It's unbelievable to me that women are posting on-line that some doctors are refusing to prescribe Hormone Therapy as part of their treatment plan for the symptoms of Menopause. Others are over-prescribing hormones. Some women don't trust their doctors at menopause because they don't like or understand what they said. Keep in mind, irritability is a symptoms of menopause. Just saying.
These tidbits of "don't believe your doctor" or "they're must be something better or more" come from none other than the likes of social media. Twitter. Facebook. Instagram. Many menopausal women are being misinformed by social media mavens (marketers) penetrating social media platforms. Millions of women have been treated appropriately by a multitude of doctors.
But the social media mavens share one story, usually theirs, where they were insensed (remember the irritability) and become menopause "influencers," hired to sell products by companies because they have followers. 10,000 to be exact. That's what you need for companies to be interested in paying you to preach about their products.
I understand the need for camaraderie. No one wants to believe they're alone on their island. But it's disturbing when I see social media mavens on-line dispensing medical advice. This puts women's health at great risk. Go to your doctor. Get a second opinion if needed. Know thyself.
I'm in the media, I understand that sensation sells but it also harms. I am trained as a Registered Nurse, Nurse Continence Advisor and Sexual Health Educator. My area of speciality is women's intimate health. Below the belt. Vaginal. Sexual. Bladder. Pelvic Floor. Health.
As a Registered Nurse, I am obliged to adhere to the standards set out by the British Columbia College of Nursing Professionals (BCCNP). When women present to my office with peri or menopausal symptoms, I do a full assessment and then send a letter to her doctor with a synopsis including symptoms, conservative treatment measures, their effectiveness and my recommendations including why a woman may benefit from Hormone Therapy or not or other treatment options.
This professional letter addresses three issues.
- It provides the doctor with a full assessment of their female patient, saving them time.
- It educates women and their doctors with evidence informed research and;
- It provides the recommended guidelines included in my letter for women experiencing this natural transition of life.
Women benefit from this. So do doctors. The occasional doctor who "refuses" to treat with Hormone Therapy or over prescribes or doesn't titrate a woman's dose, may need only receive one letter from another member of the health care team in order to change their tune for the tsunami of symptomatic women flooding their offices.
HT is prescribed to relieve:
- Hot flashes
- Vaginal dryness that can result in painful intercourse
- Other problematic symptoms of menopause, such as night sweats, flushes and dry, itchy skin, insomnia etc.
- Mood and mental well-being
- Risk of osteoporosis
There are side effects like breast tenderness. And risks to hormone therapy. For example, diagnosis of breast cancer increases when combination Estrogen/Progestin (EPT) is used beyond 3-5 years. For every 10,000 women who use EPT for more than 5 years, there will be 8 additional breast cancers diagnosed.
Women who take EPT over the long term, or start Hormone Therapy in the mid 60's or after 10 years from menopause face an increased risk of heart disease.
Doctors or Speciality Nurses with medical training of Menopause collaborating and sharing #UpToDate information with their colleagues is critical to appropriate treatment of the peri-menopausal or menopausal woman. But doctors stay up to date on their own.
Because of social media, we have many individuals who lack the knowledge/training about peri-menopausal or menopausal symptoms yet routinely provide #Misinformation. The sole purpose is to make money off the backs of vulnerable women who don't feel well and are desperate for help. They often base their information on their personal story. We all know. Stories sell.
I recently read on social media that a "red-light" vaginal device promotes hydration, improves sensation and increases confidence, claiming to treat dryness and leakage of urine. #FakeNews
There've been no clinical trials. Never tested. Simply. Not true. These devices are approved by the FDA/Health Canada as "wellness devices' that's all. They are nothing more than a battery-powered dildo with a red light.
Sticking a rather large plastic device into a midlife vagina where estrogen has decreased is cockamamie.
Not to mention, there have been reports of burns and blistering after using red light devices. These may lead to infections, fissures and chronic pelvic pain. Ouch! It is affordable though at $400-500 bucks!! #Sarcasm
The only confidence you will gain is in knowing that these "red-light" devices are a sham. Within the scientific community, there’s little consensus about the treatment’s benefits.
Take anything you see on social media about peri-menopause or menopause with a grain of well.....sweat. Unless, it is the feed of a physician, nurse, psychologist, pharmacist, pelvic floor physiotherapist in women's health with expertise. Also know that no one should be dispensing medical advice on Instagram, Facebook or Twitter. I am asked all the time. But I can't. It is so unprofessional. Assessment is key.
This is why doctors may do the proverbially "eye roll" when a woman comes to see them for Hormone Therapy or not with whatever #hashtag was recently tweeted on twitter.
Women may have heard on social media (I did) that doctors don't treat menopause well or don't listen to women. Simply untrue. Some doctors may be better informed than others, because some choose it as a speciality.
Menopause is also so common, physicians are very comfortable in their treatment offering, whether it be oral contraceptive pill for women in their 40's experiencing menopause or HT in the 50's or low dose anti-depressants, anticonvulsants or centrally acting alpha-agonist medications for hot flashes.
Doctors have the foundational knowledge and are trained in menopause and Social Media marketing mavens are not. It's that simple. That disturbing.
