“That mission has now been slightly adjusted: I especially want the generations after us to no longer run into the same walls as today’s women.”
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What are examples of those walls?
“The largest wall has almost been demolished. Until ten years ago it was a bit like: ‘The menopause is part of it, you just have to go through it and then it will pass by itself.’ Above all, you shouldn’t medicalize it. Personally, I find that a bit short-sighted, because women do have complaints. That’s a fact.”
“I would then receive the comment: ‘It doesn’t kill women.’ Then I always said that women don’t die from urine loss, but we help them with that too. Menopause is part of women’s health care. Even if you have no complaints, it has consequences for your health in the long term.”
“Fortunately, we are increasingly realizing that women are really not men. I have always said: we mainly distinguish ourselves in three things. We get our periods, can have children and go through menopause. Having children has always been a big focus, but the other two are still lagging behind.”
“The transition in particular quickly becomes a bit of a joke. And that makes it even more difficult for women to discuss their complaints; at home, but also in the workplace.”
Are menopausal complaints always recognized as such: by women themselves, but also by general practitioners, for example?
“No, not always. But look, I have a lot of missions. General practitioners are always a bit of a bogeyman, but I think I know more general practitioners who have good knowledge than gynecologists. They’ve really caught up. It is often not recognized by company doctors, cardiologists, psychiatrists – you name it. When I give a presentation, I always have a fixed slide with a quote from Johan Cruijf: ‘You only see it when you realize it.’ And so it is.”
“After a lecture, a rheumatologist once came to me. She said: ‘I was really shocked by your story, because I didn’t know that muscle and joint complaints can also be part of menopause. I think that I have therefore not helped many women for whom I could not diagnose rheumatism.’ Doctors are slowly starting to realize that women are really different from men.”
“For example, due to the loss of estrogen, all women after the age of sixty are more likely to develop cardiovascular disease. If you also have additional risk factors and you do not know this about yourself, then you cannot take any measures. That is why I believe that all women should have this knowledge from the age of forty – and preferably earlier.”
“If it were up to me, the transition would be covered extensively in biology textbooks. We are all going to work longer, life really doesn’t end at fifty. You’re only halfway through, aren’t you?”
Why did this special transition outpatient clinic have to be created?
“People soon found me and I also attracted more complicated cases, such as women with gland disorders, cancer, muscle diseases or psychiatric disorders. Within the hospital, I would then consult with the internist, cardiologist or psychiatrist to help them as best as possible. But at a certain point I thought: I’ll keep calling.”
“That’s how the idea for a menopause team came about. Every time a woman came with a complex problem, I would be able to make use of the expertise within the hospital more quickly. We noticed that we could help women so much better, and the consultation hours were subsequently created.”
“If a woman comes by because of psychiatric problems, we can now immediately put together the right team so that she can answer all her questions. Many tears are shed at the clinic, because women feel very heard.”
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Pressure on the outpatient clinic
For years, women from all over the country have been trying to get an appointment at the menopause clinic. The waiting time increased so much that the consultation hours are now only accessible to patients from North Holland. Women still have to be patient for four to five months. “And then we make a strict selection,” Van Dijken emphasizes. “It shows how dire the need is.”
The MOP is not intended for people with ‘mild’ complaints. Van Dijken: “Someone who has hot flashes but is otherwise healthy can get the GP back on track relatively easily. That is also an important moment, but much less complex.”
Two-thirds of the women who come to the OLVG in Amsterdam are dealing with psychiatric problems. Van Dijken and her colleagues also see women with cancer, diabetes and thyroid disorders. There are also women with PMS or PMDD, and women who entered menopause at a (very) young age.
Serious complaints
The team does what it can, but Van Dijken realizes that many women do not yet receive the help they need. “I am bombarded every day with calls and emails from healthcare professionals from all over the country who are struggling with women with serious complaints. This concerns women who wish to commit suicide. You don’t want to keep them waiting.”
Together with psychiatrist Sandra Kooij and cardiologist Janneke Wittekoek, Van Dijken founded the H3 network to bundle their knowledge about the women’s body and better integrate women’s care. “We want better network care to emerge in the Netherlands. So I tell other doctors, as often as I can, that we can help women well with our outpatient clinic. And that there is a great need for it.”
“An external colleague now attends consultation hours every week, because they want to set up the same thing in their own hospitals. That is exactly what we need.”
What help can you offer women – in addition to hormone therapy?
“We really see the tip of the iceberg, a very selected group. Yet nutrition and lifestyle are also our number one priority. This actually belongs to the GP or nursing menopause consultant, but we see that women can often still make some improvements to their health.”
“Due to the severity of the complaints, we often prescribe hormone therapy. For women struggling with psychiatric conditions, we do this in combination with other medications and through all kinds of other treatments: from cognitive behavioral therapy to light therapy for sleep. And we can help women with ADHD, for example, with apps, because they need more structure.”
Risk factors
“Lifestyle is important for your overall health. But women especially need to know their risk factors. If you had high blood pressure or gestational diabetes during your pregnancy, your risk of cardiovascular disease increases after menopause. This also applies to migraines. And if one of your parents has osteoporosis, your risk is more than doubled.”
“If you don’t know all this, you cannot grow older in a healthier way – even though you should start doing it on time. You need to exercise enough and eat sensibly. And there are also a number of triggers for menopausal complaints, such as coffee, cola and tea with theine. Ginger tea is guaranteed to cause night sweats, and the same goes for alcohol.”
“Smokers enter menopause earlier and have more complaints. This also applies to overweight women and if they are seriously overweight, you should not take hormone therapy.”
Is this why you think it is important that we talk more about menopause and that information improves?
“It would be nice if all women received information. From the central government for all I care. We see more and more that companies give transition workshops, but it still doesn’t happen enough.”
“What is a thorn in my side, for example, is that women from the age of fifty are checked twice a year for breast cancer, but no one routinely checks blood pressure and cholesterol. While thirteen times more women die every year from cardiovascular disease than breast cancer. It is the number one cause of death among women.”
“The ball is starting to roll more and more, which means that commercial parties have also discovered that there is a revenue model to the transition. If you go to the drugstore, you will find all kinds of pots that are supposed to remedy complaints. People also suddenly call themselves hormone specialists even though they are not medically trained.”
Good information
“Women are insecure and will take anything, causing them to spend a lot of money on things that don’t help. So make sure you get the right information and that this is always linked to a professional association or a healthcare professional.”
“I always say: make it a topic of discussion yourself. Last year a woman told me that she is in a group of eighteen women. She said: ‘I’m the only one affected by the menopause.’ Then I immediately blurted out that I was sure twelve of them were lying.”
“Only one in five women does not experience any problems, and even then, menopause has major consequences for your overall health. You just notice that your body is changing: your muscles, your figure, your hair structure, your nails… We should be able to talk about that in a normal way.”
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2024-01-06 08:38:02
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