The Current - Menopause is costing women their careers

Episode Date: November 20, 2024

Tracy Gomez says perimenopause turned her life upside down and eventually cost her her job — and she's not alone. A new B.C. study of more than 1,500 women looks at the economic impacts of menopause and perimenopause, and the barriers to getting treatment.

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. It's like hitting a brick wall and not coming out the same person on the other side. I can't get anyone to take me seriously. I lost my career because of the symptoms. Nobody prepares you for it quite the way it happens. Those are some of the experiences women captured in a new study that examines the economic and health impacts of menopause and perimenopause.

Researchers in British Columbia surveyed more than 1,500 women in that province, and the goal was to better understand how going through menopause affects women's health and their work, as well as the barriers they face in accessing treatment for their symptoms. Dr. Lori Brotto is Executive Director of the Women's Health Research Institute of BC. She's a professor of obstetrics and gynecology at UBC and the study's lead scientist.

Dr. Brotto, good morning. Good morning, thanks for having me. Thanks for being here. Why did you want to do this? Look at the health impacts of menopause, good morning. Good morning. Thanks for having me. Thanks for being here. Why did you want to do this? Look at the health impacts of menopause, but also the economic impacts. So despite the fact that all persons assigned female at birth will undergo the menopause transition in their lifetime, we do know that there is a lot of myths and disinformation surrounding menopause, a lot of lack of awareness, and a real shortage of research. So this was an opportunity for us, in partnership with Pacific Blue Cross and the BC Women's Health Foundation,

to really generate some scientific data to provide education to the public and provide new research so that women could live better. One of those quotations I read in the introduction was, nobody prepares you for it quite the way it happens. I mean, how common was that, that sentiment that people felt unprepared? It definitely came up very, very clearly in the study findings. Many women felt like they suffered in silence. They felt stigma that prevented them from either talking to their family doctors, if they had a family doctor.

And when they had impacts on the workplace, they felt very embarrassed to mention that they were having these symptoms and ask for some accommodations. Tell me more about what you heard from women that were part of the survey, but the care that they received or didn't receive from their health care provider. Yeah, so thankfully about a quarter of the women who were experiencing symptoms were receiving evidence-based care. So that's the good news, and that tends to be higher than some of the other national and international surveys that we found. But the downside of that is it means that three quarters of them were not receiving evidence-based care. They were paying out a pocket on average of about $900 per year to care for their menopause symptoms. And they were

tending to go to individuals like massage therapists, psychologists, naturopathic doctors in order to have some relief from their symptoms. We found that a very small proportion of our participants actually were even talking to their own primary health care providers about it. And as came out in some of the interviews, many of them who were talking to a family doctor about it were not met with, I think, the evidence-based care that we would hope women receive, and some of them reported even feeling dismissed. What's going on there? I mean, we have talked extensively on this program about the underfunding of research in women's health broadly. There was a woman in the study who said she'd never had a conversation with her health care provider at all about this. From your perspective, what's happening that would lead to that? about this? From your perspective, what's happening that would lead to that?

So I think, you know, at its core, there is a real lack of information and education on all levels. We certainly don't have the same amount of education around what to expect during menopause, say to the equivalent during menstruation and puberty. Many school districts provide, you know, what to expect during puberty talk, and we simply don't have the same. And so when women are experiencing other, let's say, life stage related changes in their health and well-being, they're more likely to, you know, attribute their symptoms to those other things that are going on that might be age-related, as opposed to saying, could this be part of the menopause transition? And at the root of it, I mean, part of that is about education, but it can go back to training for healthcare professionals. I mean, what's at the heart of

that, do you think? I do run a provincial women's health research institute, and this is a question that we grapple with on a daily basis. When we look at national funding for women's health research, it is a tiny, tiny proportion, less than 7% of the national health research funding is dedicated to women's health. So if that's the entire envelope that's dedicated to looking at understanding and finding treatments for these issues, even a smaller proportion is dedicated to menopause. So we're lagging quite behind in doing research and therefore making discoveries in women's health research writ large, it's still not prioritized. And that's why it's so important that reports like this get out,

that we advocate for more research dollars towards women's health and women's health research, and that we also take a look at our training programs, yes, medical schools and residency programs, but also allied healthcare professional training to make sure that they are getting accurate, updated, evidence-based training to help manage the patients are getting accurate, updated, evidence-based training to help manage the patients that they see with menopause-related symptoms.

