Women between the ages of 45 and 64 make up 27% of the U.S. population. Add in another 15% for women 65 and older, and the percentage hits a remarkable 42% of the U.S. population. According to multiple reputable studies in women’s health, one in three women expresses significant menopausal symptoms that hinder their daily activities.
The population of women in Duluth over 45 is estimated by the U.S. Census Bureau at 28,000.
Women most affected by menopausal symptoms are between 45 and 64. My mother, aunts, and grandmother are all of this age and all have weathered their menopausal changes, some with the aid of prescription hormone replacement therapy.
A shared experience is of a healthy, shift-working woman, 45 years old, struggling with significant night sweats and insomnia for three months. She makes an appointment with her primary-care provider, who has been seeing her regularly for health care for the last few years, since after the birth of her daughter. She previously had regular care with her OB/GYN doctor but felt “too old” for her follow-up routine visits. So she transitioned to a local primary-care provider. At this visit, she hoped to receive some aid for her bothersome symptoms.
“I don’t have the luxury to be this tired all the time from not sleeping due to these horrible night sweats,” she said to her doctor. “I need to be efficient at work so I can provide for my family. Is there something I can take or do?”
Her primary replied, “I have to refer you to an OB/GYN, because I do not have the expertise to manage patients with hormone replacement therapy, which is a treatment that can help you.”
She is frustrated because she took off work for this visit and now has to make another visit in the OB/GYN office in three weeks and has an additional drive of 35 minutes. But she complies.
At her next visit, she is struck with how “old” she feels, surrounded in the waiting room by young expecting mothers and their buzzing children. She meets with the OB/GYN provider, who spends a brief seven minutes with her, and she leaves feeling very comfortable with a new prescription of hormone replacement therapy.
The problem is this common treatment of hormone replacement therapy, or HRT, is not routinely instructed to primary-care providers in their mandatory continuing-education requirements, particularly in low-risk women. Primary-care providers are required to have continued education as part of their licensure to practice medicine.
These providers serving female patients include medical doctors, nurse practitioners, advanced-practice registered nurses, and physician assistants. This problem leads to increased costs and referrals for low-risk patients and a loss of revenue for providers who have the capacity to manage this highly effective and safe therapy for close to half of their patient population.
As a women’s-health nurse practitioner, I have heard this common story from many female patients, and it is time for the health care system to listen. All primary-care providers need regular, mandatory continuing education on hormone replacement therapy treatments. This mandatory education should include the large body of evidence that supports the safe use of HRT in menopausal women and the important risk factors when HRT is not appropriate.
HRT can be counseled, prescribed, and managed in low-risk women by primary-care providers.
Regionally, the practice of managing HRT is diverse and is very typical practice in urban settings while much less common practice in rural areas where primary-care providers are pivotal.
My primary-care colleagues continue to ask how to treat female patients who have multiple high-risk factors and who shouldn’t be on HRT. My rebuttal is that their keen knowledge is correct: HRT is likely not the treatment for these female patients. A referral to an expert in women’s health is highly encouraged for high-risk women. The population of high-risk women is typically amongst younger ages or is found during pregnancy or through routine surveillance in all care settings.
With mandatory continuing education for primary-care providers in managing safe hormone replacement therapy for women, their confidence in the medications and the management of these low-risk women will increase, along with provider satisfaction from patients.
Kelsey Thompson of Duluth is a women’s-health nurse practitioner in Minneapolis. She received a bachelor’s degree in nursing from the College of St. Scholastica. She earned a masters in women’s health and a doctorate in nursing from Duke University in North Carolina.