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Stories: Voices from the frontline

Rebecca Dunsmoor-Su, M.D.

Rebecca Dunsmoor-Su, M.D., wants to help women through the aging process. As our medical director for menopause, she’s intent on guiding women through the physical and emotional changes they may experience along the way. And soon she’ll be able to do that in our forthcoming Women’s Health & GYN Specialty Services, surrounded by other specialists who can offer our patients multidisciplinary care tailored just to their needs.

As she prepares to open the clinic, Dr. Dunsmoor-Su answers our questions on menopause, how the medical community has historically let down women and what she’s doing to offer them something better.

How well has the medical community and society at large prepared women for menopause and the unique health challenges that come with it?

We’ve done a terrible job of educating women about menopause. It should be taught in sex ed. If we're going to tell a woman she's going to go through puberty, we should also tell her that she's going to go through menopause.

Even within the OB-GYN field, a lot of us struggle talking about menopause because we are put through a training program that teaches us to deliver babies and do C-sections and gynecologic surgery without spending any time on the subtle stuff, like caring for women as they age.

Why is there a lack of focus on menopause?

We don't do a good job with women's health in general in this country. It's not considered important. For generations the medical establishment had no women in it, so they really didn't understand women’s needs.

And, unfortunately, society tells women that the minute they’re over a certain age, they're useless and undesirable. So talking to women about the normal aging process—weight gain, what your skin is going to look like—is not acceptable, because we're taught that we're supposed to be 20 until we die.

How has the way that we care for women who are in menopause changed over the last couple of decades?

The biggest shift has been how we use hormone replacement therapy. Fundamentally, as a woman goes through menopause, her endocrine system is failing. So it makes sense to replace it with hormones. That’s what we did for many years, and women who took them felt great.

Then in 2002 the Women's Health Initiative put out a press release saying that hormone replacement therapy that involves progesterone increased the risk of breast cancer. And suddenly, boom, everybody said, "Oh my God, my hormone replacement causes breast cancer. I have to stop."

In the years since then we have taken a critical look at that study and the interpretation of the data, which actually doesn't show the things they said it showed in that press release. So really there's not a high risk from progesterone. There's no risk of breast cancer with estrogen. In fact, it may even be protective.

In between those two time frames, though, a lot of women were having a lot of problems, but when they went to their OB-GYNs and their primary care physicians they were told, "No, you can't take hormones."

What challenges have those shifting messages created?

Two-thirds of the discussions that I have in my clinic every day are around how to use hormone replacement safely. What I tell women is that what we didn't know before and what we know now is that the key to hormone replacement therapy is when you start it. It's safe to start under 10 years from the start of menopause, but ideally under five.

My patients ask me about the risk of breast cancer with hormone replacement therapy. What I can tell them is that estrogen does not cause breast cancer and that micronized progesterone, which is more commonly used nowadays, probably does not increase the risk either.

More importantly, what I tell them is that breast cancer is not the thing they should be asking about. One in eight of us will have breast cancer in our lifetime, but it's not the thing that kills women. Cardiovascular disease and bone disease, though? Those are the two top killers of women as they age, and hormone replacement therapy can actually prevent them.

How do you hope to address some of those educational and care gaps with our new Women’s Health & GYN Specialty Services?

For a very long time, the OB-GYN field has been the keeper of women's health. But when you walk into an obstetrics and gynecology clinic, it's full of pregnant women. So our goal is to establish a clinic that focuses on the woman who is done with her child bearing or not planning to bear children at all.

The clinic will offer women access to a variety of specialists in one space, from minimally invasive gynecologic surgery to menopause treatment with hormone replacement therapy to psychiatric care to referrals to cardiologists who specialize in women's health.

How can gifts from our community help?

There are two roles for philanthropy in this clinic. One is to help us open it. It takes a lot to bring together all these specialists and find a space for them.

What we do hasn’t traditionally been highly valued by society, and what we do is not often reimbursed by insurance companies. So ongoing philanthropy will also help us offer services like group work for women who are going through menopause and educational programs that help them to understand what menopause is.

We'd like to make that available to all women, not just those who can afford it.

For more information about menopause care at Swedish or to schedule an appointment with Dr. Dunsmoor-Su, visit our website or call 206-215-6300.

For more information on how you can provide comprehensive care to women as they age by supporting the Women’s Health & GYN Specialty Services, contact Lorna Kneeland at 206-215-2217 or lorna.kneeland@swedish.org.