I'd said in the introduction, one of the quotations that I read was, I lost my career because of the symptoms. 20 women told you that they believed they had lost a job due to menopause-related symptoms. Tell me more about that and how surprised you were to hear that. Yeah, so that was definitely a surprising finding. We found that over a quarter of our participants said that untreated menopause-related symptoms were directly impacting their work, either days missed work, their performance at work, their ability to concentrate. And it certainly makes sense in the context of when you think about untreated symptoms such as hot flashes and night sweats that might wake a person up in the middle of the night

dozens of times, thus impacting their ability to concentrate and perform and be present during work. But again, the vast majority of them kept this information concealed. And so then we also looked at other impacts on workplace. And indeed, 17 of our participants said that they felt that they lost their job over menopause related symptoms. And that might seem like a small number when you consider, you know, absolute numbers. of women now who believe that either they weren't promoted for a job, turned down for promotion, or that they lost their job altogether as a result of untreated symptoms of menopause. That speaks to information that came out in a study last year from the Menopause Foundation of Canada and Sun Life, saying that unmanaged symptoms of menopause cost the Canadian economy an estimated three and a half billion, with a B, billion dollars per year? You don't sound, I mean, that math adds up, the numbers add up to you.

They sure do. And that's why when we talk about menopause, yes, ultimately, we're talking about the individual woman or person and her symptoms and making sure that they are managed, that she has access to care. But there's an economic cost to this as well. And so, you know, to those employers or workplace settings who might personally be disinterested in menopause, hopefully the economic impacts would make most of those bodies interested in menopause and making sure that women are having access to evidence-based care. Can I ask you about that more? I mean, just again, focusing on health is one thing, but as I mentioned in the introduction,

this is also about the economic impacts. That as sad as it might be to say, that if those numbers come up and the numbers are as staggering as they are, $3.5 billion per year, that that's going to get people to pay attention in ways that perhaps just talking about the health impacts on women would not.

Yes, it is. And it's sad that we have to sort of rely on the economic numbers to make the case that, you know, treating women's health as something vitally important is as important as it is. But sometimes we do rely, and certainly we look at policymaker decisions, etc. They are based on the economic impact. Just finally, is there any evidence that you have seen

that employers and policymakers are making those changes? Well, we presented the findings at the health forum on November 1st earlier this year, and it was to a room full of employers and employer unions, as well as health insurance companies. And there was a lot of interest and a lot of kind of public statements about commitments that those groups were wanting to make as a result of hearing the findings. I think for a lot of them in the room, they were wanting to make as a result of hearing the findings. I think for a lot of them in the room, they were shocked to hear the statistics that we found in the report. And they stated that they were very committed to making workplace policy changes to support women who are suffering in silence. You'll be watching, I would imagine. Yes, we will be.

Laurie, thank you very much for this. My pleasure. Thank you. Laurie Brotto is Executive Director of the Women's Health Research Institute of British Columbia and a professor of obstetrics and gynecology at UBC. She's also the lead scientist on the health and economics research report on midlife women in BC. In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. were everywhere in the news. So I started a podcast called On Drugs.

We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with season three of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy. On Drugs is available now wherever you get your podcasts. Tracy Gomez is now post-menopausal, but when she was perimenopausal,

she struggled to get the information and support she needed. She's in Toronto. Tracy, good morning to you. Good morning. Do those stories that we just ran through with Lori sound familiar to you? Oh boy. It was like tick, tick, tick, tick, tick. Do you mind? I mean, it's awkward tick, tick, tick, tick, tick. Do you mind? I mean, it's awkward. We're talking about your personal health here. These are personal questions, but do you mind going through the ticks? What sounded familiar in particular? I think just the lack of understanding and awareness as it relates to menopause symptoms, knowing where I

