Changing Physicians’ Attitudes Toward Menopausal Health: Lessons from the Women’s Health Initiative
Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM, NBC-HWC
As a board-certified family physician with over 20 years of experience, I have dedicated my career to improving the health and well-being of women, particularly those navigating the challenging phases of menopause and perimenopause. My journey into this specialized field was deeply personal, driven by my own experiences and the realization that many women, like myself, were not receiving the comprehensive care and understanding they deserved.
Today, I want to address a critical issue that continues to impact the quality of care for menopausal women: physicians’ attitudes toward menopausal health, particularly in light of the findings from the Women’s Health Initiative (WHI).
The Women’s Health Initiative (WHI), launched in the early 1990s, was a landmark study aimed at understanding the health risks and benefits of hormone therapy (HT) in postmenopausal women. The WHI’s findings, particularly those related to the risks of hormone therapy, had a profound impact on medical practice and public perception[1].
The study revealed that combined estrogen and progestin therapy increased the risk of breast cancer, heart disease, stroke, and blood clots, leading to a significant decline in hormone therapy prescriptions and a wave of fear and confusion among both patients and healthcare providers.
While the WHI provided valuable insights, it also led to widespread misconceptions and an overly cautious approach to hormone therapy. Many physicians, influenced by the initial WHI findings, became hesitant to prescribe hormone therapy, even when it could significantly improve the quality of life for women suffering from severe menopausal symptoms. This cautious stance was further compounded by media coverage that often highlighted the risks without adequately addressing the nuances and potential benefits of hormone therapy for certain populations.[2]
As a result, many women were left to endure symptoms of menopause with inadequate support and treatment options. The fear of hormone therapy overshadowed its potential benefits, particularly for younger postmenopausal women and those experiencing debilitating symptoms such as hot flashes, night sweats, and mood disturbances. This has led to a significant gap in care, where women are either undertreated or not treated at all, despite the availability of effective therapies.[3]
It is crucial to recognize that the WHI findings should not be interpreted as a blanket condemnation of hormone therapy. Instead, they highlight the importance of personalized and shared decision-making in menopausal care. The WHI showed that while hormone therapy is not suitable for chronic disease prevention, it remains a valuable option for managing menopausal symptoms in women who do not have contraindications and who are within a certain age range or early in their menopausal transition[4].
To address this issue, we need a paradigm shift in how we approach menopausal health. Here are a few key steps that can help change the current landscape:
1. Education and Training
Physicians need comprehensive education and training on menopausal health and hormone therapy. This includes understanding the nuances of the WHI findings, the benefits and risks of hormone therapy, and the importance of individualized care. Medical schools and continuing education programs should prioritize menopause education to ensure that future generations of physicians are well-equipped to support their patients through this critical life stage.[5]
2. Personalized Care
Every woman’s experience with menopause is unique, and treatment should be tailored to her specific needs, preferences, and risk factors. Shared decision-making, where physicians and patients collaborate to make informed choices about treatment options, is essential. This approach empowers women to take an active role in their health and ensures that they receive the most appropriate and effective care [6].
3. Addressing Misconceptions
We must actively work to dispel the myths and misconceptions surrounding hormone therapy. This involves clear communication about the risks and benefits, as well as the potential for hormone therapy to significantly improve quality of life for many women. By providing balanced and evidence-based information, we can help women make informed decisions about their health[7] .
4. Holistic Approach
Menopausal care should not be limited to hormone therapy alone. A holistic approach that includes lifestyle modifications, such as diet, exercise, and stress management, can greatly enhance overall well-being. Integrating functional medicine and lifestyle medicine principles can provide a comprehensive framework for supporting women through menopause.[8]
5. Advocacy and Support
Finally, we need to advocate for better support systems for menopausal women, both within the healthcare system and in society at large. This includes creating supportive workplace environments, raising public awareness about menopause, and ensuring that women have access to the resources and care they need to thrive during this transition.
In conclusion, the WHI has provided invaluable insights into menopausal health, but it is imperative that we move beyond the initial fear and caution it generated. By embracing a more nuanced and personalized approach to menopausal care, we can ensure that women receive the support and treatment they need to navigate this stage of life with confidence and vitality. As healthcare providers, it is our responsibility to lead this change and advocate for the well-being of our patients. Together, we can transform the narrative around menopause and empower women to reclaim their health and vitality.
REFERENCES:
[1] “Women’s Health Initiative”.
[2] “The Last Word On Hormone Therapy From the Women’s Health Initiative”.
[3] C. G. Solomon and J. V. Pinkerton, “Hormone Therapy for Postmenopausal Women”.
[4] J. E. Manson et al.. “The Women’s Health Initiative Randomized Trials and Clinical Practice”. American Medical Association. May. 2024. 10.1001/jama.2024.6542.
[5] B. Tariq, S. Phillips, R. Biswakarma, V. Talaulikar and J. Harper. “Women’s knowledge and attitudes to the menopause: a comparison of women over 40 who were in the perimenopause, post menopause and those not in the peri or post menopause”. BioMed Central. vol. 23. no. 1. Aug. 2023. 10.1186/s12905–023–02424-x.
[6] G. Richard-Davis, A. Singer, D. D. King and L. Mattle. “Understanding Attitudes, Beliefs, and Behaviors Surrounding Menopause Transition: Results from Three Surveys”. Dove Medical Press. vol. Volume 13. pp. 273–286. Dec. 2022. 10.2147/prom.s375144.
[7] A. Cagnacci and M. Venier. “The Controversial History of Hormone Replacement Therapy”. Multidisciplinary Digital Publishing Institute. vol. 55. no. 9. pp. 602–602. Sep. 2019. 10.3390/medicina55090602.
[8] C. A. Ryan, W. A. Ghali, R. D. Boss, M. A. Moskowitz and K. M. Freund. “Care during Menopause: Comparison of a Women’s Health Practice and Traditional Care”. Mary Ann Liebert, Inc.. vol. 8. no. 10. pp. 1295–1302. Dec. 1999. 10.1089/jwh.1.1999.8.1295.
