“If menopause symptoms are affecting your quality of life, let’s talk about it.”

Beth Battaglino has worked in the health care industry for more than 25 years promoting public education programs on a range of women's health issues. She’s launched and is the Chief Executive Officer of HealthyWomen, which has received recognition from Oprah magazine and Forbes. She’s also a practicing nurse in maternal child health in Red Bank, New Jersey. In addition to her nursing degree, Beth holds degrees in political science, business and public administration from Marymount University. She’s a competitive runner and enjoys skiing, sailing, and welcoming new babies into the world. 

Dr. Barb: Over the past few years I've had the opportunity to work with HealthyWomen to communicate about perimenopause, menopause, and sexual health. Recently, HealthyWomen did a large survey in conjunction with WebMD, and they came back with some very interesting findings that I think women and providers—and hopefully many people—should hear about and understand the impact of midlife women aging, and what their health needs are going to be. So, today I've invited Beth Battaglino, the CEO of HealthyWomen, which is an independent nonprofit health information source for women. She's going to talk about what they learned in the survey, which was recently made public. Thanks for taking the time to be with me today, Beth.

Beth: Thank you so much for having me on your program. I'm really, really happy to talk with you today about helping women in our recent initiative with WebMD, a national survey called "Aging Smart and Aging Well," which we specifically designed to advance the health and wellness of women in their 40s, 50s and beyond to raise awareness and education by understanding what women today are thinking about when it comes to aging.

Dr. Barb: Let me step back a little bit and share with our listeners more about HealthyWomen, just that project as a whole. What's your mission? Let's talk about HealthyWomen first.

Beth: Sure. So, HealthyWomen is the leading independent, not-for-profit women's health organization. Our goal is to provide medically vetted information; we’re a go-to, trusted source for women's health and wellness information. So if you're thinking about women's health and you're thinking about medically vetted information and trusted information, visit healthywomen.org. It's an organization that I restarted in 1997 with two other partners, and we were the first women's health website that went live that addressed all women's health and wellness issues. We beat out WebMD. We actually beat out the Office of Women's Health, and just created a hub and resource, a hub for information and education and resources for women.

Dr. Barb: Wow, that's really remarkable. So, how many years later, 20 plus years later? Here you are, a leader. I think some really exciting things have been coming out of your efforts, and it feels like women's health is really having a moment, so to speak, and being heard. And I'm excited that you're at the front of it, kind of creating the message that women need to hear. So let's dive into the findings that came out of “Aging Smart and Aging Well,” and what do you want listeners to know about what's happening? What should we know? What should women be doing to advocate for themselves?

Beth: Well, women, first of all, need to feel free—feel empowered to talk to their healthcare providers about concerns, their health concerns. One of the reasons we did this survey and really focused on women in the middle is because we as HealthyWomen are still getting questions and concerns about hormone therapy and about menopause. We're like, "Okay, if we're still getting these questions, and even talking to friends and family members that are still thinking that hormone therapy can cause cancer, and that it shouldn't be taken, or they don't even know their options as they age and going through menopause, there's a need to do some education and awareness around that."

So that's why we started talking to WebMD to see if they would be interested in partnering with us on a bigger initiative to really focus on women, 40s and 50s and beyond. To really understand what they are thinking about when it comes to aging. More importantly, so we can address the gaps and make sure that they're educated. So that's how this all started. It started with that Women's Health Initiative study—the findings that came out in 2002—people that had been taking hormone therapy for a number of years heard about the survey findings, got scared, and hormone therapies are rarely being discussed anymore. And just even menopause is very rarely being discussed, and that's what we found in our survey.

A majority of the women, 75 percent, reported experiencing at least six symptoms of perimenopause and menopause. When women in perimenopause and menopause reported lower rates of physical and emotional wellbeing compared to postmenopausal women. Once post-menopause, however, women said that their physical and mental health improved with 40 percent of postmenopausal women rating their physical health as very good or excellent, and 60 percent rating their mental health similarly. 

So, what we're finding is that women going through menopause are not talking to their healthcare providers about the symptoms that they're experiencing, but once they get post-menopause, they're saying that their health is improving; their physical health is improving. So there's a need to educate the women that are going through perimenopause and menopause.

Dr. Barb: Yes. So, I just want to emphasize, when I saw the survey results and went through the data and this idea that 75 percent, I think this is worth emphasizing, 75 percent of women report at least six symptoms of perimenopause and menopause.

