‘You walk in and you’re family’: Women share in menopause support group struggle for treatment

When Michelle Bingham started having symptoms just after her 40th birthday, she was told she was too young to be menopausal. After years of fatigue, hot and cold flashes, and other signs of menopause, she is seeking hormone therapy that may relieve her symptoms.

“It’s very isolating, because you don’t know what’s happening to your body. If it’s just you’re tired or stayed up too late, or if it’s something more,” Bingham said.

In the last two years, Bingham has been diagnosed with perimenopause – a yearslong process in which a woman slowly produces fewer sex hormones despite continuing to have a regular period. While menopause typically does not occur until a woman is in her 50s or later, the effects of perimenopause can be felt much earlier than many expect.

“Women in their 40s typically start experiencing a decrease in the amount of estrogen and other hormones produced in the ovaries. Experiencing symptoms during that time is not uncommon,” said MultiCare Rockwood OB GYN Lacey Marks.

Menopause occurs when a woman has not had her period for more than a year. Often menopause is thought of as an “on-off switch” in which a woman’s period stops, but that clean menopausal transition is not the case for many women, Marks said.

Now 44, Bingham went several years without treatment for her perimenopausal symptoms. But she recently started attending a Spokane support group with other women on the same journey.

“It feels like a lot of times as a female, our feelings are put off as us just being emotional. That I’m too young, you’re just depressed, you’re just anxious. But in this group, there’s no judgment. You walk in and you’re family.”

Fitness coach Steph Shimkus started the support group in recent months, as many of her menopausal or perimenopausal clients needed to know they were not alone.

“It is lonely and isolating going through perimenopause and menopause. Many women suffer from depression and anxiety that is exacerbated by this transition,” Shimkus said. “I want to offer a place where women can come sit with other women and know that there is a community for them.”

Symptoms felt during menopause or perimenopause include hot flashes, night sweats, mood swings, rashes, vaginal dryness and pain during sex. Largely caused by the decrease of sex hormones in the body, these symptoms can be treated by medicine that reintroduces estrogen, progesterone and other hormones.

Hormone replacement therapy had been the standard treatment for menopausal and perimenopausal women, but a study in the early 2000s linked the treatments to an increased risk of heart attack and stroke. The Women’s Health Initiative study led to the Food and Drug Administration requiring the drug to have a “black box” label that greatly discouraged doctors from prescribing hormone therapy.

“At the time of the Women’s Health Initiative study, one in every five women were on hormone replacement therapy. But after the study, it dropped to less than 10% of patients,” Marks said.

In recent years, the conclusions of the 2002 study have come under question, and the FDA is now considering the removal of the black box label. A majority of women in the study were post-menopausal, and many of the increased risks were caused by reintroducing hormones to a body that had lived without them for many years, according to Marks. Recent studies have found risks decrease if the therapy is introduced while the body still produces some amount of hormones.

Last month, the FDA conducted a panel on whether the warning should be removed. Agency head Marty Makary has indicated his support for the move.

“Fifty million-plus women have not been offered the incredible potential health benefits of hormone replacement therapy because of medical dogma,” Makary said in opening remarks at the panel.

Marks is supportive of removing the black box specifically for vaginal estrogen products because the estrogen that is absorbed into the body is “near zero.” Vaginal estrogen products are used to help with localized vaginal symptoms of menopause, such as pain with intercourse and vaginal dryness. Other forms of hormone replacement therapy increase the estrogen overall in the body.

In her practice, Marks has seen hormone replacement therapy “make a profound impact on so many women.”

“It is really unfortunate that so many women were just taken off hormone replacement therapy so abruptly, and it has been a detriment for women,” she said.

Still, she said the FDA needs to do as much research as possible before removing the black box warning from all hormone replacement therapy products.

Some women with whom Shimkus works have used hormone replacement therapy, while others have not. She has seen a difference in those who do, and hopes the black box label is removed so more women can receive treatment.

“Taking off that black box label would be incredible because it will start the healing of a whole generation of women who were afraid of medicine that would help them feel better.”

Shimkus opened fitness center Blossom Whole Wellness a year-and-a-half ago, specifically because she found healthy habits in exercise and diet improved her own perimenopausal symptoms.

“I didn’t know that I was old enough at 42 to start having perimenopausal symptoms. I was not prepared, and I got really sick. And I don’t want women to suffer the way I did, and to wander around blindly for the rest of their adult life wondering why they’re sick and don’t feel right,” Shimkus said.

For Bingham, the exercise at the fitness center has reduced many of her symptoms.

“I have found exercise helps a lot not only physically, but mentally. It just really helps kind of calm everything down,” she said.