Menopause: The Clinical Gap

Jun 9, 2021

Treating menopause is not easy. Menopause can afflict women in two ways. The first is physical symptoms such as hot flashes, night sweats, vaginal dryness, and insomnia. These can be treated quite successfully and at low risk with hormone replacement theory.

On the other hand, mental health symptoms such as irritability, decreased libido, anxiety, and depression are more of a treatment challenge. While theories exist, it’s not well understood why anti-depressants such as SSRIs and Benzos do not work well for mental health conditions associated with menopause.

Moreover, existing anti-depressants have limitations, including slow onset times and unpleasant side effects, including feelings of agitation, various gastrointestinal symptoms, and low sex drives.

There are also clinical challenges that complicate treatment protocols and hinder the patient experience in the absence of proper treatments.

We have performed extensive patient and physician research on how patients are currently treated for menopause-related mental health issues and by whom. Our findings illustrate a significant and often unaddressed clinical gap.

Essentially, women are caught in a medical ‘no (wo)mans land’ where insufficient remedies meet siloed specialties and practice area dynamics.

Insufficient Remedies and Time

Today, menopause-specific treatment options lack a therapeutic problem that is still not well understood from a medical perspective. Simply put, Ob/Gyns do not have the therapies to treat both the emotional and mental symptoms of menopause.

Practice dynamics also complicate matters. Busy Ob/Gyns often have waiting rooms full of patients and don’t have time or education to properly address the patient’s mental health conditions – not to mention having the right medicine to prescribe (see above).

Their standard practice will refer the patient back to a Family Physician or a Psychiatrist for additional care. Thus, the patient is ‘ping ponged’ within the healthcare system. This hassle and delay in treatment deliver a less than ideal patient experience.

Inevitably, many patients give up and end up suffering throughout menopause. The ones that persist through this healthcare ping pong match eventually will get the only drugs available – SSRI or Benzos – which usually don’t end up working anyway.

Siloed Specialties

Most Ob/Gyns lack the training to deal with mental health conditions and are most comfortable treating the patients for physical symptoms to prescribe hormones readily. At the same time, psychiatrists are comfortable dealing with mental health issues but are ill-trained to deal with physical menopausal issues. Finally, the typical primary care physician will view menopause as a complex and interrelated physical and mental syndrome best handled by a specialist. The primary care physician will most likely not initiate any treatment and will refer the patient to an Ob/Gyn or Psychiatrist, depending on how the patient presents their symptoms.

The medical community did not go out to design this clinical gap. Unfortunately, the holistic nature of symptoms and ailments associated with menopause crosses multiple specialties and treatments over different periods. And the current research gap in understanding why current anti-depressants don’t work as well for menopausal women as they do in other clinical scenarios remains problematic. These challenges get magnified when care and treatment turn to the more serious case of PMDD, a subject for a later post.

The ideal solution for menopause-related mental health conditions is to give the front-line Ob/Gyn and primary care physicians a drug they could simply prescribe in their office. Eastra Health’s mission is to uncover this treatment and close the clinical gap through psychedelic-derived medicines.

Mitchell Osak
CCSO