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- [00:00]
A
Welcome to Advancing Health. Coming up in today's podcast, why isn't a normal phase of life that affects all women met with more understanding and attention by the medical community?
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B
All women who are fortunate enough to live till middle age experience menopause. Yet for something that impacts half the population, menopause remains one of the most overlooked areas in healthcare. It's time for that to change. Julia I'm Julia Resnik, senior director of health outcomes and care transformation at the American Hospital Association. On today's episode, I'll be talking with two leaders in menopause research and practice from University of Illinois at Chicago's College of Medicine. Dr. Pauline Mackey is a professor of psychiatry, psychology and obstetrics and gynecology. And Dr. Makeba Williams is a professor in the department of obstetrics and gynecology. Together, they are the leaders of the center for Health Awareness and Research on Menopause, also known as charm. We'll be discussing why menopause awareness matters and how hospitals can step up to provide better, more responsive care to women as they age. So let's get right into it. Dr. Williams. Professor Mackey, thank you so much for being here for this conversation.
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C
Thank you so much for having us.
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D
It's great to be with you.
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B
So let's do a little bit of level setting for our listeners. How does menopause affect women's health as they age? And why should health systems and clinicians be paying closer attention to it? Dr. Williams, let's start with you.
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C
We know that about one and a half million women will become menopausal every year, and that's half of the world's population. Menopause follows the aging ovary and we see declines in many of those hormones, namely estrogen. Estrogen has an important role throughout the body, binding to more than 300 receptor sites. And as a consequence of the changes in hormones, the changes in estrogen and the eventual decline, we can see changes throughout many of the organ systems within the body. We see changes to our cardiovascular systems, our neurocognitive systems, our muscles, our bones, our urinary systems, brain, mood, you name it. There can be many changes. And these changes also present at a critical, pivotal time in a woman's life. We see this as a window of opportunity to optimize health, to optimize and minimize disease states that may present during this critical midlife window. So this is an important area of health because these symptoms, unaddressed symptoms, can impact overall quality of life, well being and have social and economic consequences as well.
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B
Professor Mackey anything you want to add to that?
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D
I think it's really important for women both in their immediate lives. What can I do right now to feel better and also to understand the long term consequences of decisions that we make at this point in our lives for our long term health?
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B
Half of the population experiences this and it seems like right now menopause is kind of having a bit of a moment in public conversation. Why do you think that is?
- [03:23]
D
I think most of this started when there was an introduction of the first FDA approved highly effective non hormonal medication for hot flashes. And with that came advertising at the super bowl and the Golden Globes. And people were like, what is VMS paired with? That was a highly influential article that came out in the New York Times Sunday magazine saying women have been misled about menopause. And that was the number one gifted article of all articles in the New York Times that year. So women were asking questions, there was a new solution that might have addressed women's fears about using hormone therapy and possible risks to their health. And we hit it. And I would say it's beyond a moment now. It is everywhere. And I think that's a beautiful thing because we're not feeling the stigma that we used to feel about menopause and we're having the conversation. So now we just need to meet the questions with the appropriate evidence based answers.
- [04:40]
B
Yeah, and I've definitely noticed that too, like talks of the estrogen sticker are everywhere. And you know, 40 isn't old anymore. It's our generation who's using Instagram and all of the other social medias to elevate these issues beyond just medical encounters with doctors. Despite all of this, I know there continue to be gaps in awareness and research. So what do you think those gaps are and how can we help fill them?
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C
Well, we certainly see that there are gaps in medical education, medical training that have left many clinicians, whether it's a physician, a physical therapist across the healthcare spectrum, have been left under prepared to meet this increased awareness, the, the increased demand and self advocacy that we see many women and patients expressing during this time period. We know that we have to work really hard to meet those existing gaps in medical education, in training, so that we are better providing care for women. Additionally, we know that there's more research. My colleague, Dr. Mackey can certainly address that. But there are some clinical and research questions that we also need to be answered while we are meeting these unmet needs and training.
