Thoughts and advice on caring for women diagnosed with early menopause: Health Practitioners’ perspectives

It’s very mixed. I think it’s very rewarding because often women feel terrible and you can make them feel much better very quickly. So I find that really rewarding. I find being able to explain what’s happening to them very rewarding. Often women, particularly with spontaneous menopause, because they’re otherwise well, often they’ve had a lot of symptoms that have been unexplained and being able to have an explanation is very satisfying. So that’s really good.

Sometimes there’s a lot of distress, particularly for younger women, and that’s quite hard. And you feel quite a little bit lost I suppose because you know that they need a lot more support than they get and you sort of – when they leave your office, they’re out there on their own and there’s not much for them. I think a lot of them would benefit from just someone to debrief with. But, yes, you can see a psychologist through Medicare, but can you access someone who knows about the area, who has some understanding. It’s very – there’s not a lot to guide them and often there is a lot of distress associated with it.

Early menopause is I think one of the most challenging things we deal with, largely because we cause it. I’ve treated a lot of women with breast cancer and also gynaecologic cancer and they tend to be the two cancers that are most likely to cause early menopause. The problem with menopause is that it’s such a broad reaching health problem all the way from the acute side effects of menopause being hot flushes, arthralgias, loss of libido often that occurs precipitously, to long term side effects like cardiovascular disease, bone health, and different problems and probably accelerated ageing, so from that point of view, we are dealing with a really broad area.

I think initially 20 years ago people just threw their hands up in the air and said, “Bad luck. You’ll be cured and too bad,” [laughs] and a lot of women had a lot of issues around particularly the rapid onset of menopause, hot flushing, emotional lability, arthralgias and other issues with their joints and muscles and loss of sexuality, so from that point of view I think it’s much better identified.

The problem with the condition is, one, we cause it, so from that point of view there’s a feeling that you get a perfectly well woman and you turn her into someone that’s not perfectly well often, particularly with breast cancer where they have often minor surgery and they don’t have many things done. So the drugs we give them are the culprit that causes these problems and premature menopause is not all bad because prognostically it’s often good for their cancer particularly breast cancers, but not good for the myriad of things I talked about otherwise.

So there is that feeling of guilt as a doctor that you’ve actually done something that causes a lot of side effects. Despite the fact that it will keep them alive, you have to make sure that their quality of life is good and quality of life with early menopause sometimes is horrible. You would say that there’s probably 10% of women that go through it that become debilitated for life because of the some of the significant problems that it causes.

On the other hand, there’s the 10% to 20% of women that sail through it and don’t get a lot of major issues and then there’s kind of the group in the middle that get hot flushes, sleep disturbance, all of those kind of things and they’re all exacerbated by long term endocrine therapy, particularly for breast cancer. So those symptoms, even if they would settle normally over a period of time, when you would go through menopause, tend to continue because of the medications that we give for quite prolonged periods to keep their cancer from coming back. So it’s a very challenging issue, early menopause.

My advice for any of my colleagues is always be suspicious. If you ever see somebody whose periods are irregular or missing for more than three or four months, investigate them. All it takes is an FSH, of course. Obviously you do a good history and so on, beforehand, but the only test you really need is an FSH and if it’s raised repeat it six weeks later. It’s not expensive, we’re not busting the Medicare budget, and it will help people to have a diagnosis made sooner rather than later.

The other advice I’d give them is share your problem with your friends, and if you don’t know quite what’s going on or you are a bit concerned talk to one of those of us who run a public clinic or talk to a local endocrinologist, or gynaecologist with an interest in the area to see what more you can find out. Don’t be afraid to look up the Australasian Menopause Society, Jean Hailes, or IMS, they’re good websites and there’s lots of help available. So I think that would be my key advice, don’t miss it. Whatever you do, don’t miss it.

I think my advice would be just to find out what it means for the woman and not necessarily assuming what it means to her. She might have her own particular concerns that this diagnosis brings up. I think being willing to put aside the time to have those staged consults, getting help with the health coaching, etcetera, trying to get a sense of the impact of symptoms on her life as well and the importance of not being judgemental if women come in and ask about different treatments, non-pharmacological treatments.

There’s a lot out there that are being marketed quite aggressively and, I think women do deserve the chance to sit down and have someone present the evidence for it. So if there is no evidence as in, there’s a lack of evidence, then be honest about that and say, “We don’t know. It might work, it might not.” Safety can be an issue as well with interactions and so on. But just being willing to listen to her and be respectful of her values and preferences.

Taking their opinion, and their feelings, and their problems, as if it is yours. I don’t like people telling me; I like people to invite me to be involved in my decision-making. But it’s not, for me to say this is what it is, or not at all.

They don’t come to you because they like… It’s not that they don’t like seeing you, but they don’t come to you for a social liking. So you want them to go out with either more information, or some sort of problem-solving, or something for them to try to think of, some sort of knowledge, or some sort of whatever. You know, so they go out with something. That you still open your door for them to come back and discuss it. You don’t want them to feel as they are ignored, or belittled, or door is closed. This is either this or not at all.

I think the thing is you’ve got to be proactive, and you’ve got to be patient and really work through the options and opportunities. The other thing is, you’ve got to look at the whole patient. So, you don’t just do a blood test, you’ll look at what things are going on in their lives that can maybe help, even though it’s not evidence-based. I think you have to appreciate the enormity of the diagnosis, and be careful about your words, and also about providing support. Always, always provide options. A discussion about what we can do, worst-case scenario and best-case scenario.

If a patient – it’s hard to talk about that. Really – patients will appreciate you saying, “Okay, so this is the worst it could possibly be, and this is what we’ll do if it is like that,” do you know what I mean? I think they appreciate knowing that.

Sometimes the patients will say “No, I’m really struggling with this, but the doctor says I’ve got to take the tablet.” I think maybe we need to be a little more open to the fact that there are pros and cons, and for the patient ‘…’ The pros for us is we are going to stop the breast cancer coming back and yes, that’s a pro for the patient. The cons for us, they get hot flushes but that might be a big problem for the patient and we need to recognise that and to try and help the patients deal with that. Rather than saying, “Well if you stop your tablet the cancer might come back.” I think we need to see it as ‘the problem needs to be looked at with them to see how it can be resolved as much as you possibly can.’

Be aware that when we push these young women into early menopause, it’s really quite a harsh thing. And it’s not surprising some of them take a little while to adjust. And that we should just be aware that it is hard for them. We are doing the best we can, we are trying to stop the cancer coming back, but for them it’s very difficult.