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Menopause is a period in the journey of life that all women will pass through, but each will write their chapter differently. Navigating the twists and turns of this transition is challenging for women and medical professionals.
"There are midlife women everywhere because women spend about a fourth of their lifetimes in menopause and post-menopause," says Camille Moreno, DO, NCMP, a doctor with University of Utah Health. "We still need to better serve these women,"
Moreno is the medical director of the Midlife Women's Health and Menopause Program at U of U Health. The program was created in 2021 after professionals in the Department of Obstetrics & Gynecology heard the concerns of women in the communities they serve. "Patients were telling them that there has to be someplace that focuses more on the menopausal patient population and this age group of women," Moreno says. She believes the menopause program will further empower women to get the answers they need before they run out of the patience and time to best treat their symptoms.
"By the time we see them (patients), especially in the primary care setting, we are trying to manage their diabetes, their high blood pressure, and their high cholesterol," Moreno says. "But we could have intervened earlier to prepare them for this stage in life and possibly prevent them from even getting those diseases."
If no one is talking about menopause with a woman going through the transition and experiencing troublesome quality-of-life symptoms, then Moreno predicts confusion and frustration will replace sound medical advice.
Kristy Nalder, one of Moreno's new patients found out in September 2022 that she is in menopause. "So, I am newly informed about my menopause status," says Nalder, a professional woman in her mid-40s who is married with children. Two years ago, during the COVID-19 pandemic, she started feeling out of sorts.
"There's a lot of things I chock up to the stress of COVID-19 and all the world turmoil, but I started experiencing extreme fatigue and migraines," Nalder says. "I never had classic hot flashes, but I was so tired, irritable, and low libido. I thought it might be hormonal."
Nalder's quest for answers began almost immediately, but as the months passed by and the medical bills stacked up, none of the doctors or other health professionals she consulted connected the dots to menopause before Moreno diagnosed the transition.
"I honestly was a little bit surprised," Nalder says. "But at the same time kind of relieved that okay, this is what's been going on, this is what I have been going through, and I finally have a doctor who is going to help me through all of this."
Patients like Nalder give Moreno hope for the future. "Someone like Kristy went out and sought help and never really gave up this fight or the challenges," Moreno says. "Patient stories like hers motivate me to do my job well every day and show up for my patients." She is encouraged by the growing number of midlife women who are empowering themselves with knowledge, sometimes gathered on the internet, who then seek clarity from the medical community. "Most women do look up their symptoms online," Moreno says. "They read blog posts, they listen to podcasts, and they buy books because every woman has a different journey. They go through these symptoms a little bit differently, although it's the same mechanism that causes your body to slowly change and undergo these physiological changes."
At the Midlife Women's Health and Menopause clinic, Moreno and others on the team are ready to respond to patients who have questions about their symptoms and risk factors. There are nine providers, including Moreno, who are menopause certified by the North American Menopause Society (NAMS). Moreno was impressed with her colleagues' response to this need in the community.
"Just to get this group of providers to sit for the NAMS exam while they are trying to do what they do every day for their other patient population is huge," she says. Now, these professionals are ready to talk about symptoms like hot flashes, night sweats, anxiety, headaches, vaginal dryness, heart palpitations, and a lower sexual drive, along with treatments.
Once a woman's menopausal symptoms come into focus, Moreno says it is easier to assess which treatments are the safest and most effective for individual patients. "We know that menopausal hormone therapy is the most effective treatment option, with up to 80% effectiveness," Moreno says. "Then these phytoestrogen supplements that you can buy over the counter are no better than placebos, so about 30% effective. But women turn to over-the-counter supplements because they are readily available."
After her diagnosis, Nalder says, "I looked around at other women and thought some of them had to have gone through this, so why hadn't I heard them talking about menopause?" Now, she is looking forward to the conversations she will have with Moreno and with other patients navigating the menopause journey.
Moreno is excited about the discussions she is already hearing. "Women are coming to me and others with questions about menopause," Moreno says. "They are finding the program (at U of U Health) and they want to do better for themselves, their family, and all those people who depend upon them," Perimenopause and menopause are not trouble-free, but when you know the facts, they are easier to manage.