For example (and I read this on social media) an influencer who has no medical background wrote something to the effect of this; "having sex will treat your vaginal dryness!" Really? Has she tried this herself? If she did, she would know it would be so painful.
Low vaginal estrogen is the #1 cause of dyspareunia (painful sex). Yeah that makes sense, a penis would hurt but a plastic dildo won't? Having sex does not treat vaginal dryness, ladies and gentlemen. Ever.
But it might make you crazy because you could be thinking, "this sex thing is killing me" or "what's wrong with me that this won't work?" So you think its all in your head #MissInformed. And you suffer because #SocialMediaSally said so and sold a few more products at your expense.
Not to mention, the vulva which is more often than not referred to as the vagina on social media by influencers. The vulva has its' own blood supply and needs to be treated when dry or itchy....separately or together with the vagina, however you look at it. But you gotta look at it. Doctors and nurses do.
During an assessment, I look at/inspect a woman's external genital organs which includes the mons pubis, labia majora, labia minora, Bartholin glands, and clitoris, collectively called the vulva and document it.
It is within my scope of practice to do a limited internal vaginal exam to check for leakage, vaginal tissues, bleeding, drainage, loss of architecture, pelvic floor muscle strength, prolapse and latent leakage using a speculum. I assess a woman's vaginal health and look at function. I dispel myths that my patients see social media all day long. Because women are on their phones all day long.
When women report their menopause symptoms to me, I am able to dig deeper because I have the gift of time which many doctors do not. Quantifying the number of hot flashes and the impact on a woman's life is important to treatment.
I also review specific symptoms such as sleep loss, fatigue, leakage, love life, hair loss, eyes, sexual desire, body image, weight gain (related to decreased estrogen during peri-menopause), vaginal dryness, joint aches and pains, past treatments, mental state and more.
I take measurements: Blood pressure, Heart Rate, weight, waist circumference because this helps to determine cardiovascular disease risk.
So after assessment, visual inspection of the vulva and limited internal exam of my patient's vagina, I write a letter to my patient's doctor, outlining a synopsis and symptoms and may make Hormone Therapy recommendation such as Low dose localized estrogen cream internally and on the vulva too.
This way a woman will be provided an adequate amount of estrogen cream from the pharmacist. I may recommend vaginal DHEA which may reduce vaginal dryness, discomfort and pain during sex without raising systemic estrogen levels.
Many women have been prescribed an estrogen pill for their vasomotor symptoms; hot flashes, night sweats and flushes. The recommendation is actually transdermal or gel because it bypasses the liver and bypassing hepatic metabolism appears to result in more stable serum estradiol levels without supra-physiologic concentrations in the liver.
By avoiding first-pass metabolism, transdermal hormone therapy may have less pronounced effects on inflammatory markers, while oral hormone therapy has more pronounced hyper-coagulant effects (very dangerous) and increases synthesis of C-reactive protein (Translation: higher risk of heart attack).
Women not only learn, they feel heard and go to their doctors being better informed and bypassing Dr. Google altogether as most smart women would. And it is through shared evidence-informed literature for patients and doctors that we deliver excellence in health care for women.
It is the doctor's responsibility to discuss risk vs. benefit for any women's peri-menopause or menopause hormonal treatment. We need to educate women yes. But that often comes when providing physicians with information. We work together, doctors and nurses in the best interest of women, all women! But I stay in my lane.
Many doctors appreciate letters outlining detailed symptoms, quality of life along with citing literature. Doctors receive little information about menopause, vaginal health, sexual health and/or bladder health in medical school but experience comes with practice, a medical practice. In my work, I am always advocating for my patients or helping them to advocate for themselves with information. Knowledge is power.
There are many other health care professionals who are part of the medical management team of the peri or menopausal woman such as pelvic floor physiotherapists, pharmacists, researchers, nurse practitioners, physician assistant, and psychologists. The key is staying in your lane.
Social media influencers play a role in our medical lives indeed. But because they lack medical, nursing, pharmacy or psychology training, they are not qualified to dispense any medical advice on-line. When they spread sensational stories, it has the potential to harm women. They need to stay in their lane.
Think about it. A clinic would never hire social media influencers because they are not qualified to deliver medical care. When did twitter become a clinic? It is high time this false medical industry on-line be regulated.
Doctors, nurses and other HCP's are not paid to promote a product. Their use of a treatment is based upon review of clinical trials, academic literature and trying it on patients with certain symptoms in their practice to see if/how if works and/or who the best responders might be. They will also provide you with all of the options. #ExperienceMatters.
Ladies, the next time you see an influencer on social media, spewing what seems to be medical advice, stop. Look to what products they are they selling. Listen to your heart. Hear what it's saying. What companies are these influencers in bed with?
The role of an influencer is to sell clothing on-line not cloak their products in #MissInformation about medicine and make a profit.
Maureen McGrath RN is a Nurse Continence Advisor and Sexual Health Educator in Women's Health. She is in clinical practice in Vancouver, North Vancouver and Surrey, British Columbia. She hosts the Sunday Night Health Show a live listener call in radio show in Western Canada. It airs on CKNW 980 in Vancouver, CHED 630 in Edmonton, CHQR 770 in Calgary, CJOB 680 in Winnipeg.
It is also available on iTunes, Google play and Spotify. https://omny.fm/shows/cknw/playlists/sunday-night-sex-show