WOMEN’S HEALTH
Menopause A multidisciplinary approach BY RACHEL S. CADY, MD, FACOG
W
omen over the age of 50 represent the nation’s fastest-growing population segment, according to recent Census Bureau data. This group—currently 64 million, or one-third of all American women— is expected to continue to rise rapidly as women live longer. The average woman lives one-third to one-half of her life in postmenopause, and 75% experience significant menopausal symptoms. Unfortunately, the small number of menopause specialists across the nation does not meet the demand, and Minnesota is no exception. The state’s menopause specialists are clustered mostly in metropolitan areas. Access to care for patients in rural areas presents both a challenge and a unique opportunity for new models of care.
One region’s story Throughout my years of OB-GYN practice in multi-specialty clinics in Crosby, Aitkin, and Mora, the change in demographics and needs of our patients has become more apparent. The population is aging in our area. Women desire a better quality of life but are bombarded with weak
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guidance from questionable sources about their midlife/postmenopausal care. They are longing for avenues to address what is often an array of new and seemingly “strange” symptoms. They are busy women, a “sandwich generation” who do not want to travel far and wide for fragmented care. Cuyuna Regional Medical Center’s general OB-GYN department wondered if we could help fill the void in menopause medicine—and, if so, how to identify the “what, why, and how”? The “what” was the manageable part: the growing number of retirees to our Brainerd Lakes area. Many of my OB/GYN colleagues were not trained in menopause medicine or women’s sexual dysfunction treatment, nor in the unique needs of this aging population—but we wanted to learn. The “why” was that this is a dynamic area of medicine that is rapidly evolving. As a group, and as a hospital, we resolved to do better. The interest was there, along with the ever-growing need. The “how” was going to be through hospital support, careful planning, and continued learning. For a couple of years, we took stock of our local resources, did our prep work, and learned from others. To have a treatment center, we would need a team: dietitians with specialty training in menopause weight management, pain specialists, easy access to pharmacists for medication review, pelvic floor physical therapists, mental health providers with an interest and understanding of midlife, and many other components and involvement from primary care and other specialists. And above all, the mutual desire to do a good job, to fill a need, and to provide local care to patients. Throughout the course of attending live and virtual conferences from menopause and sexual medicine societies, hitting the books, networking with more seasoned practitioners in the arena, and becoming certified through the North American Menopause Society (NAMS), we were finally able to start our program.
Assessing needs The menopause transition (perimenopause) and menopause comprise a time of opportunity to make overall health assessments, plan for the future, and address the unique set of accompanying symptoms. This can be incredibly challenging for women to navigate on their own.
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AUGUST 2020 MINNESOTA PHYSICIAN
The spectrum of concerns, questions, and bothersome symptoms associated with this natural phase of life varies dramatically. Bleeding concerns, low libido, painful sex, vulvar pain, hot flashes, weight gain, sleep disturbances, anxiety/mood changes, and hot flashes are just part of the vast array of common symptoms. Addressing health care maintenance guidelines, hormone replacement therapy (HRT), bone health, cancer risk assessment, and cardiac health is equally important for comprehensive care. All are paramount to healthy aging. Tragically, three out of four women who seek medical help for menopauserelated symptoms are left disappointed, confused, and misinformed. While Menopause to page 264
