By JULIE MINDA
Deb Soholt first became aware about 12 years ago of a pent up demand among women for help navigating the physical changes they experience in middle age.
Soholt's employer, Sioux Falls, S.D.-based Avera Health, had scheduled a community presentation on hormonal changes in women in midlife. Event organizers expected a few dozen women to R.S.V.P. More than 350 signed up.
"We saw that there was a huge community need" to address the midlife health concerns of women, said Soholt, who now is director of women's health for Avera. That insight spurred Soholt and a team of leaders at Avera to study what midlife health services women wanted in Sioux Falls, confirm an instinct that there was a gap in services and then create the "Midlife Care for Women" program to help women address holistically the hormonal fluctuations and other conditions common in middle-aged women.
Avera is among a growing number of U.S. health facilities that are bundling and reinforcing the services they offer to women aged about 40 to 65, who are experiencing perimenopause, menopause and other hormonal changes; pelvic and vaginal conditions related to menopause; breast health concerns; and osteoporosis or osteopenia.
Beyond the standard
Soholt said programs like Avera's promote wellness and prevention and take a whole-body and mind approach to women's health and aging, an approach that is not necessarily historical operating procedure for traditional gynecological practices. In many cases, Soholt added, physicians are challenged by only having 10 or 15 minutes to talk to perimenopausal or menopausal women before prescribing therapy — that's just not enough time to hear and respond to a woman's health concerns, she said.
Part of what a woman gets when she goes to the Avera center is time and personalized attention from the clinical staff, which includes a physician medical director and two women's health nurse practitioners. Consultation constitutes about 60 percent of the ongoing patient-clinician interaction. (The expectation is that after an initial series of appointments, women will return to the center several times over the years as their bodies continue to age and change.)
Nancy Pitcock, a nursing executive who helped start the Center for Midlife Women at St. Vincent Anderson Regional Hospital of Anderson, Ind., said "we need to understand the body and understand what to do" to address underlying causes of midlife health concerns in women. Pitcock is chief nursing officer at the Ascension Health hospital, which modeled its program on Avera's.
Christina Jackey, an advanced practice nurse and certified nurse midwife with St. Vincent, said St. Vincent's and Avera's centers clinicians "find out why things are happening — is it hormone imbalance, nutrient absorption, diet, activity, stress, medications?" Through an extensive discussion of the woman's concerns and health history, and using the results of a battery of tests which may include bone density screens, thyroid tests, hormone balance tests and colonoscopies, clinicians at St. Vincent and Avera point women not only toward hormone rebalance therapies but also toward lifestyle changes including exercising and eating better that can improve their hormonal balance and health status.
Both facilities work with compounding pharmacies to tailor prescription hormone dosages as well as vitamins, supplements and over-the-counter medications, as needed, to the individual makeup of the patient, said Soholt. Both facilities said they complement — they do not replace — the services of the patient's gynecologist.
"We restore women back to who they are" if they are experiencing health issues or symptoms, and help them prevent or forestall other potential health issues, for instance through stress reduction, Soholt said. The treatment goal is for patients to achieve functional balance between all of the systems in the body and to improve how patients respond to stress and inflammation.
Managing changes
Many health concerns middle-aged women experience — hot flashes, mood swings, bone loss, abdominal weight gain — can be linked to imbalance in the hormones estrogen and progesterone as women near and then enter menopause. Decreasing hormone production impacts a woman's menstrual cycle and can cause hot flashes, vaginal and urinary tract changes, headaches, night sweats and sleep disturbances, according to a web resource from Buffalo, N.Y.-based Catholic Health System.
The system markets an array of its services for middle-aged women including breast, ovarian and osteoporosis disease diagnosis and treatment, and some cancer treatments as "Women Care" services. It presents community health forums on women's health issues.
While hormone replacement therapy is the most common treatment for symptoms brought on by hormonal changes in middle-aged women, some studies have associated certain dosages of hormones with an increased cancer risk; and some researchers have linked hormone therapies to blood clots, stroke, gallstones, breast disease, bloating, weight gain, headaches and mood swings, according to the Catholic Health System website resource.
In part because of such risks, "the answer is no longer just to prescribe a pill. We've done that too long, and it doesn't always address the problems" middle-aged women experience, said Dr. Wendy Marshall, medical director of The Women's Center at Presence Saint Joseph Medical Center's Healing Arts Pavilion in New Lenox, Ill., a facility that opened this summer and that tailors services to women over 40. Cardiologists, counselors, endocrinologists, gastroenterologists, gynecologists, urologists and other specialists at the center work as a team to address health changes at midlife.
Presence Saint Joseph is centralizing its services for middle-aged women at the Healing Arts Pavilion, so patients can schedule back-to-back appointments including mammograms and gynecologist and cardiologist visits at one location. The facility has a spa-like atmosphere, with massage services and fluffy robes. In the soothing environment, patients have lowered blood pressure and respiration rates and less anxiety, said the center's office manager, Laura Yurisich.
Body balance
Mary Kay Garry, a 53-year-old fund-raiser in Sioux Falls, has been a patient of Avera's center since she began experiencing hormone-related hot flashes, weight gain and drops in her energy level six years ago. She said the center's clinicians took the time to build a relationship with her and have counseled her to adjust her lifestyle to maintain her health as her body changes, for instance by advising her on how to reduce her stress level.
At a women's center at Northridge Hospital Medical Center, Northridge, Calif., staff see themselves as providing a concierge service, giving reliable information to women in midlife and referring them to clinicians who can address their health concerns, said Casey Barbiera, Northridge director of ambulatory services. Northridge frequently hosts physician presentations to educate middle-aged women on how medications, diet, exercise and stress can impact their changing bodies. Nana Deeb, vice president of clinical services at Northridge, said misinformation abounds about midlife body changes and treatments, and so women appreciate having a forum to hear accurate information and ask questions.
High expectations
Deeb and Barbiera said most women who seek out specialized midlife health services are highly educated professionals who have done their homework on midlife health; they know what kind of services they want, and this often includes homeopathic treatments. They are willing to look elsewhere if a provider can't deliver specific treatments they seek.
Deeb noted the majority of patients seeking midlife health services at Northridge either have private insurance or Medicare. At Avera, noted Soholt, the midlife services clients are among the facility's most reliable payers.
Building up a specialty in midlife health services can be a challenge, according to those who spoke to Catholic Health World — facilities may need to hire new specialists, provide more education to current staff and add new facilities and equipment, depending on the approach they take.
But the experts said taking a preventive approach focused on an aging population is consistent with where U.S. health care is heading — with incentives now to focus on wellness.
Copyright © 2013 by the Catholic Health Association of the United States
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