It has come to my attention that some women are reporting that some doctors are refusing to prescribe Hormone Therapy as part of their treatment plan for the symptoms of Menopause. Some are over-prescribing hormones. These two tidbits come from none other than the likes of twitter.
I am curious because I am wondering if women are being misinformed by social media marketers penetrating twitter, Facebook and Instagram these days.
These marketers are “influencers,” hired to sell products by companies because they have followers and the magic number of followers is 10,000. That’s what you need for a company to be interested in paying you to preach about their products or sell their service.
As part of a Health Care team and as a Registered in line with the standards set out by the British Columbia College of Nursing Professionals (BCCNP), after I have assessed a women, I will write a letter to all of my patient’s doctors with my synopsis of symptoms, conservative treatment measures, their effectiveness and recommendations as to why a woman may benefit from Hormone Therapy or not.
This professional letter addresses three issues.
- It provides the doctor with a full assessment of their female patient, saving time.
- It educates women and their doctors with evidence informed research and;
- It provides the recommended guidelines which are included in my letter for women experiencing this natural transition.
Women benefit from this. So do doctors. A doctor who refuses to treat with Hormone Therapy or over prescribes or doesn’t titrate a woman’s dose, may need only receive my letter once in order to change their tune for the tsunami of symptomatic women flooding their offices.
HT is prescribed to relieve:
- Hot flashes
- Vaginal dryness that can result in painful intercourse
- Other problematic symptoms of menopause, such as night sweats and dry, itchy skin etc.
- Mood and mental well-being
- Risk of osteoporosis
But there are risks to hormone therapy. For example, diagnosis of breast cancer increases when combination Estrogen/Progestin (EPT) is used beyond 3-5 years. For every 10,000 women who use EPT for more than 5 years, there will be 8 additional breast cancers diagnosed.
Women who take EPT over the long term, or start Hormone Therapy in the mid 60’s or after 10 years from menopause face an increased risk of heart disease.
Doctors or Speciality Nurses with medical training/understanding of Menopause collaborating and sharing #UpToDate information with their colleagues is critical to appropriate treatment of the peri-menopausal or menopausal woman.
Because of social media, we have many individuals who lack the knowledge/training about peri-menopausal or menopausal symptoms and who routinely provide #Misinformation with the sole purpose of making money off the backs of vulnerable women who don’t feel well and are desperate for help. They may base their information on their personal story. We all know. Stories sell.
I recently read on social media that “red-light” devices promote hydration, improve sensation and increase confidence, claiming to treat dryness and leakage of urine. Who Says when there’ve been no clinical trials? False claims. Simply. Not true. These devices are approved as “wellness devices’ that’s all. They are nothing more than a dildo with a battery and a red light to make you feel like it’s doing something.
Vaginal tissues are sensitive when healthy and when unhealthy such as when estrogen decreases at midlife, sticking a rather large plastic device is cockamamie.
Not to mention, there have been reports of burns and blistering after using red light devices which may lead to infections, fissures and chronic pelvic pain. Ouch! It is affordable though at $400-500 bucks!! #Sarcasm
The only confidence you will gain is in knowing that these “red-light” devices have never been through any clinical trials. Within the scientific community, there’s little consensus about the treatment’s benefits.
Take anything you see on social media about peri-menopause or menopause with a grain of salt. Unless, it is the feed of a physician or nurse in women’s health with expertise.. Also know that no one should be dispensing medical advice on instagram, Facebook or twitter. Assessment is key.
This is why doctors may do the proverbially “eye roll” when a woman comes to see them for Hormone Therapy or not with whatever #hashtag was recently tweeted on twitter.
Women may have heard on social media( I did) that doctors don’t treat menopause well or don’t listen. Simply untrue. Some doctors are better at it than others, because some choose it as a speciality. Obs/gyns have the medical knowledge and are trained.
For example (and I read this on social media) an influencer who has marketing expertise but no medical background wrote something to the effect of this. “having sex will treat your vaginal dryness!” Really? Has she tried this? It will not treat vaginal dryness. Having sex will hurt when you have vaginal dryness. That is one of the symptoms of vaginal dryness.