am right now, you know, had I been, you know, in terms of just informed about what the potential symptoms would be, I would have prepared differently. But it was basically almost too late. It was only recognized as menopause by my doctor, who, by the way, is a female, who I've been with for over 30 years. It was only recognized as menopause when I stopped menstruating as frequently. But before that, years before that, I'd had issues with, you know, heavy bleeding, fatigue, anxiety. There were a whole bunch of sort of perimenopausal symptoms that didn't really get treated. And so did you, I mean, one of the things that I'd raised

with Laurie was the quotation that nobody prepares you for it quite the way it happens. Did you think about or talk about menopause before those symptoms became really pronounced? No. And that's the thing. And even if it was, it was just, it was me asking my doctor. She's like, no, you're not in menopause yet because you're still having your period. And that was basically it. Like, she didn't really understand that I was actually going through perimenopause.

And so what she was doing was she was treating individual symptoms, but not looking at things holistically. You know, again, based on what I've read from the Menopause Foundation of Canada, there are certain things that doctors can do, whether it's a HRT or other treatments that they can provide to help women as they're going through their perimenopause and preparing them for the actual menopause phase. HRT is hormone replacement therapy. Right. Not knowing is a really, like you're kind of in limbo, right? And it's a really strange place to be. What was that like for you that living in that uncertainty? It was very frustrating

because I was in my forties, very athletic. So I was running half marathons. I was cycling long distances and doing all of this stuff and a lot of high intensity workouts. And for some reason, I started gaining weight and it didn't make any sense. So in my head, it was like, okay, well, push yourself a little harder, eat a little less. But I didn't realize that because I was losing estrogen, my cortisol levels, my hormones were out of whack. And that was causing part of the weight gain, which was also contributing to the anxiety. So I was just basically, you know, uninformed. And I was doing things that I thought were the right and healthy things to do.

But I was basically exacerbating my perimenopause and menopause symptoms. exacerbating my perimenopause and menopause symptoms. How did all of that roll together impact your ability to live a full life, to function? It got to a head in 2023, where I actually had to take a leave of absence from work because I was literally on a Zoom call with a client and I had the worst hot flash to the point that I looked like I'd run a marathon. I was just completely soaked. And there were other things that were happening. I was forgetting names. I was losing focus. It was just a whole bunch of really terrible symptoms. And I just asked, I said, look, based on everything that I'm dealing with, I just need to take a break. So I was able to take a leave of absence from work, work with a therapist,

you know, try to understand what I needed to do with my health. I found, fortunately, the Menopause Foundation of Canada. I was able to get some information about why, you know, some of the things that I thought were going to be helpful were actually working against me. So I had to make some lifestyle changes. Once I returned to work in sort of September of 2023, it was difficult for me to find a role that I could do that didn't sort of exacerbate my menopause symptoms, meaning stress, et cetera. And also, given that I think a lot of people knew at my age, like I was 53 going on 54 at the time, it was very difficult for me to find projects. With that being said, in 2024, I basically lost my job because I wasn't able to find anything that,

without naming the employer, I worked for a consulting firm. So the onus is typically on the consultant to find a role. And I wasn't able to find anything that was quote unquote billable. So I ended up losing my job as a result. How are you now? Well, it's been a challenge because I'm not married. I'm supporting myself. And I'm really trying to figure out what to do next. So I am leaning into figuring out what I can do for my health, how I can help other people, because that's the thing. If I had talked to myself, based on what I know now, when I was 46,

I don't think I would have lost my job. I really think I would have been able to navigate through this journey differently. And I think I probably would have been in a better position as it relates to my health. I mean, what are the supports that you would want? You talked about, you know, if you're able to talk to yourself back then, what are the supports that you would want in place so that other women don't have to go through what you went through? Talking to my doctor about what perimenopause is, what menopause is, talking to my doctor or anyone really about what sort of changes you have to make to your exercise routine because of the fact that you're losing estrogen. And then because of that, your hormones are going to go out of balance, which

would potentially, you know, cause weight gain or contribute to anxiety. There's all of these things that I would have made changes if I was having those conversations. That's what I would love to do, is to get the message out to these women that do your research, get this information, talk to your doctor, and point to evidence-based research that the doctor can say, okay, maybe we can do this. Your story is really important because a lot of other women will have experienced what you did. As I said, it's hard to talk about personal things, but it's really important. And I really do appreciate you being willing to speak about this.

