Gynecologist issue re: menopause diagnosis
June 19, 2020 5:33 PM   Subscribe

Short version: Gynecologist says I am post-menopausal, despite meeting none of the criteria including cessation of periods. He thinks my menstruation is post-menopausal bleeding and that I must be ill in some way. I have the overwhelming need to argue with him, but I am fairly sure it will lead to a crappy result. Somewhat ragey snowflake details inside that will likely influence your answer. I have already spent a bundle on testing and need to find a polite way to put the brakes on this. Help me find one?

I was planning to see a gynecologist in April in my home country, because I have had some vaginal pain that had begun waking me up at night. I suspected it was due to a cervical polyp I've had for several years; my cervix is incredibly sensitive. My periods have also been intermittent and sparse.

When COVID-19 hit I was in New Zealand. Due to the risks of travel my partner and I have decided to stay here for a while. A local friend recommended that I see her gynecologist, who is one of the top doctors in the nation. Due to lockdown, our first call was a teleconsult. I told him about my sparse periods, vaginal pain, and the previously diagnosed polyp and gave him my age, which is on the young side for menopause but not out of range generally.

He said the vaginal pain must be due to dryness, and seemed skeptical of the polyp. He also said that the pain was probably psychological. "That doesn't mean it's not real, but it means it comes out of fear of what's happening rather than an actual physiological reason," he said. He added that I was probably postmenopausal, and wanted to send me for a blood test to confirm. I told him that I do not have vaginal dryness, and I most definitely did have a polyp that my last gynecologist decided to "watch and wait" on, but I would be happy to get the blood test. He directed me to the NHS site about menopause to read up on the subject.

I have almost none of the symptoms on the NHS site. The ones I do have (depression and incredibly mild incontinence, like three drops of pee per day) are issues I have had for twenty or more years.

At our next (in person) appointment, the doctor said my FSH numbers were "screaming," well over the threshhold for menopause. Therefore, he said, I very likely had uterine cancer and would need a biopsy. He repeated his statement about my vaginal pain coming from dryness and I repeated that I do not have dryness; in fact my cervical mucus thickens just like it would around ovulation and thins later. He stated that I was incontinent and implied it was to the level of needing a diaper; I explained again: it's been three drops a day for twenty years, has not gotten worse. He acknowledged my statements and repeated that, I am postmenopausal and would need a biopsy to test for uterine cancer.

He then performed a vaginal exam and removed the polyp. (He seemed a bit surprised that it was actually there.) He said things seemed more normal than he expected and rather than a uterine biopsy at the hospital I could get a sonogram, and if everything looked normal then we'd look at other things than uterine cancer.

After a few days of healing from the polyp removal, the vaginal pain that had been waking me in the night went away. Hooray!

I asked him to send my blood test results. I was shocked to see my FSH was 19, which in the guidelines that come with the blood test, as well as NHS hospital guidance, is listed as "ovulatory" and is below the FSH 30+ result for "menopause" by 11. Based on the date of the test and the date of my next period, it would make absolute sense for me to be ovulating at that time.

I had to wait until I healed and then until my period was over, then got the (really uncomfortable and not cheap!) sonagram. The doctor emailed me with the results, saying "Your womb is normal for a post-menopausal woman." I responded, "Is it normal for a perimenopausal woman? Because I just had my period on {date]." He said, "Yes, but you are postmenopausal and experiencing postmenopausal bleeding."

His diagnosis flies in the face of all diagnostic criteria. My FSH is way too low for postmenopause and I don't have the symptoms. I am skipping some periods and the ones I do have are lighter, but they have all the leadup symptoms of my periods (i..e. a migraine and period shits).

Perhaps part of this is a cultural gap. Perhaps women here tend to understate things as compared to women in my country, and he is exaggerating my statements in his head to be in line with what he thought.

I recognize at this point my best option would be to get a second opinion. Or, you know, just not bother doing anything further, because all evidence points to early perimenopause. He is a well-known and well-respected gynecologist and this is a tiny country where everyone knows each other. So I'm concerned that I will have problems getting future medical care if I say, "let's stop these tests" or argue with him or try to get a second opinion.

