Mum on Menopause

Many women suffering from menopausal symptoms are miscommunicating with their doctors or not talking at all about possible treatments, according to recent surveys from The Endocrine Society’s patient education resource, the Hormone Health Network. The nationally representative surveys of 810 women, ages 45 to 60 years, and of 424 primary care providers about menopause and related health issues were conducted in an effort to better understand how menopausal women are faring 10 years after researchers halted the Women’s Health Initiative’s clinical trials on hormone therapy.

According to the women’s survey results, half of women in this age range are experiencing symptoms of menopause and most say at least one symptom is moderate to severe. Of women experiencing menopausal symptoms, a majority, about 70 percent, say the symptoms have negatively affected their quality of life, and 7 percent regard the impact as serious. Yet, just over a quarter of those with symptoms report receiving any type of treatment. White women are twice as likely to be treated as African Americans.

The survey also finds that many women are not seeking advice from their health care providers about different options to treat their symptoms, even though they say they feel comfortable talking to their primary health care providers or gynecologists about menopause in general. Three percent of the women experiencing symptoms say their provider referred them to an endocrinologist for treatment. The comfort level of talking to doctors, however, varies across demographic groups. Women with a college degree and high incomes are significantly more likely to say they are very at ease with physicians than their non-college graduate and lower-income counterparts. Eighty percent of the high earners say they are comfortable compared to 56 percent of the low-income women.

In the survey of OB/GYNs, family doctors, and internists, 90 percent of the physicians say they are comfortable talking to patients about menopause, but 20 percent fewer think the patients feel the same way. Data also suggest that women may not be talking about all of their symptoms with their doctors—particularly male physicians.

Although 55 percent of female physicians say it is very common for women to talk to them about a lack of sexual desire as a result of menopause, only 38 percent of male physicians say the same. Nine in 10 doctors say women are more forthcoming when talking about hot flashes but shy away from talking about other symptoms.

“Most of us in this field pride ourselves on communicating well with patients,” says Cynthia Stuenkel, an endocrinologist specializing in menopause at the University of California, San Diego. “On the other hand, I know that some clinicians have intentionally washed their hands of the entire menopausal symptom relief hormone therapy package because of frustration with the controversies about hormone therapy and conflicting expert opinions about the best approach to therapy.”

The women’s survey confirms that many women are unfamiliar with treatment options. Less than one-fourth of women had considered hormone therapy to treat symptoms. Just 17 percent reported receiving the therapy to relieve hot flashes and sleep disturbance. Nearly half of the participants had negative impressions of hormone therapy and 62 percent expressed concern about side effects such as breast cancer, blood clots, and heart disease.

Doctors expressed similar observations in the physicians’ survey. Women are uncomfortable with the risks and therefore unwilling to consider hormone treatment, according to doctors. More than half of them believe patients are confused about the therapy.

“Left with the impression that hormone therapy isn’t a safe option, far too many women are suffering in silence thinking they have no options for symptom relief,” says Stuenkel. “There are a number of lifestyle, over-the-counter, and non-hormonal prescription therapies. We know that for some women, however, hormonal therapy provides the most effective relief for severe menopausal symptoms.”

More than a third of the women surveyed get their information from TV, magazines, and other media, and another third from family and friends, followed by 20 percent who use the Internet. However, nearly half of the women say the information on menopause is often confusing and they don’t know which sources to trust.

At least 61 percent of the physicians surveyed say that consensus on the effectiveness of various treatments is sorely needed. Adds Stuenkel: “Women deserve to know that the experts do agree about the safety of hormone therapy for young, healthy women close in time to menopause when symptoms are likely most severe.”

Many Women Experience Moderate to Severe Symptoms of Menopause

Two-thirds of respondents say they have experienced symptoms of menopause, and half are currently suffering symptoms. Nearly half have hot flashes and interrupted sleep. A third experience mood swings and lack of sexual desire. About one-fourth report vaginal dryness and irregular periods.

Certain symptoms of menopause, such as interrupted sleep and hot flashes, are felt more severely than others. One-third of women say their symptom of interrupted sleep is severe or moderate; another third say the same about hot flashes. Twenty-eight percent of women describe their lack of sexual desire as severe or moderate.

Lack of Familiarity with Hormone Therapy

Less than one-fourth of women (23 percent) have considered hormone therapy to treat menopausal symptoms, and 17 percent report having received the treatment. The most common reasons for using hormone therapy are to relieve hot flashes (66 percent of users) and sleep disturbances (50 percent of users).

Although 52 percent of women are very or somewhat familiar with hormone therapy, 48 percent are unfamiliar with the treatment. This lack of familiarity could be an impediment to starting conversations with their providers on the topic. Those with a high school degree or less education and lower incomes, under $25,000, are more likely to be unfamiliar with hormone therapy than others.

Mixed Impressions of Hormone Therapy

Almost half of women ages 45 to 60 years (47 percent) have a neutral impression of hormone therapy, probably due to a lack of familiarity. Among others, impressions of hormone therapy tend to be negative, with 11 percent expressing a positive opinion of hormone therapy compared to 42 percent who have a negative impression.

Many women (62 percent) express concern about side effects of hormone therapy. Seventeen percent say they are not concerned, and 20 percent do not know enough to form an opinion.

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