Thank you. Thank you. Take care of yourself. Thank you. Tracy Gomez is in Toronto. Dr. Jen Gunter is an obstetrician-gynecologist, best-selling author of the books The Menopause Manififesto, Blood and the Vagina Bible. She regularly debunks misinformation about menopause online and in her sub stack, The Vagenda. She has also written about the growth of products targeted at women who are going through menopause, which she calls a menopause gold rush. Dr. Gunter, good morning to you. Good morning. Tell me about the

use of that phrase gold rush. Well, I mean, it seems pretty apt. You know, I think that clearly we've heard about how women have been underserved, right? And they're looking for answers. And whenever you have gaps in medicine, there are predators that are willing to come in and whether it's, you know, fears about vaccines and predators coming in there to push a specific anti-vaccine agenda, or you have gaps in care about menopause and people coming in to sell supplements, compounded hormones, hormone pellets, all different kinds of things that at best have no chance of helping, but at worst could be very harmful. The market is expected to pass something like $24 billion US a year by 2030 when it comes to

menopause. Oh yeah, I'm not surprised. And these know, these products sell because propaganda works, you know, pushing them works. And because as we heard from Lori and from Tracy, women are often unprepared for menopause and then unable to speak with doctors about it. Right. You have that. And then you also have the fact that evidence-based healthcare providers are beholden to the truth. So we don't oversell our products. We don't undersell them. We talk about the realities of what menopause hormone therapy can and can't do. We talk about the realities of non-hormone therapies. We don't, you know, tell you that it's going to solve every single thing in your life, right? So there's also that aspect of it as well. What are some of the

more popular treatments that are being sold to women to cope with symptoms of perimenopause or menopause? And what are they claiming to do in the absence of the research that Laurie was speaking about? Well, I would say the most dangerous ones are hormone pellets. It's a hormone that have been pressed into a pellet about the size of a rice, and there are doctors doing it in Canada. And this produces wild swings in hormone levels and a lot of potential health, really serious health concerns. People can develop significant bleeding, endometrial cancer. They can get enlargement of their clitoris. They can get balding, acne, all kinds of things.

So you can get standard hormone therapy, menopause hormone therapy that's been vetted by Health Canada. And these products haven't been. There's also the massive influx of supplements. And we see even physicians in the States with large supplement lines, you know, physicians who have a large menopause, I would say, presence online, and they're now monetizing that with supplements. And most of these products will do nothing, but some could definitely be contaminated and some could potentially cause harm. So there's a lot of money to be wasted and false hopes to raise. You say it's always hard to write about medical BS because the energy it takes to debunk it is

infinitely more significant than the lack of effort and research it took to create it. Yeah, that's true. I mean, when I'm writing about some of these products that I'm, you know, I've pulled 20 or 30 articles and I'm reading through it and I'm thinking the person who designed this supplement didn't read any of these things. They read an abstract, and then just, you know, called up a, you know, a company that does white labeling and ordered their product. And, you know, now they're making easily hundreds of thousands of dollars a year, if not more, off of a product that's unstudied. Well, and the tone that you have is angry, because it feels like you seem to be suggesting

that people are being played in some ways because of the lack of information. Well, I'm not suggesting it. I'm absolutely saying it. Absolutely, people are being played. They are being taken advantage of. If you're a physician and you're selling a line of menopause supplements, you're taking advantage of people. If these products worked, they'd be in the Canadian Menopause Society guidelines. They'd be in the Menopause Society guidelines. they'd be in the Canadian Menopause Society guidelines, they'd be in the Menopause Society guidelines, they'd be in all the guidelines. And the fact that they're not is testimony that there's no data to support them. And yet it's interesting, the ecosystem is interesting because there's this movement to get