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B
Professor Mackey, can you talk a little bit about what those are it's important
- [06:06]
D
firstly to recognize that we do know a lot about menopause. I think we hear, oh, we don't know anything about menopause and that's just not true. We have guidelines that are, you know, 3 to 4 inches thick because of the amount of evidence based information we have on menopause. And of course, we need to know more. We know a lot from the gold standard natural history study, which is the Study of Women's Health across the Nation, or swan. And that really told us what happens to our bodies that's due to menopause versus the fact that we're getting older versus the combination of the two. Really important information for women to know. Because if a symptom or a change is menopause related versus if it's aging related, sometimes that can tell us that the treatment is different depending on the cause. Right. So that's really important. But that study was initiated back in the mid-1990s and our population has changed. Thankfully, our scientific methods have changed, they've gotten better. And we also have a better sense of what biomarkers, what should we be measuring in the blood, what should we be measuring in my own work in the brain, for example. And so I think we're ready for an overhaul of kind of the next generation of science on this area. And in addition, we have some really important clinical questions, a lot of questions about hormone therapy. I think we have a very good understanding of what it's good for and what it's not good for. We have perhaps less of an understanding of the perimenopause. This really for some women and not for all. Clearly, 29% of women sail through menopause without a problem. But for some women, the perimenopause is really problematic. And you know, we don't have any FDA approved medications for symptoms in the perimenopause. So I think that in particular is an unmet need in women's health. What's the best way to treat the perimenopausal woman who is having a new onset of cognitive symptoms or mood symptoms? How do we best help women along the life course of the menopause transition?
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B
Absolutely. And how do we help women so they don't have to suffer through this period of several years? I'm sure that there are differences in how people experience menopause in different communities and different populations. Can you speak to that at all? And what factors might drive those differences?
- [08:30]
C
The study of women's health across the nation was a multisite, multi ethnic cohort. Study that looked at various groups of women, Chinese women, African American women, Hispanic women, as well as white women, to detect differences in how women were transitioning into menopause. We looked at seven different cities across the nation. Cities like Chicago, Detroit, Pittsburgh, Newark, Oakland and Los Angeles. And from this study, we gleaned that while menopause is a universal event, excluded, experienced by women who live long enough with their ovaries, the ways in which these women experience it is very unique. So we saw some differences where we saw that women of color, African American women, will experience these hot flashes and night sweats for a longer duration. In fact, it was about 10 years compared to white women who experienced these symptoms for six weeks, 0.4 years. We saw differences not only in the duration of symptoms, but also in the intensity as well as the frequency. And though this study is more than 30 years old, we are continuing to glean differences. And there is more yet to be learned, because that was seven cities across the country. And we know that the demographics of our country have changed, so there is much more to learn. But we know that this is a very unique experience and we need to pay attention to those cultural factors that drive these differences.
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B
My one sentence takeaway is that women are complex and the experience of being a woman differs by woman. Care needs to be individualized to that person. So I want to make sure we talk about charm. The center that the two of you lead, can you tell us about what that is and what you're learning through it?
- [10:39]
D
So the center for Health Awareness and Research on Menopause was launched last March in an effort to really consolidate everything that we've been doing in this arena in those mission areas. So we've been raising awareness both individually and through our engagement with different societies. Dr. Williams is the president elect of the Menopause Society. I'm the past president, president of that organization. I'm also the current general secretary of the International Menopause Society. And so it's really important that we have these academic medical society partnerships in raising awareness. And we also recognize that the University of Illinois, Chicago, we serve the underserved in Chicago. And so consistent with our mission, we want to do a lot of awareness raising and research and education that address our patient population's needs. This is who we focus on in our studies. This is who we focus on in our educational efforts as well. So we want to continue the research that we've been doing imagine now for more than 25 years of continuous NIH funding. So we're considered old guard. We've Been doing this, it's our bread and butter for, for quite a long time. And as one of the largest medical schools in the nation, we're in the top three depending on the year, we have a responsibility to make up for these decades of lack of education. And so we're really paving the way, leading efforts to get funding to introduce the medical school curriculum that all of our medical students need so that the kinds of stopgap measures that Dr. Williams mentioned, training current providers in the field, can really be something we do for just a few years so that the actual training is integrated more into medical school and residency training. So we have an active portfolio of research and activities in all of those mission areas in an attempt just to do better by women.
