Dr. Janet Choi, Progyny's chief medical officer, shares why employers need a strategy for supporting women and families at all stages of life, from family planning to menopause care.
Transcription:
Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio for the authoritative record.
Alyssa Place (00:09):
Hi everyone. I'm Alyssa Place, editor-in-chief of Employee Benefit News, and for today's leaders, I'm joined by Dr. Janet Choi, chief Medical Officer at Progeny. Hi Dr. Choi. How are you?
Dr. Janet Choi (00:20):
Good. Good to see you, Alyssa.
Alyssa Place (00:21):
Yeah, thank you so much for joining me today. Today we're going to talk a bit about menopause and the different benefits that are available right now. And it really seems like there's been this growing awareness and emergence around menopause and around different benefits and the needs for women in this demographic. But why is this really also an employer issue? Why is this really something that employers should have on their radar right now?
Dr. Janet Choi (00:45):
Well, speaking as an OB, GYN, and as a woman who's gone through menopause, perimenopause, post menopause and living the rest of my life is even postmenopause. Basically, every single woman is going to at a certain age, whether it's as early as 30 40 into her fifties and frequently while she is employed and working, is going to go through midlife and there will be some individuals who will not experience any sort of problematic symptoms in others who will experience every single symptom in the medical textbooks, leaned in some cases early retirement, reducing work time, reducing productivity. And this is a reason why I think employers do need to pay attention, plus it's the right thing to do to show real holistic support for their female employees.
Alyssa Place (01:27):
And I think there's the stereotype that a woman going through menopause is just having a hot flash, and that's sort of the scope of what menopause is. Can you explain what are some of the symptoms that could emerge during that perhaps even 20 year gap where a woman is going through the menopause time?
Dr. Janet Choi (01:46):
Yeah, this is a great question. So although historically people have a associated and equated menopause with hot flushes or vasomotor symptoms, whether it's in the middle of the day, so you're in the middle of a meeting, you have to take off your coat, your sweater, your scarf, because suddenly you're all red in the face and hot and sweaty and then chilled or night sweats where a person would be sleeping, woken up sometimes multiple times at night because they're experiencing these waves of heat and then chills. Although about 80% of women going through menopause will experience that or those symptoms. That's not really the primary driver where people are turning and seeking for really good sound medical support. It's oftentimes the other changes that occur around midlife, whether it's in one of the top three or four or five concerns, and women will sometimes go to when they're trying to find the right provider to support them, is through really frustrating weight gain where patients will say, I've been eating super healthy, I've been super fit and active all of a sudden in the past year or two, I've been putting on some weight around the midsection that I cannot seem to lose.
(02:47):
And I'm worried about how that's going to affect things like cardiovascular disease risk, stroke risk, dementia risk, diabetes risk, and all those kinds of concerns do increase over the midlife, right, and post menopause. So it's far beyond just vasomotor symptoms. There are other symptoms too that women oftentimes don't talk about but can affect their ability to work and function fully both at home and at work. And those include things like mood symptoms. And so unfortunately the statistics show that there is a real increase in suicidal ideation, suicidality around this time, so impacts on mental health, even for individuals who've never suffer depression or anxiety in their younger years, sometimes they'll come in and say, I'm actually feeling kind of depressed or I'm having more anxiety. In fact, I ran to the ER twice last month because I was convinced that at age 46 I was having a heart attack and I was really upset.
(03:43):
I was sucked away because the doctor said that my EKG was fine, but I don't feel right. So it's not just hot flushes, it's mood effect. It could be weight impact, metabolic and cardiovascular disease issues, joint pain, vaginal dryness and urinary frequency. Things like that can actually really adversely if you're not getting the right support quality of life. And what's frustrating is there are solutions available and oftentimes women just need to get connected to the right providers. The other thing I wanted to call up is in your first question, I forgot to sort of why should employers care so much when there was a recent study that came out about a year or two ago looking at lost productivity due to menopause related symptoms. And what's the researchers found of suse Mayo Health Clinic publication was that just shely from the lost days of work associated around these sort of unmet needs for menopause symptoms where women were seeking care, it was costing employers close to $2 billion. So again, from a dollars and cents perspective, employers really need to step up and care child support.
