My friend, M (you’ll remember her as the Menopausal Squirrel), felt pretty good about her health care practitioners. She liked and trusted her gynecologist right up until she began her menopause journey with a plethora of symptoms including hot flashes, mood swings, and insomnia. That’s when things got ugly.
On an office visit, she asked about remedies and symptom relief. Her gynecologist recommended HRT. M. wasn’t too keen on that idea given the press since the WHI study. “What else can I do? ” she asked. “Antidepressants” was the answer. “No other options?” she queried. “There’s nothing else we can do,” she was told.
She walked out of the office and never went back.
Now I’ll be the first to admit that it can’t be pleasant to have a hot, bitchy woman demanding relief and answers in your office when you don’t really know what will help. And I truly understand as a health care practitioner how much you want to offer a definitive answer to such questions. Especially when your local drug rep has just offered you a sheaf of paperwork detailing why this might be a great new use for an old favorite drug.
Still, I gotta think that “I don’t know” might be a better start than “How about an antidepressant?” A fabulous followup might be “I’ll try to find out what other options might be helpful.”
A simple medical professional review session is in order here for all healthcare professionals involved in the care of menopausal women. And all menopausal goddesses are invited to read along to learn how to frame some of their questions in discussions about symptom relief or management.
Review Statement # 1: There is no silver bullet.
This is a phrase often used in health care circles to mean that there is no single drug, therapy, or regimen that will eradicate, alleviate, or cure any given syndrome or set of symptoms.
(It is well known that health professionals speak their own language – not sure where the silver bullet metaphor came from unless it was referring to the single thing that can kill a werewolf. While we may feel like we change as much as these lupine creatures during menopause, there really is no silver bullet for us.)
Review Statement # 2 All treatments have adverse or side effects.
Duh! And antidepressants have some whoppers!
Review Statement # 3 All Patients Are Individual
You wouldn’t think that this would even need saying. I heard it over and over again in nursing school. Still…………..
Review Statement # 4 Choose the least interventional option first for any symptom or disease state.
Okay, fans, moisture wicking clothing, natural progesterone cream, and go up from there. Need I say more? To suggest that HRT or antidepressants are the first or second or only answers goes contrary to this very basic rule. Never try to shoot a fly with an elephant gun. At least not until it goes rogue.
Review Statement # 5 Conduct a Risk-Benefit Analysis before prescribing treatment.
Take into account severity of symptoms, prognosis, and medical history versus possible benefits minus adverse effects or danger of future medical problems. In other words, examine the risks and potential benefits for each individual patient together with that patient. The operative word being Together.
Are antidepressants bad? Or wrong? Heck, no. If one is suffering from depression that interferes significantly with daily living, these drugs can literally be lifesavers. This type of clinical depression is an indication that the benefits might outweigh the not inconsiderable risks. Should they be a first line for hot flash relief? Absolutely and unequivocally NO. The risk-benefit teeter totter will be weighted the other way.
Review Statement # 6 Involve the Patient In His/Her Own Healthcare
Duh again. Yes, it’s inconvenient. Yes, it will likely take longer. And the outcome will likely be far more satisfying for all concerned.
To be fair, I can’t tell you how many physicians over the years have told me that their patients don’t want to be that involved in care decisions; they just want to be told what to do. It’s possible we consumers have been at fault by not communicating our desire for involvement or by being too compliant or passive.
We need to prove them wrong and take an active role in symptom relief and control. Empower yourself, ask questions, seek information and move ahead as a full fledged participant in your own Menopause journey.
What did M do when she left her MD’s office? She shopped around., albeit hot flashing, grumbling, and sleep deprived.
She found an integrative wellness clinic that offered wellness counseling including dietary solutions and bioidentical hormones. Options were offered only after extensive testing for her hormone status, including thyroid as well as cortisol, estrogen and progesterone levels. She’s feeling 100% better. Especially since she is now in partnership with her healthcare provider/s.
Want to learn more about your own options? Check out Women In Balance, a non-profit organization dedicated to educating women about their health and wellness options.