscopies.
  2. Don’t suffer in silence!  If you suffer from symptoms like hot flashes, sleep disturbances, painful intercourse, etc. there is help available.  It is always best to have an established primary care physician who can either manage or refer you to a specialist in menopause management.  If the physician you have been referred to is unwilling to discuss options such as bio-identical hormone replacement or complementary and alternative health practices, then know that he or she has a limited scope of practice. Remember that there is no “one-size-fits-all” approach to menopause.
  3. Beware of junk science. Just because we don’t have all the scientific answers we’d like, it is important to seek modalities that have been vigorously studied and proven to have a benefit.  Certain supplements have shown no benefit compared to placebo.  Also, it is important that the risks of even “natural” products are discussed with your physician.
  4. Be prepared to pay. Unfortunately, supplements and certain prescriptions (e.g. Bio-identical hormones from compounding pharmacies) are not covered by most insurance plans. Also, the time required for a complete evaluation and implementation of a personalized plan for menopause management is not fairly reimbursed by most insurance plans. This is why many specialists in the field do not participate in insurance plans.
  5. Seek Value. You should be clear on what you will be expected to pay and on what services you will receive for your money.

 

Article submitted by Dr. Regina Kaufmann, MD of BodyWise Specialists. (321) 729-4243 or bodywisespecialists.com

 

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