Why Your Doctor Doesn’t Understand Your Symptoms

Not every doctor is trained in hormone health. Here’s how to ask the right questions, and advocate for correct diagnoses and treatment.

Does it ever feel like you and your doctor are speaking two different languages? Or, that you are being prescribed treatment that doesn’t seem quite right?

You’re not alone, and just as Western medicine is evolving, so too are patients. We have more access to information than ever before, and when it comes to your health, this is a good thing. Still, medical info abounds on the internet, some trustworthy, some…not so much. When you suspect you might be experiencing hormone imbalance however, how do you express that to your doctor, and avoid getting treated for a different problem entirely?

Let’s take a look at women’s hormone health in the larger scope of a doctor’s medical training, why hormone health issues are commonly misdiagnosed, and how to ask the right questions next time you visit your doctor.

ARE DOCTORS TRAINED TO UNDERSTAND WOMEN’S HORMONE HEALTH?

Yes and no, and it very much depends on which kind of doctor you’re seeing.

Your primary care physician (PCP) is trained to look at big-picture problems with your health, and are often versed in more common hormonal issues, such as thyroid disease and diabetes. Imbalances in estrogen and progesterone? Those are less part of their training, but fortunately, that’s where your OB-GYN can step in, right? Think again. From Futurity^[1]:

“Not even one in five trainee obstetrics and gynecology doctors in the United States receives formal training in menopause medicine, training most of them say they want.

A new survey, published in the journal Menopause, shows that some American ob/gyn residency programs fail to offer trainees any formal curriculum or clinical experience focused primarily on women’s pre- and post-menopausal health.

“Our results suggest that to serve a fast-growing population of aging women in the boomer generation and beyond, ob/gyn residency programs need to address this training gap,” says senior investigator Wen Shen, assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine.”

What’s more? About 70 percent of survey respondents said they wanted more expertise in menopause physiology, hormone and non-hormone therapy, menopause-related bone health, cardiovascular disease, and metabolic symptoms; a majority also indicated they were barely comfortable in managing women with menopause-specific problems.

Isn’t that astounding?

Things are better with naturopathic physicians and doctors who practice integrative medicine; the downside there is that not all insurance covers those visits. OK, how about an endocrinologist – a hormone specialist? From Prevention Magazine^[2]:

“Endocrinologists like to think of themselves as partners in crime in your care. “Often, we’ll schedule one-time visits with a patient to help them learn about their disease, but their PCP will take the reins in managing it,” says Tan. “Our visit becomes more focused on education rather than treatment.”

Which is helpful…but…wouldn’t it be nice to have an ongoing conversation with an expert about your hormone health?

We’re here to encourage you to have that conversation with your PCP or your OB-GYN, no matter their training, because misdiagnoses can and do occur.

ANTIDEPRESSANTS AND OTHER DRUGS YOU MIGHT NOT NEED

Before we talk about the ways a hormone imbalance might be masquerading as, say, depression, let’s also say this: Western medicine is in many ways incredible, and medical issues that affect your emotional outlook are very real. That being said, female patients are constantly being prescribed medicine they don’t actually need (and may in fact make their conditions worse), so let’s examine why that is. From Tonic^[3]:

“A recent study found nearly one in six American women, some 16 percent, are currently on an antidepressant. And a 2011 government query of Americans’ health shows millennial women are three times more likely than their male peers to be taking an antidepressant—some 9 percent vs. 3 percent. Among older women the disparity is even greater: 23 percent of women 40 to 59, and 19 percent of those over 60, compared to 8.5 and 9 percent of men, respectively.”

So again, the question here is: why?

In the U.S., antidepressants are the third most commonly prescribed class of drugs, after painkillers and cholesterol medicine. And that’s not an accident: as psychiatrist Kelly Brogan, a longstanding advocate of natural treatment methods, explains: “We’re told a tale about depression—that it’s a chemical imbalance. We’re told it’s a disease like diabetes,” she says. “But in six decades of research there’s actually no science to support that. It’s more akin to a fever—a symptom that tells you the body is struggling with something, but not what that is or what you should do about it.”

