Pollie on Hormone Imbalances, Gaps in Care, and Taking Control

20 million is not niche

Chances are you did not grow up with heightened awareness of reproductive hormonal health disorders like polycystic ovarian syndrome (PCOS), endometriosis, and functional hypothalamic amenorrhea. These conditions are the cause of a range of symptoms, from irregular periods and hair loss to blood sugar imbalances and debilitating cramping.

Hormonal imbalances do not just cause in-the-moment symptoms, though: they are the leading cause behind infertility, and can also lead to diabetes, heart disease, and estrogen-driven cancers.

If you are new to hormonal imbalances, here are some stats to consider:

An estimated 1 in 10 women has PCOS, which is a disorder caused by high androgens (male hormones), anovulation, and a “string of pearls” of follicles around the ovaries, amongst other symptoms. PCOS is the #1 cause of infertility and can lead to other chronic conditions like diabetes, heart disease, and estrogen-dominant cancers.
1 in 10 women is approximated to have endometriosis, which is when your endometrial cells grow outside your uterus. This condition’s root is unknown, but there is a strong link to estrogen dominance.
Roughly 3% - 5% of women have functional hypothalamic amenorrhea (FHA), or period loss that results from high levels of stress and/or too-high energy output.

Awareness is fortunately starting to grow with the work of women’s health upstarts and activists. But, since half of these disorders go undiagnosed and years for diagnosis, we are dealing with a serious education problem, and there is certainly much work to be done.

Doing the math on the above statistics illuminates that nearly 20 million women in the US alone have one of the above reproductive disorders. That is over 2x the population of New York City. 20M is not niche, but clearly there is a gap between this prevalence and awareness around these conditions.

The paradox of a broken system and sea of resources

To put it simply, the US healthcare system is not optimized for spending quality patient to provider time.

If you are covered by employer-sponsored insurance or a different private health plan, chances are you see doctors who are in-network for your insurance. Over the past few years, the healthcare system has seen a trend of medical practices consolidating: think large health system mergers and smaller physician practices being acquired by larger ones.

In general, consolidation means more standardization. Both for profit and non-profit health systems have financial goals and the larger the organization, the more stringent meeting these goals tends to be. And these organizations impose goals upon the doctors that work for them, as they are the mechanism in which health systems and practices make revenue — by seeing patients.

To put it bluntly, doctors’ employers encourage them to be profitable.

For an MD working at a health system or practice that abides by a fee-for-service (FFS) model, being profitable means spending less time with patients because less time equates more transactions. While many institutions have switched or are in the process of switching to value-based care, the transition has been slow and downward pricing pressure over time has crafted a patient - provider interaction that is hurried and in many cases not thorough.

Hormones are complicated because they are so interconnected. Our gut, blood sugar, brain, and various other endocrine-producing glands are all involved, and when something is off-balanced there is very often not a direct answer as to why it is imbalanced. It takes time and trial and error to uncover, and many physicians do not have this time.

One size fits all is not the best approach

One of the most common treatment methods for reproductive hormonal imbalances is just putting a patient on birth control. 14% of hormonal birth control in the US is prescribed for non birth control reasons — but rather to manage female “issues” like cramps and acne whose root generally lays with hormonal imbalance — which equates to a $1B+ annual value. For some, birth control might make sense to manage these symptoms, but for many it’s a bandaid solution.

This has created a system in which (not all, but most) women must advocate for themselves: diagnoses do not come easily, and answers about managing symptoms can be even harder to find.

Finding your fit

Tools like Proov and fertility tracking apps are a great place to start your hormonal health journey. These tools are giving women a level of self advocacy that did not exist several years ago - the ability to take a test at-home and bring it to your OBGYN to signal that something is indeed wrong (!) puts control back into the consumer.

But taking the next step to make changes — both to your lifestyle and medication or supplement regimen — can be confusing and dangerous on your own. Our bodies respond to various inputs differently, and experimenting unsupervised can lead to issues and further health problems. For that reason it is generally recommended that women consult with a specialist who can work with you to make an actionable difference while properly monitoring your care and health.

While working with a women’s health specialist is a great place to start if you have a known reproductive hormonal imbalance or think you are experiencing symptoms of imbalance hormones, it can be difficult to find someone who fits your style.

What should you be looking for when searching for a women’s health specialist for your specific needs? Here are some ideas:

Budget: Whether you need someone that’s in-network with your health plan or can spend a bit of money out of pocket, being clear on your budget is step one. Note that many specialists, even if they are not covered by traditional insurance, are generally HSA/FSA reimbursable.

Communication: Do you work better with someone who takes a tough love approach, or is more lenient? If your provider’s communication style clashes with what resonates with you, you’ll likely clash as opposed to work together as a team.

Credentials: Just as your OBGYN helps you in a different way than an endocrinologist would, so do the rest of women’s health specialists. If you are looking for extensive bloodwork and the ability for a provider who can prescribe pharmaceutical and herbal medication, a naturopathic doctor may be for you. If you are looking for someone for support with more day-to-day activities (e.g., meal planning and fitness goals), a health coach may be more appropriate.

Treatment methods: If you’re vegan for ethical purposes and you decide to work with someone who has written three books on maintaining a keto lifestyle, chances are you won’t work well together. The same goes for openness to medications like birth control and Metformin for managing symptoms for more short-term purposes. You are more likely to consistently follow a treatment strategy that jives with your current values, interests, and goals, as opposed to molding yourself to changes you don’t enjoy.

Specialty areas: While healing cystic acne and trying to conceive are both rooted in principles of re-balancing hormones, they require a different skill set from providers. Knowing what specialties you are looking for can ensure that you are getting a more targeted perspective and plan.

Many of these practitioners do not work within large health systems and are not built into the natural referral network, which is generally centered around OBGYNs and endocrinologists when it comes to hormonal issues. This means it is up to patient research to find them. Tools like Pollie can help you find a specialist to manage your symptoms and achieve your goals in a way that feels authentic to you.

References

Cahill, David. “PCOS.” BMJ clinical evidence vol. 2009 1408. 15 Jan. 2009

Parasar, Parveen et al. “Endometriosis: Epidemiology, Diagnosis and Clinical Management.” Current obstetrics and gynecology reports vol. 6,1 (2017): 34-41. doi:10.1007/s13669-017-0187-1

Meczekalski, B et al. “Functional hypothalamic amenorrhea and its influence on women's health.” Journal of endocrinological investigation vol. 37,11 (2014): 1049-56. doi:10.1007/s40618-014-0169-3

Jones, Rachel K. “Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills.” Guttmacher Institute, Nov. 2011, www.guttmacher.org/sites/default/files/report_pdf/beyond-birth-control.pdf.

“U.S. Contraceptive Market Size, Share: Industry Report, 2020-2027.” U.S. Contraceptive Market Size, Share | Industry Report, 2020-2027, Feb. 2020, www.grandviewresearch.com/industry-analysis/us-contraceptive-market.