0
0
A concerning gap in menopausal care persists within the United States, fueled by enduring misconceptions surrounding hormone replacement therapy and deficiencies in the training of new doctors. Consequently, countless women are forced to grapple with the physical and emotional burdens of this life-altering transition.
These inadequacies have prompted a surge of healthcare professionals to transition from traditional practices to virtual startups specializing in women’s health concerns. They now treat patients who approach them in desperation and frustration after years of unresolved issues.
Ironically, the solution often proves to be deceptively simple, according to specialists: low-dose estrogen-containing vaginal creams. These creams can effectively address a range of menopause symptoms, from vaginal dryness to recurrent urinary tract infections.
Dr. Ashley Winter, Chief Medical Officer and urologist at Odela Health, a digital women’s health clinic, emphatically states, “Without a doubt, this is one of the most impactful interventions I’ve ever offered to a patient, and yet it remains underutilized.” She further explains that the traditional healthcare system falls short in addressing menopause as gynecologists typically focus on reproductive issues, leaving post-childbearing women without adequate care.
Over one million women in the United States undergo menopause annually, with a 2022 survey revealing that four out of ten women experience disruptive menopause symptoms affecting their work performance on a weekly basis.
Unfortunately, many women are not receiving the appropriate treatment they need. Faulty data from the early results of the Women’s Health Initiative (WHI) in 2002, which initially suggested increased risks associated with hormone replacement therapy, contributed to the confusion. Subsequent analyses revealed the opposite: hormonal therapies benefit cardiovascular and bone health, particularly for younger women or those in the early postmenopausal stage. Hormone replacement therapy (HRT) can be administered through various methods, including gels, creams, patches, pills, suppositories, or intrauterine devices, with systemic HRT impacting the entire body and local HRT, such as vaginal estrogen cream, targeting vaginal menopausal symptoms. Myths concerning health risks related to systemic and topical HRT have long been debunked, with research confirming their safety.
Despite two decades of progress dispelling these misconceptions, a significant knowledge gap persists among the public. The FDA still mandates a black-box warning on estrogen products based on outdated data, a move that healthcare professionals view as one of the most detrimental public relations mishaps in modern medicine.
Dr. Stephanie Faubion, Medical Director for The North American Menopause Society, and Director of Mayo Clinic’s Center for Women’s Health, points out that the lack of public knowledge reflects a more profound problem: even healthcare providers lack sufficient training on menopause-related issues. Dr. Faubion highlights the complexity of hormone therapy and its varying effects based on factors such as dosage, treatment duration, and formulation, making it challenging for many to comprehend.
Dr. Ashley Winter shares her personal experience, revealing that her six-year urology residency never covered the role of vaginal estrogen in managing urinary problems. It was only during a one-year fellowship on sexual dysfunction that she learned about this treatment. After years of prescribing medications with limited results, Dr. Winter transitioned to Odela, where she now utilizes her fellowship knowledge to assist women battling debilitating symptoms.
Urologists are not the only healthcare professionals lacking appropriate training. Obstetrics and gynecology residencies also provide limited knowledge on menopause treatments. Dr. Ghazaleh Moayedi, an OB/GYN and complex family planning specialist, explains that systemic issues in training programs often result in uninsured or publicly insured patients being directed to medical residents. Unfortunately, this excludes women actively going through menopause who may not meet these criteria.
The reluctance of patients to adhere to prescribed local hormone treatments serves as another obstacle, driven by lingering doubts stemming from early research misinformation. Dr. Andrea Rapkin, a professor of obstetrics and gynecology, notes that patients sometimes fail to follow treatment regimens, despite reassurances. However, there is a growing interest in vaginal hormones, offering hope for better menopausal care.