Beth: Right.

Dr. Barb: So that is the vast majority not having one—it's not about sleep, it's not about just one or two, it's six symptoms. Listing those symptoms, they include hot flashes, fatigue and sleep issues, mood, brain fog, night sweats, and weight gain. So, talk about having major disruption in a woman's life, there we have it. I'm so grateful that you're bringing attention to this because we're on the same bandwagon, Beth; you and I’ve crossed paths on a number of levels. But this idea of not having safe and effective treatment options has really suppressed the conversation completely. The misperceptions around safety and efficacy has just been lost. So, I hope most providers get the information that you've discovered, recognizing that their patient is being impacted whether they hear it or not.

Beth: So what was really... you bring up such a great point, such a valid point, because what we found through our discussion when we launched the survey results—and we had a panel presentation in Washington, D.C., with healthcare providers—and what clearly came out of that conversation was the need to educate a lot of healthcare providers on midlife women and their health and their health needs. Healthcare providers, many of them do not have the information and resources to properly have the conversation and to do proper education. So, that's the gap, and that's something that we look forward to addressing, working with healthcare professionals and working with some organizations to make sure that we're not only educating consumers. There's a need to educate health care providers who want to focus on midlife health and wellness for women.

So, that certainly needs to be addressed because what they're saying is they don't have, they're not updated, and they don't have the current resources to manage some of these conversations. So there's a need to do more, and that's what our phase two looks like. Now that we understand where the consumer is coming from, let's understand what the healthcare provider is coming from, and let's figure out how we can provide the education and the resources to not only educate consumers, but also the providers.

Dr. Barb: Yes, and I hope this is a call to action for providers to seek a resource, and that your site for instance, might be a resource or hopefully there'll be some efforts put into making accurate information available to providers so they can help their patients. I think the flip side of our 75 percent of women having six or more symptoms, only three to four percent said they were having really no associated symptoms. So despite, I think, many providers saying, "Oh my patients just don't bring it up or no, they're not bothered by it or no, they're not seeking treatment for it." probably is more a lack of awareness than actual lack of symptoms.

Beth: Right. Lack of awareness or just not thinking this is a normal part of aging and there's nothing that can be done. Or, “I've heard about hormone therapy, but I know it's,” “I've heard it's bad, so I'm not going to.…” The patient's not bringing it up because there's still some myths and the clear facts are not being teased out, and then the healthcare providers are not having the conversation about "Are you experiencing any symptoms." Again, that need for education and the need for a conversation, both by consumer and healthcare provider, there's definitely a need.

So, I think that piece that we were so glad that we were able to do is really say, we're hearing about it, we know our audience is interested in it. Where are we right now in going into 2020? Are women are still as confused about menopause as they were almost 20 years ago, and that came through loud and clear. Yes, they are still going through the symptoms like we've just discussed, but there are treatment options available, both over-the-counter and prescription, and it's not one-size-fits-all, but it's worth having that conversation and figuring out if you are exhibiting signs and symptoms, and this is affecting your quality of life, let's talk about it and figure out what the solve is.

Dr. Barb: I think the other big message I got from it was those women who are experiencing mental health conditions like depression and anxiety, and how few of them are actually seeking and are receiving proper treatment to address those, and the huge impact it has. I think the survey suggested that it was having an equal negative impact as a cancer diagnosis might have in your life. It kind of took my breath away as I read that.

Beth: It is, and especially with mental health now, I feel like there is more awareness about mental health issues, and almost like a permission to talk about them. Especially with the way we see celebrities, and some of the commercials that are focusing on resources and organizations that are embracing and saying, "We're here if you need us." But the fact that that came out so strongly in the surveys still says red flag and that there's more that needs to be done. While it's not just the symptoms of hot flashes and lack of sleep, there's also that mental side of it that needs to be addressed. So yes, we were very glad that that was flagged, but more importantly, the need for not only our organizations but other groups to do more work around this.

Dr. Barb: I would say in talking with perimenopausal, menopausal women, anxiety probably is the number one emotional-related symptom that's bothersome for women. Your survey suggests only 16 percent of women with anxiety actually discuss the issue with their providers. So again, it breaks my heart to think so many women are trying to figure out how to get through this— 

Beth: Yeah. I think that anxiety thing is hard, right? Because, for most of us we think it's normal, and that's what our surveys show, too, is that for many of us, we just think everyone's got high anxiety, and we're just dealing with it. And I think that's such a good point that you brought up and our survey validated. Are providers are talking about anxiety, but more importantly the consumer, most women think that that's just a normal part of living, the anxiety. So, we kind of dismiss it when it's really not. I think a lot of us have high rates of anxiety, and we're not sharing that. And we don't even know how to bring it up. We don't know what the “normal” amount is.