Alyssa Place (04:53):
And you mentioned so many things about the different symptoms. You also mentioned some women go to the doctor and they're sent away. I think that's really a common experience for women and also this fear of bringing up that something might be wrong. So can you talk a little bit about the psychological piece of that? There are resources and benefits available, but there's a huge stigma for women when it comes to their health and wellbeing, menopause and otherwise. How is that affecting their approach and even an employer's ability to say, oh, it seems like my employees need this kind of support.
Dr. Janet Choi (05:28):
I'm really glad that you brought this up and I'm really glad that hopefully audience members will hear this is I think there is a huge stigma around aging, particularly aging in the workplace, particularly amongst women. I think a lot of women are afraid that if they bring up some of their concerns around their health that they might be further marginalized for demoted or not allowed to advance further. And so I think there's a stigma there from a social perspective, and I do see positive signs of that evolving and diminishing, but it's not totally gone in certain parts of the country. So I do want women and their employers to realize that these are normal life changes that can be adequately addressed more than adequately addressed, so that women can continue into, I consider this my prime and their prime and be a really productive contributor to their workplace as well as at home.
(06:15):
So in terms of further stigma, I think when you look at from the care providers like OBGYNs, typically those are the first providers, women we will frequently turn to. And if you're lucky, you have A GYN who is really well-versed, done a lot of post-residency self-education to learn more about the most evidence-based solutions for the menopause array of symptoms. And it's not just hormone therapy, but we can talk about that in a second. But unfortunately, when you look at some of the very recent statistics within the past two or three years, there was a survey of all the OB g OBGYN residency directors in the country, and only about 23, 20 4%, we need to just fact check that number 2320 4% said that they offered any sort of menopause related training during that four year OB GN residency program. So oftentimes it's not that the OB GN doesn't care or doesn't want to support their patients well, but maybe they don't have the right foothold and education and background to really support a person's needs when they go to their doctor's office.
(07:18):
Some women will turn to their family practitioner or their internist primary care providers. And when you look at the residency training program there, I think the recent survey said, let less than 10% of those residency programs offered any sort of menopause training. And it's not. I think the problem is human beings, our bodies and systems are so complex, like even OB, GYN, there's so much to pack in and learn safe gynecologic health STI prevention, contraception, oncology support too, that it's really hard to make sure that everybody is learning every single important piece. Thankfully, I think more and more educators in these programs for residents are realizing how important the need is there to support. Oftentimes women will spend half their life postmen.
Alyssa Place (08:03):
Wow.
Dr. Janet Choi (08:04):
Yeah,
Alyssa Place (08:05):
I mean, one of the things that I've written about and we talk about on EBN is this idea of culturally competent care. And I really think that that does apply when you're talking about menopause. And I wanted to start talking about some of the treatments and how women can get access to doctors who are trained or who have the resources that can really guide them and what those resources and treatments look like today.
Dr. Janet Choi (08:28):
So it can range from instance, our progeny menopause clinical educators. The minute a member onboards, if their employer decides to adopt a menopause program, every single member is assigned their own nurse clinical educator who's been well-versed and trained in the areas of perimenopause and menopause. And so that first step, just symptom validation, hearing the members' needs goes a very long way to providing that initial really kind of badly needed and missing support. The number of calls that I've heard come into our clinical educator teams. It's really remarkable to me how many times women will come in saying, yeah, I turned to my physician a few years ago, but then I kind of gave up because when I talked to 'em about X, Y, Z symptoms, they kind of dismissed me and didn't offer any solutions. So I just thought I had to kind of grip my teeth and bear it and then just suffer through it.
(09:18):
I didn't realize there were resources. So having someone meeting them at the front door validating their symptoms and educating on things like lifestyle tips, how to move, change your movement patterns, how to tweak your diet to really kind of optimize how you're feeling now in midlife can go a long way. And then more importantly, helping you connect the dots to, if you want a medical provider connecting you to someone who is specialized in the area, whether it's a women's health nurse practitioner or a GYN or an internist, again, additionally trained in the area of menopause. And one relatively easy way to see if your provider has gotten sort of sought an extra certification is to see if they have that MSCP initials after their name and their MD or their NP sign doesn't necessarily mean that if they're missing those letters and it stands for Menopause Society certified practitioner here in the us, if they're missing letters, doesn't necessarily mean that they're a bad provider.
