Blog of the Society for Menstrual Cycle Research

Should Symptoms Always Be Treated?

May 24th, 2012 by Heather Dillaway

An article on Medscape News on May 7th reported survey results that suggest that “fewer than one third of women with menopause symptoms are receiving treatment for those symptoms.” The article goes on to report that about half of women aged 45 to 60 report “menopausal” symptoms (e.g., hot flashes, sleep problems, mood swings, decreased sexual desire, irregular periods, etc.). In addition, the survey apparently reports that over half of the women reporting symptoms define those symptoms as having some negative effect on their lives. Thus, the assumption is that these symptoms should be treated and, at the very least, lessened.

However, in this same article, it is noted that only 7% of women on this survey reported “very negative” symptoms. Many women reported their symptoms as “moderate.” The article goes on to suggest that only about one-quarter of survey respondents contemplated using hormone therapies to treat symptoms and that too many symptoms go untreated.

So, my question is: did anyone ask women whether they wanted treatment for their symptoms? And did anyone ask women what they meant when they said they had “moderate” symptoms? Did anyone ask women what they meant when they said symptoms had a “negative” effect on their lives? And if all symptoms that are documented are “negative,” what does it mean to have “very negative” symptoms?

This article goes on to tell about a new “Menopause Map” developed by The Endocrine Society and a Hormone Health Network for women who need help figuring out whether and how to get treatment for symptoms. But, the assumption here is that symptoms should be treated and that any symptom that is documented is bad enough to warrant that treatment.
Over the last ten years I’ve interviewed a lot of perimenopausal women. Granted, a portion of women going through this reproductive transition have terrible symptoms that are indeed unmanageable and treatable. But, a lot of women (in fact, the majority) seem to be able to handle their symptoms on a daily basis. Movies like Hot Flash Havoc hype up the fact that “menopausal” symptoms are unmanageable for everyone. The new “Menopausal Map” referred to above also makes it seem like all symptoms are potentially unmanageable. The Medscape News article that I’m referring to here also assumes that “untreated” symptoms are problematic. But maybe they aren’t for everyone.

The Society for Menstrual Cycle Research often steers away from using the word “symptom” and often refers to “signs” of menopause or the menstrual cycle – specifically because of the negativity associated with the word “symptom.” If you have a “symptom” of any kind, the assumption is you should run to the doctor! And untreated symptom seems like a problem. But is it really?

One of the perimenopausal women I interviewed way back in 2001 said to me outright “symptoms are supposed to be negative.” The point she was making was that the minute you say you have a symptom, people assume you have a problem.

I’d like us to think more about whether all symptoms really need medical treatment. Maybe we just need to give ourselves time to breathe. Time to sleep 15 more minutes. Time for a break at work. Time to drink more water and less coffee. Time with our partners, kids, friends, parents. Time for ourselves. And then maybe we can really assess whether we need that Tylenol for our headache or hormone therapy for our hot flashes. And the very fact that there are so many non-pharmaceutical options perimenopausal symptoms these days tells us something – women don’t actually always want to run straight to the doctor because they have a “symptom.”

Does a symptom always have to be negative? Does it always need treatment? I think we need to work on what the word “symptom” really even means.

4 responses to “Should Symptoms Always Be Treated?”

  1. Jacqui says:

    Great article Heather. What if a symptom were just your body trying to speak? What if it’s trying desperately to draw your attention to something and not just to that aching head or that burning bladder infection. We tend to be so literal in our response to symptoms, thereby missing out on the ‘vital feedback’ that they are giving us. It would be lovely to think the women from this study are tuning into to their negative symptoms but I’m guessing most are just ‘suffering in silence’ – the womanly thing to do since time immemorial.

  2. Paula Derry says:

    I also think this was a great article. One other point: The article said that “Overall, half of women aged 45 to 60 years report experiencing menopausal symptoms. Of those, 69% reported that their symptoms have a negative effect on their lives (very negative, 7%; somewhat negative, 62%), whereas 31% reported no negative effect on their lives.” That word “somewhat” could mean anything at all. Does stubbing my toe hurt? Somewhat, it’s different than nothing but not by much. Does a sinus headache I am coping with affect my quality of life? Somewhat, it’s unpleasant but not significantly affecting my life. In any case, “somewhat” means “not much.” In my opinion, a well-designed study should have had and reported some categories between “somewhat” and “very” to avoid biasing results in a negative direction.

  3. HeatherD says:

    Thanks, Jacqui, you’re totally right about symptoms as body talk – that is, bodies talking to us. Also I like the fact that you brought gender in here. Some of these “untreated symptoms” in the study I refer to are probably just symptoms that women have no time to truly pay attention to and/or purposely suppress because they are sacrificing their own needs for others (“It’s more important for me to take my kid to the doctor than take myself to the doctor”). Or are ignoring because they just learn to think of themselves and their symptoms as unimportant/not worthy of others’ time. I wonder how many women who report “negative” symptoms in this study are thinking about those symptoms positively or indifferently, and then how many are just sweeping their symptoms that should be treated/dealt with under the rug.

  4. HeatherD says:

    Agreed, Paula, and this is also the problem with survey questions in general. When you’re faced with a survey questions that asks you whether you have “very negative,” “negative,” “somewhat negative,” or “not negative” symptoms,” what does that mean? I’d venture to guess the “somewhat negative” people are probably indifferent and unbothered by their symptoms at times and really don’t want treatment most of the time. So, what does that mean about “somewhat negative” symptoms, then? Do they contradict the very meaning of the word “symptom” right now, since “symptoms” are always constructed as fully negative?

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