people to talk more openly about menopause. And then there are people who perhaps use that, I'm not saying to their advantage, but step into that space. Dr. Mary Claire Haver is one of those people. She's an OBGYN, a menopause influencer, has something like 2.2 million followers on her TikTok. And she dispenses advice like this to her followers. Have a listen. Ladies, if you're in perimenopause or menopause, here's why you may want to consider adding turmeric to your diet every day. Recent studies are suggesting that turmeric supplementation can decrease the visceral belly fat associated with perimenopause and menopause, improve gut microbiota diversity and health, decrease

inflammation biomarkers like C-reactive protein, and when combined with vitamin E, can decrease hot flashes. So she sells supplements and diet plans, but also has this hugely popular space where women can talk about menopause and perimenopause. She's called on the medical profession to do better when it comes to treating women in midlife. What do you make of that? Well, I think that she didn't disclose there that she sells a turmeric supplement. She didn't disclose that turmeric's associated with liver failure, and she didn't disclose that tumeric is associated with liver failure, and she didn't disclose that the studies she's quoting are dismal. So what do I think of that? I think that's predatory. She's also a big proponent of hormone therapy, and you've hinted at this, but what is it that women need to understand about hormone therapy in terms of what it can

and can't do? Because that's one of the things that is, I mean, sold in the true sense of the word, sold as perhaps a relief to the symptoms that people might be experiencing. Yeah, so I think we should be very careful about taking somebody with a line of supplements who profits from those sets. So I think we should look to menopause society, the Canadian Menopause Society, and menopause hormone therapy is the gold standard for hot flashes and night sweats. It can be effective for other symptoms as well, although the evidence is not as good for that. And what we're seeing with these menopause influencers online is women being told that hormone therapy can solve every single symptom, and they're not presenting it in what I would call an actual factual way. And in fact,

the Menopause Society in the United States recently had to issue a statement about misinformation about hormone therapy coming in large part from providers, overselling it as a magic wand for longevity. And we have to be beholden to the science. Here's my baking analogy. You don't correct underbaking by overbaking the next time. What people deserve are facts. And, you know, the facts are that hormone therapy, menopause hormone therapy, we don't want to call it HRT because that's actually not the appropriate term. MHT, menopause hormone therapy, is the gold standard for many symptoms.

But there are other treatments as well for people who can't take hormones. And it really takes an individual conversation with a provider who's, you know, educated on the subject to decide which is the best therapy for you. What do you make of the backlash that you faced for speaking out about this, particularly around hormone therapy? I don't really think anything of the backlash that I get because the people who send it to me, the physicians who might have issues with me, I don't respect them at all. So I don't care what they say. I just wonder, part of it is because women are trying to figure out in the sea of information and misinformation what they should do. And they're looking to try to figure out how to

navigate that sea, if I can keep that metaphor going. What advice would you give them? Right. And so it doesn't help them when people come in and say things like hormone therapy can fix every single thing in your life, right? That doesn't help the sea of misinformation. So what I try to do is I try to provide a port in the storm. I try to provide good quality evidence-based information. I think I'm really known for that. I will tell people the good and the bad with every therapy and to tell people that they really need to be aware about people who are promising you the moon, because there is no therapy that is the moon. Everything has risks and benefits. And for the majority of women, menopausal hormone therapy will be a very low risk, effective treatment for many of their symptoms, but not everybody needs

it. People who don't have any symptoms, for example, don't need to be on it. So it really just depends on the personal issues that you're having and how you want to approach them. Just finally, are we broadly as a society getting better at talking about this, do you think? Yeah, I think we are. I mean, when I, you know, first wrote my first book, The Vagina Bible, the fact that, you know, I was able to even get on, you know, some shows and say the word vagina was like a big deal. And now it's like nobody thinks about it at all. And now we're seeing more and more people willing to talk about menopause. And that's fantastic. But I would also say that people just need to be aware that

we are also so vulnerable to propaganda and misinformation. And just because somebody's talking about a subject, it doesn't mean that the information is 100% accurate. And so we all need to learn how to accurately look at the information that we're receiving. Dr. Gunter, it's great to speak with you. Thank you very much. Thank you so much. Dr. Jen Gunter is a Canadian OBGYN who practices in the United States and the author of three bestselling books around women's health, including The Menopause Manifesto. For more CBC podcasts, go to cbc.ca slash podcasts.