But my "something is WRONG on the internet!" instincts are taking over, and I really want to ask this doctor what criteria he is using to evaluate me as postmenopausal and then knock them down if they're out of line (i.e. vaginal dryness, massive incontinence and high FSH numbers).

Does anyone have a good script for what I can say to this doctor to stop these unnecessary tests without screwing me over for future care, rather than, "Why are you saying I am postmenopausal when all evidence points to the contrary, you stubborn man?"
posted by anonymous to Health & Fitness (23 answers total) 6 users marked this as a favorite
Wow, I just have to say so sorry you have to deal with this bizarre man.
posted by shaademaan at 5:46 PM on June 19, 2020 [53 favorites]

I'm not in NZ and so can't speak to how big or small the gynecology society is there, but in general, when there's this level of disconnect between patient and doctor, where neither of you believe what the other one is saying, it's time to find a new doctor.

To be clear, your lived sense of your body trumps any numbers that are or aren't out of whack ("treat the patient not the numbers") but in his mind, he's Right and if he's discounting your story in a teleconsult -- when all he has to go on is your story -- he's not going to change his mind based on your internet research. I know it would feel awesome to attack his points one by one and leave triumphant like in a Lifetime movie, but frankly, that's a non-starter.

The reason why you initially consulted him (the vaginal pain) is gone after polyp removal. That's great! It sounds like you no longer have any symptoms that concern you. Tell him "thanks but no thanks on the endometrial biopsy," wipe your hands, and move on.
posted by basalganglia at 5:58 PM on June 19, 2020 [18 favorites]

Ghost him? He's not your forever gynecologist, since as you say, you are in NZ because of the pandemic and its not your home country. A patient's failure to follow up is not grounds for anything more than mild irritation on the part of the physician and their staff. Going point by point over the criteria to try to argue him out of his stubborn belief in the face of the blood tests and your actual experience seems like an ill-fated effort in massive frustration since he already discounts what you have been telling him. Ghost him. Tell your friend thanks for the referral, he removed my polyp, and that's that?
posted by spamandkimchi at 6:36 PM on June 19, 2020 [24 favorites]

Now that the polyp is out and your pain is gone, the only physical problem you're having is The Problem of Him. There's no need to interact with him again. In fact, request your records from his office now, so you don't need to deal with him later, and so you have labs and documentation to show any (obnoxious, high-handed, male) gyn you see in the future. Ugh. Signed, vicariously infuriated.
posted by cocoagirl at 6:42 PM on June 19, 2020 [38 favorites]

You don't need his permission to stop following up on this.

You're not going to screw yourself over, either. Patients quit showing up all the time. Even if he was the last gynecologist on Earth, if you needed to come back in a year, you could say "sorry, I got busy, when can we reschedule?" and start getting grudging care and snide condescension from him again as if barely a moment had passed.
posted by nebulawindphone at 6:43 PM on June 19, 2020 [11 favorites]

How great you're no longer in pain and how sucky to have to deal with this man. Just a thought, it looks like you might be able to request your medical records so could you fire an email requesting your files and his clinical notes and diagnosis so that you can have a record to share with your doctor when you return to your home country? Then take those records to a doctor elsewhere in NZ if you want or hold on to them to consult with your doctor back home. I agree with others that you're probably fine doing this because patients change doctors quite often for a number of reasons. You don't even have to explain those reasons to anyone if you don't want to.
posted by mkdirusername at 6:54 PM on June 19, 2020 [5 favorites]

Wow wow wow. Ghost him and send the records your regular gyn. If anyone in NZ sees the tests/diagnosis and asks, just tell them that this guy had wanted to be really thorough since you were a new patient and he had so little contact with you due to COVID, but you ran everything past your regular provider and in the overall context of your health, they are confident you didn't go through silent early menopause only to develop non-imageable uterine cancer, and since nothing seems to be urgently wrong, you'll follow up on any reproductive/genitalia-type concerns when you can go home and be treated by your regular provider. They might think you're being a little foolhardy, but you're not picking a fight, just making what might seem to them to be suboptimal health choices.
posted by teremala at 6:55 PM on June 19, 2020 [1 favorite]

Fuck this guy. There are a LOT A LOT A LOT of well-respected "important" male physicians who are appallingly sexist in their practice of medicine. This is how we got to where we are today, this is how physicians are trained, and this is why its so hard to fix sexism in patient care.