(10:17):
They might be very well-versed. They just haven't taken that extra test. But that's one way to sort of suss out how do I find a provider who might be able to meet me for all my personalized menopause needs, and not only looking at things like menopause hormone therapy, estrogen, progesterone, although that can be very effective and comes in a whole wide array of forms. Very safe for the vast majority of women who might benefit from it, not just from a hot flush perspective and sleep perspective, because if night sweats are really perturbing your sleep, some individuals find that after a month or two of starting hormone therapy, if they agree with their provider that this is what they want to try out, they're finding their sleeping better, their mood is better, their ability to work and cognitively function at work is so much sharper and improved.
(11:07):
So it can be hugely beneficial. And for those of us who are really worried about, I'm personally worried about osteoporosis because I have a family history of osteo osteoporosis, which by the way, later in life, hip factors are one of the leading causes of mortality for women as they age. So hormone therapy can actually help you reduce the risk of losing bone so rapidly during this midlock transition. So that's one of many solutions. And again, it's important to connect with the right provider to figure out, one, tell them what you're personally comfortable with, what your symptoms are, what your needs are. And I know that some of our providers actually work hand in hand with specialized rdns dietician nutritionists to help people figure out a probe that meets their needs based on dietary adjustments, exercise and movement. Our team can also, a very under mentioned symptom or issue associated with menopause is GSM, genital Uase syndrome and menopause.
(12:09):
I think a lot of people are a little bit embarrassed to talk about it. That's like constant leaking of urine when you cough or, and you don't necessarily have to have had past pregnancies, although that does increase your risk of having this vaginal dryness and pain rendering sexual intimacy to be very uncomfortable and actually untenable in many cases. So getting connected with the right resources there, whether it's learning about things like over the counter safe lubrication and moisturizers to use, or getting connected with a pelvic physical therapist specialized in the area of women's pelvic floor needs. Those are the tools that I think everyone really needs access to. And you as the employer actually have the power and the ability to actually support your female employees this way by providing them access to this.
Alyssa Place (12:56):
Yeah, I mean, I think there's so much education and knowledge that a benefit manager needs to have in order to do that. I mean, at Progeny, you're really offering this as sort of one platform and one package. In addition to all of those benefits that you mentioned, I think it's important perhaps even therapy services, access to mental health support. Are there other cultural benefits that could help women during this time? I mean even just sort of an open communication of a sense of open communication with an HR leader like I am having this symptom, and what can you provide to me? What are some of those other things that could really make this journey a little easier for women?
Dr. Janet Choi (13:42):
So what I actually really love, one of my different hats that wear is as an educator with our team members. And so for our clients and prospects, we will offer up menopause, educational menopause 1 0 1, educational one webinars. And the reason why I love leading those is those are the, the audience members are the most actively vested and interested the number of questions that come up. And typically the word goes out through HR to the Women's health ERGs, but the questions that people have desire for really solid evidence-based education knowledge is powerful there. So I think that what I find interesting is because HR leads, you have so many issues that you have to handle and support for your team. Oftentimes HR leads might say, you know what? No one's really talking about menopause. So I guess it's not an issue and it's not for lack of desire to support your employees.
(14:41):
I think you need to go to your women's health ERGs, and I think you don't need to even very little conversation starter, just tell me how you feel about menopause and perimenopause and the floodgates will open and you'll very quickly realize how much need is there. And as you very importantly mentioned, Alyssa, that tie in to the mental health needs and support is vitally important. And so even if maybe you're not quite ready yet to adopt a full on menopause benefit, although I do think it's relatively cost effective to do so, enabling your women's ERG groups or I learned from one employer, one of their heads actually started a midlife menopause support group and it was highly attended. And that community building actually, and understanding amongst the employees that they were not alone was not just hugely comforting, but I think normalizing for a lot of those employees who actually thought they were going through this all by themselves. Additionally, having that connection to the really important mental health resources should you need them is vitally important. And so one of the things our clinical educators will do is if they find an initial anxiety or depression screen that a member might benefit from some additional support, they can then connect them with the employer's mental health needs.
Alyssa Place (16:08):
And we talked a lot about what you're doing at Progeny. What is next? Are you continuing to offer, you mentioned so many different things. Do you have anything new on the horizon or are you just continuing to get this platform out to as many employers as possible?
