The OBGYN has a special relationship with their women patients. Women feel more trusting and open with a doctor specializing in reproductive health, especially with issues that might be related to their hormones. Things like weight loss, fatigue, and low sexual desire are common questions OBGYNs face.
But, if you don’t have the answers, or are dismissive of their concerns, that relationship can quickly turn to one of distrust for the entire medical field.
When Hormone Disruptions Really Start
A woman’s hormones change throughout their lives but typically start to decline in the late 20s to early 30s. Throughout the early 20s, a woman comes into full fertility and rarely has problems with fatigue or sexual dissatisfaction (in the absence of other issues).
That changes as a woman enters her 30s. Many women choose to have children and are either looking to become pregnant or have young children at this age. Understandably, these women would feel fatigued. Having children is a severe disruption of a woman’s hormones, and some women never get back on track. This goes more so for women that have more than one child.
However, 20 to 30% of the population of women are now choosing to remain childless. So, how can we explain why these women end up feeling fatigued? Why are these women so stressed? Why are they developing hot flashes, gaining weight, and with a low sex drive?
Doctors are now seeing women who don’t have children and have a satisfying life with evidence of early stages of low hormones. As more women choose to remain childless or decide to have children later, it’s becoming more evident that many of the problems women face who have children may not be the children’s fault.
As published in Psychology Today, “[W]omen were juggling everything beyond themselves, and the constant self-extension was burning them out… The fluctuations can also magnify under situational and environmental stress, where increased cortisol levels cause their own cascade of negative biology such as fight-or-flight systemic responses and over time worsening risk of diabetes, vascular and cardiac disease, and more.”
“Women also have to cope with gender-specific biological vulnerabilities that increase mood and anxiety disorder risk such as menstrual-cycle-related issues (such as premenstrual dysphoric disorder), peripartum and postpartum mood and psychotic disorders as well as perimenopausal mood disorders all from female-specific hormonal fluctuations. These hormonal changes can trigger underlying genetic susceptibilities to developing depression, anxiety, bipolar disorder, even schizophrenia.”
Naturally, hormones start to decline in the 30s further, and some women are more sensitive to that than others. And as a woman moves into the 40s, small issues can become worse. What starts as just an irritation becomes an issue. The concern is that if it’s let go long enough, the issue becomes a problem.
In a woman’s late 30s to the early 40s, she truly begins to feel the effects of low hormones. Although she may not know what it is, she may approach the doctor with the feelings of fatigue, lethargy, low sex drive, and general irritation. Many doctors ignore the signs of low hormones, attributing many of these factors to depression. It’s especially true of doctors in more general practice.
Women are 1.7 times more likely to be diagnosed with depression over men. In some cases, women are prescribed medication at more than twice the rate of men. A study in the Journal of Psychiatric Neurology states: “The fact that increased prevalence of depression correlates with hormonal changes in women, particularly during puberty, prior to menstruation, following pregnancy and at perimenopause, suggests that female hormonal fluctuations may be a trigger for depression.” The study goes on to point out most studies on depression are carried out on men because of the hormonal fluctuations making the data harder to interpret.
Fortunately, more studies are emerging on the impact of estrogen on depression. In fact, some doctors are treating depression with estrogen. Many others are placing women on HRT to balance their whole body, which naturally relieves the depression. The symptoms of fatigue, low sex drive, weight gain mimicked depression, and depression wasn’t the diagnosis.
We hope this makes you wonder about the women you treat and if their bodies are truly experiencing depression or just low hormones.
But, even an OBGYN who may be open to hormone therapy may feel tied down and can only take the conventional approach of prescribing HRT once menopause is fully manifesting. The signs have to be overwhelming, and until a woman is suffering, many doctors don’t believe they can assign hormone therapy. And then, the best the doctor hopes for is for their women patients to feel “okay.”
That’s the regrettable part because starting low dose hormone therapy can help a woman feel much better. She can go from feeling fatigued and uninterested in life to be productive, engaging, and desirable.
She can go from not feeling herself to being something more than just okay.
“I was so frustrated. I knew there had to be something better. I got into medicine to help people, not just wait until they’re broken and then patch it up with a pill… [Now] I feel like I’m making a tremendous difference in their lives, especially when they come back to me and say they have energy again, they want to have sex. And I see other problems going away, like them being overweight or depressed.”
~ Dr. Armi Walker, Neuva Aesthetics at the Women’s Care Center (wccobgyn.com/)
How To Discuss HRT with Patients
Bringing up the concept of hormone replacement therapy can be challenging. Many women have preconceived notions over what HRT is and what it can do to their bodies. Unfortunately, many of them have relatives that used HRT and ended up developing breast cancer or other unwanted side effects (link to risks of HRT article).
But, the first step is to have your patients tested for their proper hormone levels. And then, if you find one of the hormones deficient or more than one of the hormones, as is often the case, you can discuss why HRT would bring them back into balance and the benefits it can give them.
Additionally, you will have to discuss the myths that surround the risks of HRT. Particularly breast cancer. Several studies show that bioidentical hormone replacement therapy can lower your chances of breast cancer. They can reduce your risk of a heart attack, breaking bones, and feeling miserable. The link above is an excellent article on how to discuss this type of thing with your patients. (See this article for studies (add a link to risks article))
Many women may also not want to jump right in with full hormone replacement therapy. They may choose the HRT methods that are easy and controllable, such as using gels or creams. Some may even step up to using patches or oral supplementation.
Very few will want to get fully into HRT that includes injections or pellet therapy simply because it’s a significant step. Although pellet therapy is the safest therapy, it is relatively unknown, and many people are afraid of the unknown.
Try to get into your patient’s heads. While this is something you experience daily and you are fully immersed in the science, this is brand new and scary for your patients. Take the time to understand their fears and answer their questions.
Help them understand that consistency and proper dosing (link to consistency article) are the keys to bringing their hormones back to a healthy level. Help them know that although they’re using the creams and gels, they might not be getting the proper dosing, or underdosing (link to article), which is very common with this method.
Fortunately, many women who try the creams and gels decide to step up their regiment by moving into pellet therapy. They realized that the amount of work they’re doing with the creams and gels does provide some relief, but takes a lot of time. You can educate your patients on how much easier pellet therapy is. Not only does it provide a consistent dose of hormones over three to six months, but it has the lowest side effect rate. Women who use pellet therapy feel better and have higher patient compliance with this mode of treatment.
Women who turn to HRT because they feel tired, have a low sexual drive, and maybe gaining weight want help. They want to feel their doctor has something to offer them, and often to their most trusted source: the OBGYN.
By offering your patients an accessible therapy, particularly pellet HRT, you can help these women feel more than just ‘not bad.’ You can help them feel good.
Low dose HRT can provide lasting benefits for women by helping reduce the chances of cancer, heart disease, and the side effects of excess weight. Talking to them the right way helps alleviate their fears and can go a long way to move a woman on to the proper HRT regime, where both you as the doctor and them as the patient thrive.