Telemedicine for Menopause Makes Care More Accessible

Telehealth has boomed during the COVID-19 pandemic, and for many care needs, it's here to stay.

For women experiencing perimenopausal symptoms, such as hot flashes, vaginal dryness, sleep disturbances, irregular periods and mood swings, a telehealth visit may provide a convenient solution and improve their quality of life.

"Women have so many unique needs across their life span and, unfortunately, have been marginalized in much of mainstream healthcare," said Laura Purdy, M.D., M.B.A., a virtual primary care physician in Tennessee. "The years of menopause transition are some of the busiest, most engaged years of a woman's life in multiple facets. Career, family and business trajectories are often peaking around the mid-40s [to] early 50s. Menopause can be confusing, unexpected and intimidating, although every woman will eventually go through this phase of life."

Virtual care eases the burden

"Whenever new symptoms arise, it is always good to touch base with a physician, but it's not always easy to get an appointment in a traditional setting," said Samuel Werner, D.O., of Family Osteopathy in New Jersey. "During menopause, the ovaries are no longer active and estrogen levels drop significantly, which is the cause of several changes."

Werner explained that virtual visits are a great way to support patients who are going through new and frequent symptoms of menopause. Telehealth allows patients to share their personal concerns and physicians to share guidance for symptom management as well as identify warning signs of more dangerous issues.

"Even for the components that can't be covered via telehealth, it is a valuable tool to screen for a need for an in-person visit," Werner said.

Another aspect of telehealth not often discussed is how it gives access to medical advice and care for people who may not be able to schedule an office visit or who do not have a primary care physician.

"The fact is that women often place their needs second after the needs of those around them. Telehealth meets women in menopause where they are: at home, in the office, on the soccer game sidelines or anywhere. Women can get the care they need without having to compromise their daily activities," Purdy said.

Aside from being accessible to women regardless of their busy schedules, telehealth care visits also provide better access to women who don't live near a menopause specialist.

"Menopause is becoming its own specialty, and many women do not have access to a trained specialist. With telemedicine, the reach is expanded to the state the provider is licensed in, so many more patients can be reached," said Tara Scott, M.D., medical director at Forum Health Akron in Ohio.

Pros and cons of telehealth for menopause

"In any doctor visit, including telehealth, the physician's evaluation consists of gathering a history and identifying any physical signs of disease," Werner said. "For menopause, there is more emphasis on the history component of the evaluation, so it is a great candidate for telehealth. In fact, one of the upsides of telehealth is for what I refer to as consultation visits, meaning the same time slot can be used for longer consultation since telehealth removes the delays involved in transitioning between rooms, obtaining vitals, etcetera."

Werner added that one of the downsides is patients with ovaries lose the cardioprotective benefit that estrogen provides when they go through menopause and it can be more important than ever to be vigilant about screening for coronary artery disease with blood pressure checks. Fortunately, there are an increasing number of methods to check your blood pressure outside the doctor's office.

Scott echoed Werner's comments, saying telehealth allows symptoms to be discussed, labs to be reviewed and interpreted, and prescriptions to be sent.

"Telehealth can be a really convenient option for women to get their menopause care," Purdy said. "The upside is that it's generally less expensive than in-person doctor visits, especially if you are not insured, and also there is a greater flexibility in timing. Appointments can be held after hours or even on the weekends."

However, telemedicine has its limitations and can't accommodate some services, such as anything requiring a physical exam.

"Telehealth can never be a full replacement for what needs to be done in person at the doctor. However, especially when it comes to simple needs such as menopause care, it is a fantastic option for women who need help," Purdy said. "It's still important in the menopause years to get Pap smears, mammograms and colonoscopies, as well as routine screening that is needed for long-term cardiovascular health."

Who is a candidate for menopause telehealth?

"In general, patients who have rigid work schedules or have transportation and mobility issues benefit more from telehealth than others," Werner said. "Further, menopause occurs around 45 to 55 years old, and many of these patients are caregivers for their children, their parents or both. Telehealth affords more options to fit their own care into a workable schedule."

Purdy said on the surface, telehealth is great for everyone, but it does require patients to have access to the technology needed to complete the virtual visit, which can be a barrier for some people. Purdy also noted that people with health insurance may be less willing to pay out-of-pocket fees, which are usually associated with telemedicine visits.

"Women are desperate for relief of menopausal symptoms, and OB-GYNs are not taught much about menopause in their standard curriculum," Scott said. "As a result, many women feel dismissed with their concerns and are often unable to find a doctor comfortable writing a prescription for hormone therapy."

Telehealth fills a medical care need that in-person doctors can't always provide, especially for people who don't have access to a physician who specializes in relieving menopausal symptoms.