Dr. Barb: Right, right. Yes. So, it is interesting. I think the other thing that you just said brings me to the another discovery you had and that was that less than ten percent of postmenopausal women have been diagnosed with vaginal atrophy. But clinically we know that that number should be a prevalence of around 50 to 60 percent. So, I think it also speaks into this idea of what women really feel like “this is just part of it, and I just need to figure it out and accept it, and there probably isn't a treatment.” Or they don't know it's associated with menopause at all. There's a big discrepancy in what we know the prevalence would be and how patients self-identify it. But then again, where patients are in receiving treatment, there was a not surprising gap between distress around that, how it's interrupting their quality of life, but yet maybe not getting the proper treatment.

Beth: Right. We've seen that. The whole vaginal atrophy conversation it stems from and where we see the uptake in that topic or that category is on the website, because so many women are embarrassed, and they don't know how to bring up the conversation with their healthcare provider that it does affect the quality of their life. Many women don't even realize that there are treatment options and vice versa with a healthcare provider. Are they asking their patients about their sexual health and just overall comfort? Are they talking about vaginal health issues with their patients and spending the time?

So, we've seen that not only in this survey but just with consumer questions and where they're going to on our site that this still has a stigma. It's an embarrassing topic, and there's certainly many, many women who are not having that conversation with their providers. It's just from head to toe. I think that's what's great in a way is that we really are understanding women's health from head to toe. We wanted to stay away from just “below-the-waist” issues with this survey. We really wanted to focus on aging smart, aging well, and looking at brain health, cardiovascular health, bone health, and then of course health below the waist when it comes to women and aging.

The survey did a great job of that, but we still have so much more work to do. I was hoping that we would see a bigger change—and I'm happy, I feel like we have done a great job in educating women—but there's still a gap, especially in this age group—this 40 and 50 year old women—we need to do more. And 50 plus, yeah.

Dr. Barb: The other thing along that line was, 60 percent of women over the age of 65 hadn't been screened for colon cancer.

Beth: Yeah, because they don't understand the guidelines. They didn't realize that the guidelines is age 50, and that's a clear call out with the Affordable Care Act. There are 26 preventative screenings that are covered under the Affordable Care Act, which is still in place right now. So there's no excuse for not getting your colon cancer screening done. However, what we found is that, some women didn't even realize that there were guidelines, and that they were entitled to a colon cancer screening.

Dr. Barb: Yes. How much of that goes back to providers recommending it, and making patients more responsible for following through? I think it's on both sides of the equation.

Beth: Yeah, it's a two way—

Dr. Barb: It's a two-way street.

Beth: It's a two-way street.

Dr. Barb: But it was interesting to me. So, my next question around that is, do you think any of this is gender related? For instance screening, do you think the answer might've been different if men had been asked the question? I don't have any sense of where men are.

Beth: Yeah, I don't know. That's interesting. Here's what I'm going to say, I think for many of us, we put everyone else before ourselves, and we've done research on that as well. So, women are great at putting their spouses—their kids come number one—taking care of their spouse, and aging relatives. I'm looking at the market that we're talking about right now, right? Women in their 40s, 50s and 60s and beyond. So, we put kids first, spouse, aging relatives, and even the dog will come before us, putting ourselves on the list.

So, making ourselves a priority, and really carving out the time to take care of us—take care of me—is so important. And I think we need to do more reminders about the importance of regular screenings that prevention does save lives, and early detection as key. If we can remember to start making us a priority, making women a priority, we're still going to come out, we're going to still see results like we did with the colon cancer screening and the fact that most women are not getting their colon cancer screening at the age of 50 or even 10 years plus.

Dr. Barb: Yeah, I think that's a good perspective. Yes, women are notorious for that across the board. What about racial or ethnic differences, did you see anything that stood out?

Beth: We did, and I'm just going to grab my notes on this. We found that black women in menopause rated their physical health more highly—it was 47 percent compared to 28 for women—as well as their mental health—60 percent compared to 38 percent.

Dr. Barb: Interesting.

Beth: Yeah. Which was very, very interesting.

Dr. Barb: Do you have any understanding of why that might be different?