Oh, but it might make you crazy. You’re probably thinking, “this sex thing is killing me” or “what’s wrong with me that this won’t work?” So you think its all in your head #MissInformed. So you suffer because #SocialMediaSally said so and sold a few more products.
Not to mention, the vulva which is more often than not referred to as the vagina on social media by influencers. Understanding and knowing the differences of female genitalia is important in part because the vulva has it’s own blood supply and also needs to be treated when dry or itchy….separately or together with the vagina, however you look at it. But you gotta look at it.
During an assessment, I look at a woman’s external genital organs which includes the mons pubis, labia majora, labia minora, Bartholin glands, and clitoris, collectively called the vulva.
It is within my scope of practice to do a limited internal exam to check for leakage, vaginal tissues, bleeding, drainage, loss of architecture, latent leakage, and/or prolapse using a speculum to look assess the vaginal health of a woman. I also look at function.
When women report their menopause symptoms to me, I dig deeper because I have the gift of time which many doctors do not. I will ask how many hot flashes/nightsweats a woman is experiencing per day as part of an overall detailed assessment.
I review specific symptoms such as sleep loss, fatigue, leakage, hair, eyes, sexual desire, body image, weight gain, vaginal dryness, joint aches and pains, past treatments, mental state and more. I provide validated questionnaires to women to ascertain the impact of her symptoms on quality of life
So after assessment, visual inspection of the vulva and limited internal exam of my patient’s vagina, I write a letter to my patient’s doctor, outlining a synopsis and symptoms and may make Hormone Therapy recommendation such as Low dose localized estrogen cream internally and on the vulva too.
This way a woman will be provided an adequate amount of estrogen cream. Often times, I write the dose and frequency too because many GP’s don’t prescribe this too often when I know that 70% of women report vaginal dryness and only 5% are treated.
Women feel heard and go to their doctors being better informed. And it is through shared evidence-informed literature for patients and doctors that we deliver excellence in health care.
It is then the doctor’s responsibility to discuss risk vs. benefit for any women’s peri-menopause or menopause treatment. We need to educate women yes. But that often comes when educating physicians. We work together, doctors and nurses in the best interest of women, all women!
Many doctors have told me that my letters outlining detailed symptoms, quality of life along with citing literature have educated them and they appreciate it. Many doctors receive little information about menopause, vaginal health or sexual health in medical schools. As for the women, when I clarify false beliefs being touted on twitter, they see me as their advocate.
There are many other health care professionals who are part of the medical management team of the peri or menopausal woman such as pelvic floor physiotherapists, pharmacists, researchers, therapists and more. The key is staying in your lane.
Social media influencers play a role in our medical lives indeed. But it needs to be without bias. When they are being paid for posts, that cannot be. When they lack medical or nursing training, they are not qualified to dispense medical advice on-line. After all, a clinic would not hire them because they are not qualified. This false medical industry on-line needs to be regulated.
Doctors and nurses do not take bribes. They may endorse a product based upon review of clinical trials, academic literature and trying it on patients with certain symptoms in their practice to see if it works. They will also provide you with all of the options. #ExperienceMatters.
Ladies, the next time you see an influencer on social media, spewing what seems to be medical advice, stop. Look to what products they are they selling. Listen to your heart. Hear what it’s saying. What companies are these influencers in bed with?
The role of an influencer is to sell clothes on-line not cloak their products in #MissInformation and make a profit.
Maureen McGrath RN is a Nurse Continence Advisor and Sexual Health Educator in Women’s Health. Maureen is in clinical practice in Vancouver, North Vancouver and Surrey, British Columbia. She hosts the Sunday Night Health Show a live listener call in radio show in Western Canada. It airs on CKNW 980 in Vancouver, CHED 630 in Edmonton, CHQR 770 in Calgary, CJOB 680 in Winnipeg.
It is also available on iTunes, Google play and Spotify. https://omny.fm/shows/cknw/playlists/sunday-night-sex-show