Kennesaw nurse practitioner Heather Quaile has been trying to debunk myths about menopause and the safety of hormonal treatments for two decades.
For that reason, the founder of The SHOW (Sexual Health Optimization and Wellness) Center was thrilled by the national attention menopause care has received lately in the form of a celebrity endorsement and a major women’s health study recognizing the safety of hormone therapy used to treat hot flashes and other symptoms.
For 20 years, middle-aged women didn’t have effective treatments to relieve the symptoms that arise from losing hormones such as estrogen during the aging process, a period known as menopause. That changed last week when the Women’s Health Initiative reversed its 2002 findings on the risks of hormone therapy.
A day later, actress Halle Berry shouted “I’m in menopause” from the Capitol in support of a $275 million federal funding bill for more research, training and awareness about the often misunderstood and stigmatized health condition that marks the end of a women’s menstrual cycle around age 50.
“It takes a movie star to get heard,” said Quaile, a DNP, adding that women’s health has been left out of research funding for decades. “I’m so excited more people are advocating for health and providers can help them.”
The proposed menopause spending bill and the reversal of the WHI findings raises hope for menopausal women and the health care providers who treat them. Doctors stopped prescribing hormones to their patients after the WHI’s 2002 menopausal hormone trial abruptly ended with concerns about an increased risk of heart disease, breast cancer, stroke and pulmonary embolism.
A follow-up to the 2002 WHI study, published in JAMA last week, shows that for many menopausal women younger than 60 the benefits of the drugs likely outweigh the risks for short-term treatment of symptoms such as hot flashes and night sweats.
“We’ve been debunking those initial findings for 20 years, knowing (hormone therapy is) safe for most people and does a lot of good” treating menopause symptoms, Quaile said. She said she believed the original WHI study was flawed because the average age of clinical trial participants was 63 and, at that age, women typically have a higher risk for complications such as heart disease.
Doctors prior to 2002 who previously advised patients to take medicine to relieve symptoms of menopause and for long-term protection against heart attacks changed their guidance. Quaile said she expanded her practice to include hormone care for women turned away from primary care doctors who don’t want to prescribe hormones or aren’t properly trained to do so.
To meet the unmet needs of this population, Atlanta OB-GYN Dr. Lathan Overstreet recently decided to focus his practice on menopause management and start the Center for Maternal and Women’s Health.
Overstreet said he was glad Berry publicly acknowledged the “disabilities” of menopause. “She has a platform and a voice. It’s good to know people share your plight and are willing to stand up for it.” For instance, “We acknowledged brain fog from COVID, but no one acknowledged it with menopause.”
In terms of the outcome of the new WHI study, he said it will take awhile for doctors to feel comfortable prescribing hormones again. “They will not flood the market,” Overstreet said. For the past two decades, he has suggested menopausal women try alternative supplements and therapies. But he believes the hormones will provide needed relief from menopause symptoms. “I will wait and look at the data.” He said he would also consider prescribing hormones again if the American College of Obstetricians and Gynecologists supports WHI’s new findings.
Atlanta physical therapist Eleanore Purser recently started the Menopause Support Atl Facebook group to help women in this stage of life find care and discuss common issues. “The WHI did a tremendous disservice to the care of women. For so long we were struggling to find practitioners who would prescribe hormone replacement therapy.”
Purser has been taking HRT for about seven months and believes they are effective in the treatment of not only hot flashes and night sweats, but other symptoms associated with menopause as well as the prevention of chronic disease.
“Halle Berry wants to be a spokesperson for menopause and that’s awesome … to leverage her influence in such a positive way.” Through her advocacy and others, “the needle is turning so we can get the care we need.”
The next step is for patients to talk with their doctors, who need further training about menopause care. “It’s not a stage of life adequately covered in medical school, and it affects women’s lives for decades. That’s pretty mind-boggling.”
Dr. Denise Umpierrez-Morley, an OB-GYN with Atlanta Obstetrics and Gynecology Associates, said menopause is not a big focus in medical school, residency and training. “Because it’s an interest of mine to do HRT, I had to seek it out. It’s one area of life I knew very little about, so I decided to take it to a new level and learn.”
Umpierrez-Morley pointed to incremental improvements in hormone replacement care since the WHI study. But if doctors didn’t keep up with the research, she understands why they might fear prescribing the medicine. Hopefully that will change with federal funding for menopause training, she said. “I was scared to prescribe HRT, so in order to feel comfortable, I had to do more training.”
Doctors should review the research, assess the risk to their patients, and discuss with their patients the risks and benefits, she said. “It involves a lot of personalized care. There are a lot of tweaking of meds. It’s not a one size fits all.”
