MENOPAUSE: DOCTORS STILL IN THE DARK AGES
So often women say, "I'm waiting for my doctor to tell me what to do."
Lamentably, few doctors are well informed about menopause, and many assume the vaguely described symptoms are psychological in nature. Since physicians are temperamentally disposed to helping people, they, too, feel frustrated at the state of scientific ignorance about women's health in the middle years.
"You don't need to know about that yet" is one standard answer women are given. The doctor pats her on the head, and out the door she goes with her migrainous headaches, ill-defined blues, or unexplained fatiguewhat could it be? More commonly, she won't even bring up menopause, and her gynecologist won't either. Some women spend the next three or five years making the rounds of internists, neurologists, even psychiatrists, with no resolution, because they all ignore the obvious.
The experience of a busy professional political activist in Washington is emblematic. Noticing her periods were scanty and intermittent, and feeling uncharacteristically draggy, she went to her internist and plunked down three hundred dollars for a complete physical. She was forty-nine. The physician took a considerable amount of blood for tests. The results shed no light on her condition. Only when the activist talked to a woman friend who asked, "What about your estrogen level?" did the light bulb flash on. She realized her doctor had not taken any hormone levels. He had never even mentioned menopause.
"The most important change going on in the body of a 49-year-old woman was never addressed," she says, chagrined at her own passivity. "Doctors treat our bodies as though we're the same machines as men, and we're not."
A woman's own signs are her best guide as to whether or not she is nearing menopause or what phase of the long transition she might be in, and whether it is causing her problems. But in order to recognize those signs, and deal with each appropriately, we must be educated. It will not do to retreat behind the defense, If I don't acknowledge it, it doesn't exist.
Gynecologists by and large find the menopausal woman an unappealing patient. She isn't going to have any more babies. Apart from a hysterectomy, there is little chance she will require surgerythe moneymaking part of the practicebut she can be expected to complain about vague symptoms and ask questions for which even the sympathetic physician has only unsatisfactory answers. With candor, a dedicated female gynecologist describes the attitudes of many of her male colleagues: "They find us tedious because we're going to take up their time, and threatening because we're smart and we're grown-upswe don't want any of their bullshit."
This is not to imply that all male gynecologists are dismissive or that all female gynecologists are sympathetic. Women who have felt the necessity to deny their femaleness in order to "pass" in male-dominated medical schools and hospital settings may disassociate from menopause entirely, and they can be quite brutal with women patients who bring them a grab-bag of complaints.
The busy doctor of either sex is likely to take an incomplete family history of the factors that impinge on menopause. Just how cursory these conversations can be is illustrated by the experience of a well-known columnist and her sister, both hard on age fifty. They consulted the same gynecologist in the Boston area to ask what to do. Despite their genetic likeness, one was told she was a good candidate for hormones. Her sister was cautioned not to take hormones. It turns out that the sisters had emphasized different subjective fears. Rep. Patricia Schroeder of Colorado, active in the campaign for women's health research and funding, cracks that "If you get six menopausal women together, you'll find that their doctors are doing six different things. Our joke is that you might as well go to a veterinarian."
Dr. Mathilde Krim, the indefatigable AIDS activist and former pioneer in interferon research, relates another typical story. "Very early on in my life I was shocked by the great indifference of male doctors to the health problems particular to women," she says, recalling the unnecessary secondary suffering of a woman cancer patient at Memorial Sloan-Kettering. Dr. Krim had been called into the group of male physicians discussing the woman's case: Her cancer was of the lung. The patient was asked what other medications she took. "Estrogen," she volunteered.
"That's the first thing to cut out," the men ordered.
"Why, if it makes her feel better?" demanded Dr. Krim. "It was absurd. The poor woman had all these problems with her lung cancer, and now she had to suffer hot flashes on top of it." But the male physicians were gratuitously adamant. And of course, the patient did not dare to raise a complaint.
There is a simple blood test a woman can ask for that is quite reliable in determining whether or not, and at what stage, she is in menopause. One should ask to have one's LH and FSH measured, along with the level of estrogen. FSH, a follicle-stimulating hormone, and LH, a lutenizing hormone, are responsible for ovulation and under the control of the hormones estrogen and progesterone. If the FSH and LH are both high, in the presence of low estrogen, it is indicative of menopause.
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Womens health