This week: Different treatment for the same diagnosis, caregiving, menopause policy, menstrual migraine, and kidney health.
Same diagnosis. Different treatment.
Same diagnosis apparently still doesn’t mean same treatment.
Women are less likely to receive coronary bypass, stents, liver transplants, and opioids than men. Doctors are also more likely to attribute women’s symptoms to anxiety, even when tests show something is wrong.
Almost none of the guidelines said women and men should be treated differently.
So...why are they?
What to ask: What are all of my treatment options, and why are you recommending this one for me?
Women don’t have a testosterone product made for us. The FDA may change that.
Women have been prescribed testosterone off-label for years. But there still isn’t an FDA-approved product made and dosed specifically for women in the U.S.
So women use a fraction of products made for men or go to compounding pharmacies — with all the dosing, access and cost problems that come with that.
Women’s health can’t just operate on: take the men’s version, but less.
This week, the FDA held a hearing on testosterone for menopausal women. The strongest evidence right now is for low sexual desire, but women and clinicians want research into other uses, female dosing, and long-term safety.
If the evidence isn’t there yet, build it.
What to ask: If you’re prescribed testosterone off-label, ask what it will cost and whether GoodRx, pharmacy coupons, or cash-pay discounts can lower the price.
Caregiving is hard enough without sacrificing yourself to it.
You can be a caregiver without calling yourself one.
Taking your mother to appointments counts. Managing a loved one’s medications counts. Fighting with the insurance company counts.
But some people don’t seek caregiver support because they don’t think the label applies to them. About a third of caregivers wanted counseling. Fewer than 1 in 6 got it.
Meanwhile, their own health quietly disappears from the calendar.
Again.
What to ask: Tell your doctor you’re caring for someone and ask what support is available. Then put your own appointment back on the calendar.
Congress finally looked at what’s missing from menopause care. It’s a long list.
This week, a Senate committee looked at what it would take to improve menopause care.
Spoiler: doctors who actually know how to treat menopause.
But more than 20% of residents got zero lectures on menopause in medical school.
Zero.
Another 58% got one.
Then there’s insurance. Only about 1 in 4 women have coverage that fully pays for menopause prescriptions, and neither Medicare nor Medicaid requires menopause coverage.
What to ask: Ask your representative what they’re doing to support menopause. If they’re not, ask why.
There may finally be a treatment specifically studied for menstrual migraine.
Migraines around your period can be longer and harder to treat — and they can get worse during perimenopause, when estrogen starts doing whatever the hell it wants.
A Phase 3 trial tested atogepant, already sold as Qulipta, for seven days around a woman’s period. Women taking it had 1.2 fewer migraine days, compared with 0.4 fewer on placebo.
The full results haven’t been peer-reviewed yet.
What to ask: If your migraines track your cycle, ask about preventing them instead of only treating each attack.
Your kidney numbers may look better than your kidneys are.
Kidney function is commonly estimated from creatinine, which your muscles make. Less muscle, less creatinine. So in some women, kidney function can look better on paper than it actually is.
Women also tend to start dialysis with lower kidney function than men, and globally, men receive kidney transplants about 30% more often.
Menopause before 45, ovaries out before 50, PCOS, and lupus are also linked with higher kidney disease risk.
What to ask: Is this estimate based on creatinine, and is there a more accurate test for me?
Know someone in the “wait, what the hell is happening” years? Forward this to her.
See you next Friday. — Trista