- [12:53]
B
Fantastic. Dr. Williams, anything you want to add?
- [12:56]
C
You talked about healthcare system access. One of our initiatives in CHARM is to look at our clinical care delivery models. With increasing demand for menopause care among women and providers that have been underprepared, this presents a challenge, a challenge to access. When we look at where our gaps in care, it would be accessing providers who are certified menopause providers who have been appropriately trained. And so while we are working on training and educating the workforce, we're also looking at deploying creative clinical models that can scale the access gaps. Looking at how do we deploy care right at the point of need in the way that communities need that that might look like shared medical appoint or group medical appointments so that we can deliver community based cares, working with community health workers, using innovative technologies and telehealth to meet the rural needs of menopause women. So that is part of what we do at CHARM is to serve as a think tank, a testing ground for these innovative care delivery models.
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B
So you are clearly looking towards the future of healthcare in your work, whether it's those care models or training the next generation of the workforce. So as you look ahead to the next guard of menopause care and advocacy, how would you like to see care evolve? And also what is one thing that you want women to understand about this stage of their lives?
- [14:38]
C
Certainly we need to get menopause care out of silos. Menopause is it cuts across organ systems, as we've talked about, and it can't be relegated just to the obstetrician or gynecologist. We need the dermatologist on board, we need the physical therapist on board, the pharmacist on board. So we need to make sure this care is recognized and delivered across specialties and across discipline. So raising that awareness is Critically important so that we can have an all hands on deck situation when it comes to menopause. And I would also like to see that those experiencing menopause see this as an opportunity to optimize health. Women are going to spend more than 40% of their lives during this time period. So recognition by healthcare providers and those who are exposed experiencing menopause of the grand opportunity we have to improve health overall is essential. And what I would like to see in our future.
- [15:53]
B
Fantastic. And Professor Mackey, I couldn't agree more with that.
- [15:57]
D
You know, menopause care should be primary care. It's a universal phenomena for women. Right. So that's how we view menopause care at charm. But at the same time, we know that if you're a woman with a clinical clotting disorder or with a history of breast cancer, you need a professional like Dr. Williams who really knows how to treat these special and more complicated cases. So we envision a future where women will be referred when necessary to a menopause specialist, but that really the workforce will be trained en masse to do better by women and to understand the basics of menopause care. This is critically important. I see two technological advances that will help women. There are new technologies that will allow women to measure hormonal dynamics in their home environment, to wear sensors and wearable devices that will be able to feed objective data forward to their providers to help in their care. I think we need to be united on the types of symptoms and systems that we measure routinely in women and understand are we making a difference? We need to measure menopause care effectiveness and to deploy models that really show a high return on investment both for women's overall well being and for a hospital system writ large. Because the World Economic Forum estimates that it's $128 billion opportunity in GDP annually. Imagine that. That's the cost of menopause, largely because women are not performing as well at work and presenteeism and absenteeism become issues. So even if one isn't like we are a cheerleader for women's health, there's just a strong economic argument to be made here. And so we need investment from all sectors.
- [17:53]
B
Well, thank you both for being such incredible trailblazers in this field, for raising awareness, for training the next generation generation of the workforce so that all women can live long and healthy lives. I really appreciate your sharing your expertise with us and thank you, thank you for being here.
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C
Thank you for having us.
- [18:11]
D
Thank you. It's been great to be with you today.
- [18:15]
A
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.