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Contributor: In the Misdiagnosis of Menopause, What Needs to Change?


Menopause symptoms are not being recognized, leading to misdiagnosis and improper treatment.

Approximately 1.3 million women in the United States enter menopause every year. Many of whom do not get correct treatment because their symptoms are not attributed to hormonal changes.

On average, women enter menopause at age 51. Officially, the start of menopause is marked by when a woman has not experienced menstruation for 12 months, not at the point of symptom onset. This is of critical importance, because most women begin experiencing symptoms much earlier, during perimenopause, the precursor to menopause. Despite its reputation as a condition that impacts older women, symptoms often begin to surface during early to mid-40s or even in the 30s.

During perimenopause, the production of estrogen and progesterone may fluctuate significantly. These hormones are messengers that connect and then activate processes throughout our bodies—our brains, hearts, blood vessels, muscles, and bones. Some people have better diets, genetics, or exercise regimens that allow them to overcome these deficiencies better.

However, while some women may weather the fluctuations better than others, the consistent loss of hormone production is inevitable and this is when aging sets in and gradually leads to joint pain, memory/cognition decline, heart disease, osteoporosis, and cancers. Basically, all of the conditions that either hurt us or eventually kill us can be traced back to hormone loss.

Wide Range of Symptoms Span Physical, Emotional, Cognitive, and Mental

Most people recognize hot flashes and night sweats as symptoms of menopause, but there are actually over 30 symptoms that may manifest due to hormonal imbalances and fluctuations, including brain fog, anxiety, joint pain, loss of libido, and bloating.

Cognitive and mental symptoms, in particular, can have a significant impact on daily life but are less known, are more difficult to isolate than physical symptoms, and are often symptoms of other conditions as well. In many cases, a patient is unfamiliar with menopause and assumes her symptoms are due to something else.

For instance, hormonal changes brought on at this life stage can cause sleep disruptions, anxiety, changes in appetite, fatigue, trouble concentrating, and mood disturbances—all of which are also symptoms of depression. Seven of the 8 conditions listed by the Patient Health Questionnaire depression scale (PHQ-8), a diagnostic and severity measure for depressive disorders, might actually be caused by perimenopause or menopause.

Consider that women of perimenopausal, menopausal, and postmenopausal ages use antidepressants more than any other group in the country. The CDC reports that antidepressant use is highest among women ageg 60 and over (24.3%), closely followed by women aged 40 to 59 (20.1%). Although antidepressants may mask 1 or more symptoms, this treatment is not addressing the hormonal imbalance at the root of the problem, which may be causing many additional symptoms as well.

Furthermore, misdiagnosis often occurs with physical symptoms. Over the years, I have treated female patients referred to cardiologists for irregular heartbeats, endocrinologists for weight gain, and marriage counselors for vaginal dryness and loss of libido. None of these specialists had prescribed effective treatments, because changes in hormone levels were not identified as the root cause.

What’s Your Comfort Level?

Menopause symptoms are similar to those of other conditions, and there is a wide variety of symptoms that manifest in unique ways in each patient. Couple this with the prevailing discomfort many physicians feel in discussing menopause and you arrive at misdiagnoses that may never be corrected.

Consider also that in the United States, 80% of medical residents reported feeling “barely comfortable” discussing or treating menopause, and only 20% of OB/GYN residency programs provide menopause training, mostly through elective courses.

This year, a survey conducted by Biote found that 25% of women aged 50 to 65 years have never been told by their doctor (primary care physician or OB/GYN) that they were in perimenopause or menopause, even though 92% of the respondents had experienced 1 or more menopause symptoms in the past year.

Even more alarming, 4 of every 10 women in this survey reported that menopause symptoms had interfered with their work performance or productivity weekly. The impact of untreated or incorrectly treated symptoms on a woman’s quality of life, personally and professionally, can be devastating.

We Need Courage; We Need Open Minds

Countless patients have asked me how it’s possible that so little is known about menopause, a condition that will eventually have an impact on every woman. The truth is that there has always been a lack of research into women’s health, and we are just now starting to realize how much we don’t know.

There is no hard-and-fast rule when it comes to menopause. Some women may experience no symptoms, and others may find their symptoms linger for decades. Lifestyle changes and natural remedies work in some cases, while in others, hormone replacement therapy is needed to bring the body back into balance.

Studying the wide range of hormone therapies, multiplied by the various delivery systems, requires time and effort that many OB/GYNs choose not to invest, concentrating on other specialties instead. There’s no single formula, and yes, certain hormone therapies are not safe, but many are and they can be extremely effective.

Writing a prescription to mask a symptom is much faster and easier than embarking on blood tests and continuous evaluation necessary to achieve hormone balance. When patients complain about symptoms that aren’t being addressed, practitioners often don’t know where to send them. I know this because my clinic is overwhelmed; for those of you who wish to specialize in menopause, there is a huge demand for your services. We welcome you, and we are happy to share our research, generated from years of success in treating menopause and helping women regain their quality of life.

What I’m asking is for you to keep an open mind.

There is no shortcut to discover treatments in an area where research has been so egregiously neglected, but we can take steps. As a medical community, we should mandate that any primary care physician, internist, or OB/GYN with a significant base of female patients over the age of 40 must participate in a continuing medical education course on menopause.

And let’s work together to eliminate the discomfort and stigma of menopause that hampers proper treatment. If you are seeing female patients aged 40 years and older, take a moment to proactively discuss menopause timing, symptoms, and treatment options. If you aren’t familiar with treatment options, refer your patient to someone who does specialize in menopause. Even a short conversation can go a long way to validate your patient’s concerns and assure them you are willing to discuss this life phase with compassion and care.

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