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URMC / Obstetrics & Gynecology / UR Medicine Menopause and Women's Health / menoPAUSE Blog / October 2021 / I am 57 years old with a range of menopause symptoms. When I go to my OB/GYN appointments, there is

I am 57 years old with a range of menopause symptoms. When I go to my OB/GYN appointments, there is never enough time to describe what I am experiencing. Is there a better way to communicate?

Your Menopause Question: I am 57 years old with a range of menopause symptoms. However, when I go to my OB/GYN appointments, there is never enough time to describe what I am experiencing. Is there a better way to communicate with my care provider?

Our Response: Your question is a good one, and one that frustrated me when I began treating patients in menopause. To make the visits of new patients more efficient and meaningful, I developed a simple questionnaire for them to complete at their initial visits (see below). Each symptom is scored as “0” if not present, “5” if present but not severe, and “10” if severe enough to compromise a patient’s quality of life. The questionnaire takes about 30 seconds to complete but provides the groundwork for a fruitful discussion focused on the patient’s issues.

In order to better appreciate the challenges that have brought you to our office, please indicate which of the following you feel are most significant to you by assigning them a number from 0 (not at all) to 10 (most significant on the list).

Table

The questionnaire was very effective in focusing the discussion. But, over time, I also was able to collect data on 120 consecutive new patients coming to my office for menopause management.

The average age of the patients was 57 years. More significantly, the dominant and most intense symptoms became apparent. By assigning 2 points for “most,” 1 point for “moderate,” and 0 points for “no symptoms,” I found that loss of libido, vaginal dryness, and pain on intercourse were the top three symptoms. They were followed in descending order by lower values for weight gain, hot flashes, sleep disorders, mood swings, wrinkles, osteoporosis risk, urine stress incontinence and urgency, and finally, and lowest, cardiovascular risk.

What I find significant in this basic analysis of 120 consecutive new patients is that the most prevalent symptoms were those that are infrequently asked by care providers or mentioned by patients in a GYN office visit. In part, a woman may feel embarrassed to talk to her doctor about vaginal dryness. For others, the complaint, “low libido,” actually may be the consequence of the pain of intercourse. Information from a questionnaire sent to 1,154 practicing gynecologists in the United States (of which 65% responded) revealed that only 40% routinely asked about sexual problems, 28.5% asked about sexual satisfaction, 27.7% asked about sexual identity, and only 13.8% asked about sexual pleasure (Sobecki, 2021). Yet, according to the American Association of Retired Persons (AARP) magazine, among 1,816 individuals between the ages of 46 and 64 surveyed, 71% said sex was still important, but 67% admitted that sexual desire had declined in the past 20 years, and only 54% were satisfied with their sex lives (AARP, 2014).

Communication among care providers or between the care provider and patient is the foundation of quality medical care (Sutter, 2009, and McElroy, 2013). Establishing good communication, however, often is more challenging than the actual care provided. Yet, in any report of adverse outcomes, poor communication always is the most common problem (Beckman, 1994, and Dayton, 2007). Utilizing a simple checklist may provide a pathway to quality care.

James Woods | 10/14/2021

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