How has the coronavirus epidemic affected management of menopause?
Your Menopause Question: How has the coronavirus epidemic affected management of menopause?
Note: Originally Published in April 2020.
Our Response: In a period of two months, coronavirus has transformed markets and the American way to a degree never experienced in our lifetime. It is hard to believe that in the beginning of March 2020, there were fewer than 100 confirmed cases in the United States (U.S.). As of this writing, there are over 880,000 cases in the U.S. A palpable casualty has been medical care. Hospitals have reduced or limited elective surgeries. Inpatients, able to be managed at home, have been discharged to free up beds for coronavirus patients. And tents outside emergency rooms have been created as triage areas to reduce patient exposure. Menopause management for mid-life women has not been spared this challenge.
Telemedicine has been applied sporadically in the past, but because of the coronavirus epidemic, it has become the lifeline between care provider and patient. Although systems differ, the process works best when patients are provided a designated time for a tele-office call. Electronic record systems have developed or are developing templates for such encounters.
Hormone management lends itself to telemedicine. Patients’ symptoms, more so than hormone blood levels, provide a roadmap for altering estradiol, progesterone, and testosterone treatments. Annual examinations and routine breast-pelvic examinations appropriately are deferred until the epidemic is under control. Complaints of vaginitis and common bladder infections can generate pharmacy prescriptions; although, without appropriate cultures, persistent symptoms dictate an office or urgent center visit. The most common requirements for an office visit are onset of pelvic pain or vaginal bleeding. In these cases, ultrasound evaluation represents the best approach for diagnosis and management.
How do patients respond to this altered form of care? Actually, the response has been quite positive. Absent the “15-minute” visit that often is the complaint of patients in traditional office practices, communication becomes less structured and, for the care provider, more open to therapeutic listening. The challenge, of course, is that the patient must describe symptoms that otherwise would be analyzed by taking a history and performing an examination in the office.
Once the coronavirus pandemic is over, will there be lessons learned? I believe that what in the past was considered “routine care” may, for many patients, transition to telemedicine care. As such, menopause medicine must learn how to provide care in a new way, and it likely will join other areas of medicine in this transformation. The coronavirus pandemic will have its casualties. The stress placed on the public, the markets, and healthcare communities will be long remembered. But, out of this life experience may emerge a better way to care for the health of our patients.
James Woods |