The Road to Awareness

An older couple walked into the therapist’s office. The marriage had been a bit rocky from the get-go, but now the woman had completely lost interest in sex. The therapist recommended that the woman seek sexual counseling.

Now, that might have been all right except that the therapist had no understanding of the very normal changes to libido brought on by menopause and thus wasn’t able to address that possibility or access resources to either reassure or help the woman.

The couple never came back.

Sue Brayne, a British therapist and author of Sex, Meaning, and the Menopause, commented in her blog on a recent workshop she conducted: “…it continues to amaze me that in a room full of therapists on their way to fifty, or who are well into their fifties and even sixties, this workshop was the first time most of them had ever spoken about the menopause in any depth, or admitted to how it is affecting their lives.”

So, while many healthcare professionals have personally experienced menopause, very few have actually received professional training or information to help others.

In a survey of 900 women conducted by womentowomen.com, 80 percent visited their doctors for help with menopausal symptoms and 60 percent came away feeling as though they hadn’t had a “supportive, honest discussion about menopause options.”

Therapists in Brayne’s workshop complained that, “their GPs [general practitioners] had no interest in the menopause, and they were often ‘fobbed off’ with unwanted prescriptions for HRT [hormone replacement therapy].”

As patients, we are often shy about discussing sexual issues to begin with, and as we’ve mentioned before, doctors rarely initiate that conversation. Throw menopause into the mix, and you may be met with discomfort, avoidance, or the “fobbing off” that Brayne mentions.

Many doctors and therapists simply aren’t equipped to understand the array of menopausal symptoms. Menopause isn’t a disease or a medical condition. A doctor can’t “fix” it. Menopause is complex in that it affects a whole bunch of physical and emotional systems, and there’s no one-size-fits-all remedy.

That said, you have every right to expect your medical practitioner to knowledgeably address your menopausal symptoms during this transitional time. And you should be able to talk openly about them. Yes, that includes sex.

So, how do you get the ball rolling with your practitioner?

• First, ask for a 15-20 minutes consult to discuss these issues with your provider. A discussion can happen during a routine appointment, but let your doctor know you want some time to talk.
• Make a list of questions, issues, symptoms, concerns. Write them down and don’t be hesitant to refer to the list.
• Pay attention to your symptoms, when they happen, how often, how intense. Mention changes that you might not associate with menopause, like sleep disturbances and intermittent memory loss. When did they start? Have they changed? What have you done to find relief?
• Be honest. It’s tempting to fudge the truth about drug or alcohol use, diet and exercise. But how can a practitioner help you without all the facts? You can go a long way down a dead-end treatment regimen if you aren’t honest with your provider.
• Identify your own expectations. What do you want from your provider? Do you need moral support, perhaps in the form of counseling? Do you need relief from particular symptoms that are affecting your quality of life? Does your partner need information about what to expect and how to cope with the changes you’re experiencing?
• Trust yourself. You’ve lived in your own skin for a long time. You probably have a good sense of what’s been normal in the past.
• Ask questions. Sometimes it’s hard to think of everything during a discussion, but don’t let questions go unanswered. Ask your doctor for the best way to communicate if you think of something later.

If you’re frustrated in your attempts to communicate with your regular provider, or you feel you’d benefit from a specialist with targeted knowledge about menopause, the North American Menopause Society has a menopause certification program as a way of assuring basic competency and assuring high-quality care. You can find a NAMS-certified practitioner in your area by searching here.

Medical professionals may sometimes struggle to find the information they need to support and treat their menopausal patients, but as patients communicate (nicely) that they expect support and knowledgeable treatment from their doctors, everyone is nudged along the road toward greater awareness.

And that can only help us all.