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Menopause, your doctor, and you

Talking to your doctor about menopause can result in finding relief and comfort or experiencing frustration. For many of us, we turn to our doctors for help with menopause because we trust healthcare providers and their expertise. So why then do some women find talking to their doctors about menopause to be anything but helpful?

The temptation on both sides is to point fingers; patients complain that doctors simply do not care and doctors lament their patients do not trust. Perhaps the greatest challenge is for both sides to overcome not an information gap, but a perception gap.

Medical vs. patient definitions
Ask your doctor and any of your friends to define menopause and you will likely get some interesting answers. While most everyone can define menopause, the criteria used can differ greatly between doctors and patients. Doctors will tend to view menopause (rightfully so) as a biomedical condition while women describe menopause (also rightfully so) as an ‘experience’ of a sort of package deal.

Biomedical definition of menopause
Healthcare professionals rely on objective ways to determine when a woman is menopausal. Evidence is based on straightforward matters including the absence of periods, measured hormonal levels, and age. Under this definition it is easier to ‘know’ that a woman aged 55 with no periods and lower estrogen levels, is menopausal. This may explain why some doctors doubt/dismiss a woman who is 40 and complains of menopausal symptoms yet still has her period. The second woman just does not fit the biomedical menopausal mould.

Defining menopause as an experience
For women, menopause is not quite so cut and dry. Think of the day you entered menopause. Unless you had a hysterectomy, you cannot point to a calendar and locate such a date. We notice over time that our bodies are changing and we know we ‘feel’ differently. You may still be menstruating and having hot flashes or feeling more irritable.

This is the big difference that leads to a failure to communicate; we define menopause based on the symptoms we experience while our doctors are checking our birth dates and our most recent menstrual period.

Generally, most women believe that menopause (rightfully so) is a phase that has sort of snuck up on them. Symptoms often occur gradually and it may take a few months or a couple of years to put two and two together regarding menopause. Meanwhile our doctors (also rightfully so) think of menopause as a phase with a definite and measurable start and finish. As a result you approach your doctor to discuss menopause based on your definition and your doctor postpones any menopausal talk based on the biomedical definition.

Your doctor believes that he or she has acted in your best interests based on their medical expertise. You leave the office more confused than ever and doubt your own body and instincts. What is going on here?

Discussing menopause with your doctor presents enormous challenges on both sides. Doctors are slowly analyzing newer research that indicates menopause is not always conveniently measured by biological yardsticks. Menopause can and does affect women outside of the classic textbook patterns. In a rough comparison, not everyone enters ‘adolescence’ on their thirteenth birthday; some start the physical and psychological transition earlier or later. Some might also indicate some leave behind the adolescent phase sooner than others. No two teens go through the same process. Menopause is another life phase that will affect each and every woman uniquely.

On your next visit, try to remember that your doctor may not necessarily be questioning your intelligence or insisting that you are not menopausal. Continue talking with your doctor to see if you can both come to an understanding of how menopause is taking place and how it is affecting you. But if your doctor fails to acknowledge your definition of menopause as a valid one, it may be time to seek another healthcare professional who is willing to meet you halfway.

This topic is fascinating and may just help you open up the lines of communication with your doctor. Read an excellent research summary at this link that explores why women and their doctors have difficulties with menopause:

Menopause, Your Doctor, and You

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