But like so many issues that touch on women’s health, the medical field (as regular readers of this blog know!) is playing catch up behind the very patients it treats. While the Western medicine model is predicated on symptom → relief, patients themselves are forming communities, seeking out alternative opinions, and understanding their symptoms as part of a root cause that needs to be healed, rather than bothersome affects that need to be dulled. On the topic of depression for example, progesterone and estrogen levels are critical: when out of whack, you can feel exhausted, moody, and foggy – like you can’t remember anything. But with better sleep, a diet that supports your hormone health, and strategic supplementation, these levels can drastically improve, no prescription needed. This is what we mean by root healing, rather than symptom relief.

HOW CAN I BETTER WORK WITH MY DOCTOR TO GET THE CARE I NEED?

Until Western medicine itself is healed (that might take a while), we like this advice from Sara Gottfried^[4]:

“While some physicians are great at blending traditional medicine with more holistic approaches, you might need to turn elsewhere for support in areas like nutrition, herbal medicine or natural hormone balance. It may be possible to work with your doctor but also to get support from a health coach, a nutritionist or some other type of practitioner who has the necessary qualifications. This might require a more proactive stance on your end – you’ll need to make sure you’re communicating important information with both the doctor and the practitioner (like your health history, supplements or herbs you’re taking, etc.) But this type of combined approach can work if you’re doing it safely and consulting both parties about the treatment you’re receiving.”

She also recommends asking for specific tests, if you’ve done your research and your symptoms seem to point to a hormonal imbalance (we’ve got info on that regarding progesterone and estrogen here). And of course, don’t be afraid to shop around for a doctor who makes you feel supported and understood.

ADDITIONAL LINKS + RESOURCES:

http://www.saragottfriedmd.com/hormone-questions-ask-your-doctor-these-6-things/
https://www.futurity.org/menopause-skills-fall-short-for-new-obgyns/
https://tonic.vice.com/en_us/article/43yjbj/doctors-are-too-quick-to-give-women-antidepressants
https://www.ncbi.nlm.nih.gov/pubmed/?term=clinician-identified+depression+in+community+settings
https://www.cdc.gov/nchs/data/databriefs/db76.htm
https://www.prevention.com/health/8-things-every-hormone-doctor-wants-you-to-know
https://www.everydayhealth.com/news/things-your-doctor-wont-tell-you-about-hormone-therapy/
https://themighty.com/2017/06/doctors-not-treating-patients-dont-understand-chronic-illness/
http://themediapush.com/the-problem-with-pellet-mills-and-women-who-need-hormone-replacement-therapy-scottsdale-internist-has-advice/
https://www.marketwatch.com/story/why-your-doctor-wants-to-be-your-hormone-guru-2014-01-30
https://www.hotzehwc.com/2015/05/antidepressants-are-not-the-answer-for-the-symptoms-of-hormonal-imbalance/
https://www.holtorfmed.com/hormones-mental-health/
http://kellybroganmd.com/4-things-to-check-before-taking-an-antidepressant/

^[1] “Menopause skills fall short for new ob/gyns,” read full article at: https://www.futurity.org/menopause-skills-fall-short-for-new-obgyns/

^[2] “Eight Things Every Hormone Doctor Wants You To Know,” read full article at: https://www.prevention.com/health/8-things-every-hormone-doctor-wants-you-to-know

^[3] “Doctors Are Too Quick to Give Women Antidepressants,” read full article at: https://tonic.vice.com/en_us/article/43yjbj/doctors-are-too-quick-to-give-women-antidepressants

^[4] “Hormone Questions? Ask Your Doctor These 6 Things,” read full article at: http://www.saragottfriedmd.com/hormone-questions-ask-your-doctor-these-6-things/?doing_wp_cron=1522188404.5133490562438964843750

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