Medical professionals who treat patients experiencing symptoms of menopause have more options available than ever before, but the treatment process is highly individualized and may present the additional challenge of overcoming patient misconceptions, according to specialists.
A pair of West Tennessee experts who specialize in treating women during various stages of menopause say it’s important for physicians and certified nurse practitioners (CNPs) to discuss with their patient not only her symptoms, but also her medical needs, quality of life expectations and treatment options to decide the best course of action.
“No two women are exactly alike or experience menopause in exactly the same way,” said Susan Murrmann, MD, co-founder of the McDonald Murrmann Women’s Clinic. “Each patient’s symptoms, needs and risk factors are different.”
The North American Menopause Society (NAMS), a nonprofit, multidisciplinary organization that provides physicians, practitioners and women with information on menopause, defines menopause as the permanent cessation of a woman’s menstrual periods. This is confirmed retroactively when a woman has missed her period for 12 consecutive months. According to NAMS, the average woman experiences menopause at the age of 51.
“Menopause represents one day in a woman’s life and is a natural physiological event,” said Diane Pace, PhD, associate professor and director of the Doctor of Nursing Practice program in the College of Nursing at the University of Tennessee Health Science Center, and a former president of NAMS.
“It’s a common misconception among patients that it’s a disease. It’s important for me to discuss with a patient that it occurs naturally in women. Some women are happy and can manage the symptoms of menopause on their own. For others, when the symptoms start affecting their quality of life, that’s when they come into the office looking for any help a clinician can offer.”
Murrmann says that typically she sees patients during perimenopause, which occurs when a woman transitions into menopause. Most women experience this phase in their 40s and 50s when their estrogen levels fluctuate.
According to both Murrmann and Pace, the most common symptoms their patients experience during perimenopause are hot flashes and vaginal dryness, which can result in painful intercourse.
As many as 75 percent of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing they seek help, according to NAMS. Currently, 17 million women in the U.S. experience vasomotor symptoms (also known as hot flashes and/or night sweats) and 9 million women experience them moderate to severe.
According to Pace, hormone therapy (HT) is the most effective therapy to treat symptoms, but in recent years many non-hormonal therapies and complementary and alternative options, such as moisture wicking pillows, Relizen, soy, black cohosh and acupuncture, have become available for patients. It can be challenging to decide on treatment for each patient because it depends on the patient’s symptoms, needs and medical history.
“There are many treatment options for patients now, and it’s important for the clinician to take time to go over every aspect of care,” Pace said. “It’s a collaborative decision between the patient and her clinician.”
Treating the patient with a certain hormone therapy can be a challenging process for physicians and can take months, according to Murrmann.
“Perimenopause is the toughest time to help a patient,” she said. “It can be a trial and error process during treatment. Sometimes the patient feels fine and sometimes she has adverse effects from the hormones. I spend a lot of time monitoring the patient to see if the hormone therapy is working, if the dosing is correct and how they are responding.”
Murrmann says that to see how a patient responds to treatment, she must perform blood tests multiple times over a period of time. Since hormone levels can fluctuate during perimenopausal time, the patient’s needs may change.
“I run these tests to see patterns and can draw several conclusions in a few months to determine what needs to be changed,” Murrmann said.
Another challenge for Murrmann is to convince the patient, as well as the patient’s other physicians, that HT can deliver results.
“One of my biggest challenges when treating a patient is to debunk the myth that hormone treatment causes cancer,” Murrmann said. “The patient’s other physicians may try to take her off hormones. It can be a challenge to get the patient’s physicians to accept that hormone therapy can be beneficial.”
According to Murrmann, this is in response to a clinical trial by the Women’s Health Initiative (WHI) in 2002.
The WHI recruited more than 16,000 women to participate in a comprehensive HT trial and monitored their progress for 8.5 years. The trial stopped prematurely when a 26 percent increase in invasive breast cancer achieved statistical significance. According to the WHI, secondary analysis of the data showed that the risk applied mostly to older menopausal women who started taking the medication late in menopause.
As a result of the initial halt in the trial, the use of estrogen dropped by 71 percent from 2001 to 2009, according to NAMS.
“The data shows that the risks of hormone therapy are rare,” Pace said. “Hormone therapy benefits are high if started in women under 60 or within 10 years of menopause.”
With so many therapies available, Pace says there is a relatively new resource available for physicians, CNPs and patients, which provides evidenced-based data on hormonal and non-hormonal therapies and treatment options.
In late 2014, NAMS launched a free mobile app for both iOS and Android devices, called MenoPro, which helps personalize treatment decisions for patients based on their personal preferences, medical history and risk factor status.
“The app has two modes for both patients and clinicians, so they can make informed choices about the management of menopause symptoms,” Pace said.
Both Pace and Murrmann emphasize the importance of collaborative decision-making when choosing a treatment.
“Hormone therapy is just a piece of the puzzle that can enhance the patient’s quality of life,” Murrmann said. “It’s important to educate them on both the benefits and risks to make an informed decision on their treatment.”
RELATED LINKS:
North American Menopause Society
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