Beth: No. We were talking about this. We were glad to see the percentage, and we don't have a strong pull through on why that is. The other piece of it was that one third preferred to treat without medication, while 25 percent said they are fearful, they're still fearful of side effects of increased risk of cancer, heart attack, and stroke.

Dr. Barb: Yeah, that makes sense. That may play into it somewhat too. I do think the favorable side of the survey did show a strong majority of women who knew what made up healthy aging—what does it take to age well—and they were able to identify eating healthy foods, living an active lifestyle, having social networks, getting enough sleep. I think it's not that women don't understand what they could do better. They're not able to for a variety of reasons.

Beth: Right, right. Yeah, and again, it could be jobs, just children, and just not being able to prioritize their health; finding time for them. I think we know what we need to do, whether we put that into practice, we're still not seeing the pull-through on that.

Dr. Barb: So, what are you expecting for next steps or what can we look forward to?

Beth: Well, now we're excited about next steps because what we're looking at is really focusing on exploring partnerships with groups that target health providers, so that we can survey healthcare professionals around menopause and midlife-related topics to really understand their perspectives, and the conversations that they're having or not having with patients. We also want to focus more on minority groups. Are there gaps in the information that they are receiving from healthcare providers, and if they are even having these conversations with them.

So, looking at the type of doctors that are seeing a majority of minority patients, and understanding what those conversations are, and what's being discussed. And if there's gaps, how can we address those better? We will also be focusing on health concerns that were most prominent for women, including some of the topics that we've covered during our conversation today—cancer, dementia, heart disease, anxiety, again colon screening—we'll bring that back, and mental health. We also looked at health insurance, because independently that plays such a significant role in rating of health, and lack of insurance is also associated with a greater proportion of fair or poor ratings of physical and mental health among all women.

If you don't have health insurance or are lacking in appropriate coverage, then that can certainly feed into some of the survey results that we saw. So, from a policy issue we'll be looking at health insurance, affordability, and access. That's where phase two is going to take us a little bit more down the road. Again, we'll still look at that whole minority gap, look at healthcare professionals and their understanding and what they need to know, and helping meet and fill in that gap, and then looking at it from a policy issue, access, and affordability.

Dr. Barb: So, just a little work ahead. 

Beth: Just a little work [laughs]. But you know what? That is okay, because I feel like we're getting there. I feel I'm so happy with the advancements that we've seen in women's health, even since I've been in women's health. I'm kind of glass-is-half-full type of person. So, I am very, very pleased with the advancements. And just realizing when I started in women's health—in 1998, oh, no sorry, right out of college in 1991—I mean women couldn't even pronounce osteoporosis. So, I've just seen such a huge advancement in the education and understanding from women. I've seen such a great advancement in women's health. Women's health wasn't even a category outside of OB/GYN. Right?

So, just seeing the amount of focus and emphasis in women's health that our medical community has, and the advancements in prevention and then treating chronic conditions and people living well, there's still a lot more to do. Especially with this whole menopause area of women, perimenopause, menopause, and post-menopause, because women want to live longer, women do live longer, but they want to live well and age well. So making sure that they have the tools and the resources to make appropriate decisions about their health is what HealthyWoman's all about. So, we're ready for phase two.

Dr. Barb: Great. So, our listeners can learn more about general women's health on your website, so check out healthywomen.org.

Beth: Thank you.

Dr. Barb: As we conclude our time today, Beth, I like to ask participants, where do you personally find fullness at this stage of your life?

Beth: I think I find fullness in the fact that I'm happy in what I'm doing. I really enjoy my work, and I think that this is something for everyone to think about. At this stage in my life, I want to be happy in my career, my work career, and I want to be happy as being a mom. So, when I put my mom hat on... and I still practice nursing. And that to me is like a trifecta because when I'm at the hospital and on the floor, I just feel like that is my time to give back, and to be part of the solution. I just feel like I have the best life right now, and I just think it's just giving yourself the permission to be happy and to enjoy where you are right now.

Dr. Barb: Well, thanks. Thanks for sharing that, and I'm grateful as a woman. Hopefully you'll continue to make a great contribution to promoting women's health as you have been. So, thanks for your efforts on that, Beth. And I want to speak personally to say my patients benefit from you.

Beth: Oh, that just—see, that makes my day, like that's my fulfillment. So thank you. I am so pleased to have known you for so many years, and all the great work you're doing in women's health. So thank you.