Perimenopause and Menopause: Q and A with Dr. Flavia Fairbanks Lima de Oliveira
Dr. Flavia Fairbanks Lima de Oliveira says internet self-diagnosis and a lack of knowledge amongst health care providers contribute to misconceptions about what was once called “the change.”
If you haven’t noticed, perimenopause and menopause are having a moment.
Just a few years ago, people were complaining about the lack of information on the constellation of issues that can characterize the cessation of the menstrual cycle.
Now, celebrity-run companies promise to relieve such common symptoms of perimenopause and menopause as brain fog, hot flashes and vaginal dryness. Perimenopause is regularly mentioned in television shows and movies and this year marked the debut of what the New York Times called “the first great perimenopause novel.”
The new visibility of what used to be referred to in hushed tones as “the change” is good news for patients. At the University of Miami Miller School of Medicine, the new Menopause Clinical Program takes a multidisciplinary approach to caring for patients experiencing symptoms related to perimenopause and menopause.
Started in August, the program has already attracted more than 200 patients referred by gynecologists, psychologists and other care providers.
“We established the Menopause Clinical Program here at UM because patients were getting sent from the PCP to the psychiatrist, the psychiatrist to the PCP. Sometimes a gynecologist would identify an issue as hormonal, but nobody was taking on organizing a program for holistic patient care. So that’s what we are doing now,” said Flavia Fairbanks Lima de Oliveira, M.D., Ph.D., the founding director of the program.
Dr. Fairbanks, an associate professor of obstetrics, gynecology and reproductive sciences at the Miller School, came to UM three years ago from the University of Sao Paolo in Brazil. In the following interview (lightly edited for clarity), she discusses the Menopause Clinical Program and the importance of multidisciplinary care for perimenopause and menopause.
Have you noticed the new surge of awareness surrounding perimenopause and menopause?
Five to 10 years ago, patients had absolutely no idea. They were completely lost. “OK, what’s going on with me? I’m not feeling well anymore. I don’t feel that I’m myself anymore. I look in the mirror and I don’t recognize myself.”
It was crazy. So, I think it’s a little better now. We’re receiving patients who at least can ask actively, “What’s going on with me? Could it be related to menopause or to hormones?”
Women have important roles. Many of them are CEOs, directors…and they are not feeling well, so they can’t produce. If we treat these women appropriately, they will be more productive
—Dr. Flavia Fairbanks Lima de Oliveira
But sometimes their information sources are terrible. They don’t know what to believe. They’ll come and say, “I started using a vitamin or supplement because I read about it online.” For me, this is the more difficult situation, because when they ask their providers about it, they don’t get answers.
This year PBS released a documentary film called “The M Factor,” put together by leading specialists in menopause who felt there was an absolute lack of information everywhere. The film showed that in U.S. medical schools, less than 5% of all in-class time is spent talking about menopause. And this is something that will affect every single woman who’s alive.
How is it possible to be a doctor with less than 5% of your formal graduate training talking about something that will affect everyone? We need to teach the providers that it’s not something that relates only to OB-GYNs. Primary care physicians need to be educated, nurse practitioners…everyone who deals with patient care.
Why is perimenopause and menopause care so important?
Back in Brazil, we have a well-known journalist, a man, who said, “If menopause occurred in men, it would be solved forever.” No one accepts that this is just aging, that everything is in your mind. No, we are looking for solutions. Nowadays, women are more productive. They’re a part of the market. They need to be useful. They need to think, they need to rest and be productive, and no one is okay who doesn’t sleep, who feels completely weak and fatigued. It’s not fair, right?
A Mayo Clinic study performed by Dr. Stephanie Faubion found that the market is losing $1.8 billion a year due to menopause. Women at that age have important roles. Many of them are CEOs, directors and many other things, and they are not feeling well, so they can’t produce. Many of them are spending their work hours going to doctors and trying to find solutions and taking medications and antidepressants, and they are always facing hormonal changes. It was established that if we treat these women appropriately, they will be more productive and the financial impact will be much better.
Over the course of working in two different countries (Brazil and the U.S.), have you noticed any cultural differences in approaches to perimenopause and menopause?
Yes, there are some significant differences. Literature, research and my own experience shows that as soon as they turn 40, Latin American women tend to ask, “What am I able to do, to eat, to take as a supplement? What can I do to avoid aging, perimenopause and menopause?”
They are looking for solutions even before a problem is present. On the other hand, they are not facing the natural perimenopause or menopause issues like something that could be related only to the aging process. So, it seems like they are really fighting against it.
How is it possible to be a doctor with less than 5% of your formal graduate training talking about something that will affect everyone? We need to teach the providers that menopause is not something that relates only to OB-GYNs.
—Dr. Flavia Fairbanks Lima de Oliveira
In Brazil, for example, official guidelines had to be changed to recommend against menopause pellets (tiny implants inserted under the skin that release bioidentical hormones). People were making crazy choices, inserting everything inside a pellet, including androgens, progesterone, estradiol and everything, combined without knowing exactly what could be happening in the future. They were more concerned about having an immediate solution than about long-term problems.
And the medical establishment said, “OK, we need to decide about formal regulation, because people are not thinking correctly. They’re putting themselves at a high risk for many other problems.”
Here in Miami, my American patients sometimes are more flexible about the natural aging process, but many of them are still worried about using hormones and the long-term side effects and cancer risks and many other things. Sometimes they’re like, “OK, I can listen to you, but I’m not sure if I’ll be using what you recommend,” because they’re still impacted by those old, discredited studies on hormone therapy replacement.
We take a team approach in the program. I’m the one taking care of the patients and everything related to the medical field. We include physical therapists because the pelvic floor is affected by perimenopause and menopause. Patients can have not only sexual dysfunction but also urogenital problems that affect quality of life, such as urinary leakage and pain during intercourse.
Psychologists are also included, because of the emotional problems associated with menopause, like anxiety and depression. We have a very close interaction with the endocrinology department, because some patients also suffer from thyroid dysfunction, adrenal dysfunction and other issues like diabetes and hypertension. We need to understand each medication holistically and how it affects our treatment plans.
When a patient arrives, we’ll interview them about symptoms and what treatments, if any, they’ve tried. Depending on need, they may undergo a hormone panel, a mammogram and an ultrasound. If patients are deemed good candidates for hormone replacement therapy, they’ll get a customized treatment program.
During the first year, they’ll have check-ins every three months to adjust medications and see how they’re feeling. Even though we started from zero, we’ve had many beautiful outcomes. People are very satisfied and they’re giving us good feedback.
Tags: Dr. Flavia Fairbanks Lima de Oliveira, menopause, Obstetrics and gynecology, postmenopausal estrogens, women's health, women's sexual health