I am 42 years old and have been really grateful for all the research and reporting that has been going on to help women prepare for menopause. I know I’m on the early side of things, but I could swear I am experiencing a number of symptoms that are reported to be indicators of perimenopause. However, when I tell this to my medical providers, they still tell me it’s probably too early to be in perimenopause. Why does it feel like this clear and proven research and reporting is unable to reach primary care providers and generalists? This leaves me feeling like I have great information that is not actionable.
—Out of sync
It is frustrating to experience symptoms and feel dismissed by medical providers. There is often a disconnect between what women are hearing in the media and what they are being told by their doctors. I think this disconnect stems from a few issues.
The first issue is related to the difference in how studies get reported in the media and how they get incorporated into clinical practice. These days, if a study has interesting findings and is related to a hot topic — menopause is definitely a hot topic these days — that study will get covered widely.
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Recently there were lots of headlines telling us that women experience perimenopause symptoms as early as 30 or 35. However, this is based on just one study that describes a possible problem. There is not evidence (at least not yet) that confirms the findings from this study or tells us what treatment options might be appropriate in these younger women. It often takes years for new findings to make their way into doctors’ treatment plans. This lag between when data is first published and when it is implemented can be frustrating to patients, but you can imagine the chaos if we changed treatment recommendations based on every study that gets published.
The second issue is one of vocabulary. To a doctor, perimenopause means something very specific. A woman in perimenopause has irregular periods — meaning her periods vary by more than seven days from the first day of one period to the first day of the next — or has lab findings, like a high follicle-stimulating hormone level, that tell us her ovaries are running out of eggs. But colloquially, the word “perimenopause” is often used to refer to nearly two decades of a woman’s life. As a result, sometimes patients, the media, and doctors are speaking two different languages. This results in a lot of miscommunication. Most 42-year-old women will not be in perimenopause based on the medical definition, but they might be having symptoms that are associated with perimenopause — technically a stage called the late-reproductive stage.
The last issue may be the biggest one, though. Most primary care doctors and OB-GYNs received very little training on the treatment of menopause during medical school and residency. Many of us, myself included, trained around the time the Women’s Health Initiative studies were being published. The first time I received any training regarding perimenopause was as an Endocrine fellow when I learned about primary ovarian insufficiency. PCPs and gynecologists must actively seek out training in perimenopause care.
A primary care provider has the daunting task of staying up to date with the treatment of everything from respiratory viruses and adult vaccination to cancer screening to Type 2 diabetes to blood pressure management. It is impossible to be completely current in every topic. What often happens is that a doctor will naturally gravitate toward keeping most current regarding the problems they see most often in their patients and in topics they are particularly interested in. They may rely more on specialists to help manage issues they are less comfortable with. Your PCP may prefer to refer women to a specialist to manage perimenopause care.
Ultimately, there are many reasons the information you are getting from the media regarding new research is not in sync with your experience with your doctor, including the time it takes for research to go from a journal publication to routine practice, miscommunications related to colloquial and technical definitions for the same word, and gaps in medical training. Knowing this can help you have better conversations with your doctor.
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