Dr. Janet Choi (16:26):
Everything sky's the limit. So for me as an OB, GYN reproductive endocrinologist is a topic that is very near and dear to my heart, and I'm very excited about the amount of interest research employer interest. They're actually, Rhode Island became one of the first states this summer to require employer led support in the workplace for midlife changes. But for us as a company, we're continually looking to expand the specialized menopause provider network that's available to our members. So all menopause specific trained providers, whether virtual or on the ground, brick and mortar, and integrating that information because we're very much data driven, connecting the dots with wearables. So whether it's an oral ring or some other wearable to try to see what can we do about your activity to try to increase that and might that actually impact some of your concerns around weight and heart health?
(17:30):
And so that's one of the many areas that we're looking into. I also am excited about the fact that, as we talked about earlier, there's increasing community awareness and community building. I'm on the clinical advisory board for a group, Halle Berry's company called Refin, and that's the company that we find very exciting at progeny and me personally because it is taking that kind of old message that sometimes women going through the normal aging midlife processes that they're becoming feeling increasingly marginalized and pushed to the side and actually celebrating this midlife change, building community, building further coaching and physical activity support. And so those are one, it's like a few of the ways that we're looking to expand.
Alyssa Place (18:23):
Yeah, I mean, at least I cover mental health a lot for EBN. And one of the things that I've seen is that there's been such a shift around the conversation where it used to be like, I would never share that I'm going to therapy or that I'm doing anything. And now it's like, if you don't go to therapy, there's something wrong with you. So conversation has completely changed. And when we talk about menopause and we see celebrities and we see commercials about this, how can that actually be used to a benefit manager's advantage? This is really a conversation that people are having. It's trendy. You have really successful, beautiful middle-aged women talking about this. How can they use that momentum to even bring this up to people above them and say, this is something we really need to jump on.
Dr. Janet Choi (19:10):
So I think it's actually can work very powerfully to the benefit managers advantage, starting off with employer brand differentiation. So by offering this kind of benefit, you can tell your number crunchers that you're actually signaling further commitment to including women of all ages across all aspects of the adult life spectrum, and also help improve recruitment and your own reputation, as I said a second ago, in terms of retaining your employees, supporting women at midlife as opposed to them seeking early retirement because they can't cope well. You get to retain experienced talent at the peak of their careers and further their growth and development and while also furthering your company's growth and development. And also just show that again back to the brand differentiation. It's actually deeper than there's a culture signal in the most positive way. Taking this proactive stance to show your employees that your leadership actually values all life stages. So creating safety in the workplace and loyalty from your employees.
Alyssa Place (20:17):
You mentioned at the beginning of our conversation that you feel like you're in your prime right now, and I wanted for you to share any advice that you have for other women who might be going through this stage of their life and perhaps not feeling in their prime or they are, what is your message to women and benefit leaders that this is a worthwhile cause to invest in?
Dr. Janet Choi (20:39):
So starting off with a very granular micro level, that woman who might feel like, I'm not feeling the best, I actually feel like I'm sinking. One, realized that that is potentially one of the many signs and symptoms of perimenopause and menopause, that it's not necessarily you per se, but some of these symptoms that maybe aren't getting the right support and treatment. And so instead of, I think succumbing to that entirely, and I know it's very hard because especially if you're deep in the depths of dystymia or depression, it's hard to crawl out of that. But recognizing that there are supports not necessarily actually almost immediately available if you just kind of take the effort if possible, to get some help. And maybe it could be something as simple as just talking to a girlfriend of yours who is going through something similar, recognizing that you're not alone.
(21:29):
That could be a first baby step. And then potentially turning to your provider. You might be surprised. Your provider actually has the resources and the wherewithal to be able to support you. And if not, turn to your hr, they're there to support you and say, Hey, I have some new needs that are coming out. What kind of benefits do we have in our suite? Because sometimes there's so many available, it's hard to tease out what can I use here to really help me over this hump? And so I think there are so many different levels of support. I think if you also look at other venues that are necessarily benefit related, but again, community building, there are increasingly, maybe because I'm the right demographic, I'm getting constant feeds on LinkedIn and Instagram, but there are a lot of very positively reinforcing links there to help when going through this space, understand that they're not alone, that they don't need to resign themselves to this, that there are ways to actually support themselves so they feel more powerful, so they feel more healthy.
Alyssa Place (22:40):
Great. Well, listen, Dr. Troy, thank you so much. It was really wonderful speaking to you. I learned a lot and I really appreciate your time.
Dr. Janet Choi (22:47):
Melissa, thank you so much. Really appreciate the opportunity. I'm so glad that you're interested in this and gave us the opportunity. I really thankful for that. Appreciate.