You don't owe him anything. Ghost him.

/cervical cancer survivor with a blessedly good gyn but then there was that shitty run-in with the oncologist consult afterwards...
posted by desuetude at 6:56 PM on June 19, 2020 [11 favorites]

i am assuming this is a white man. if you really truly cannot cope without some kind of closure on the medical issues i would suggest getting a second opinion from a poc woman who will be familiar with this kind of behavior from white men. otherwise there is no reason to subject yourself to his vile presence ever again.

and i would absolutely not worry about him being popular and well-known in the country and that somehow affecting your future level of care, because if this is how he behaves on the reg, there are absolutely many people in his profession who loathe him with the white hot rage of a thousand supernovas.
posted by poffin boffin at 10:35 PM on June 19, 2020 [13 favorites]

if this is how he behaves on the reg, there are absolutely many people in his profession who loathe him with the white hot rage of a thousand supernovas

Quoting this because favoriting it hard 1000x is not enough.

Needn't even be sexism primarily, even though in this case it almost certainly is; just industrial-grade arrogance. Even as a white cis het male I've had occasional encounters with allegedly well-respected doctors who display the same bullshit attitude. Last one was a chronic fatigue specialist who had the temerity to suggest to me that my fatigue was due to "excessive grieving" over the death of my mother four years before the consult, on the basis of my having answered "yes" when asked if I missed her. And it wasn't even him who had asked that question; it was the registrar he'd sent in first, His Grand Highness having been far too busy and important to perform any task as plebeian as showing up on time to a patient appointment.

Then there was the arsehole who reacted to my daughter's tearful reporting of severe abdominal pain by making her sit up on the edge of the trolley despite her repeating over and over that doing that was hurting her, tapping her patella with his little hammer, then declaring that he thought the issue was "probably spinal".

Frankly I fail to understand how any of these clowns gets repeat business. Fuck that noise. Dump the arrogant fuck, stat.
posted by flabdablet at 11:24 PM on June 19, 2020 [10 favorites]

Can't you just not call him back? Your business with him was resolved when he removed the polyp. I don't see why you'd even need a script. Maybe in NZ the office would call to check up? Then I'd just say "please thank the doctor but I'm no longer in pain. Thanks, bye" If the pain comes back go to another doctor.
posted by bleep at 11:26 PM on June 19, 2020

I would be surprised if doctors anywhere got together and kept a blacklist of patients who didn't follow up after they felt better.
posted by bleep at 11:29 PM on June 19, 2020 [2 favorites]

I would bet that what's going on is the first time he did an intake form he wrote the wrong (assumed) information on a chart or note, and every time since then, he doesn't listen to you or go back to check the numbers, he just refers to his previous note. and he definitely doesn't listen to the words coming out of your mouth or remember you from visit to visit.

if you could go back in time you could press him to explain the test numbers that aren't what he said they were. but finding another doctor is easier, better, and you'll have to do it anyway, you can't trust this guy even if he admits his error.
posted by queenofbithynia at 11:56 PM on June 19, 2020 [5 favorites]

I'd get a new doctor. Even a GP with women's health interest might be able to offer a second opinion.
FSH>20 in a woman not menstruating and >50 can indicate menopause but in UK/Aus/NZ is rarely measured (unless, perhaps, there is a Mirena IUD in situ stopping periods and you're keen to know). The relevant guidelines would be under RANZCOG and the Australasian Menopause Society.
posted by quercus23 at 12:15 AM on June 20, 2020 [1 favorite]

I just had my FSH tested and was curious about what levels mean in different places. In New Zealand, it may be that FSH over 20 is considered post-menopausal. In the UK, it looks like over 30 is regarded as post-menopausal. In the US apparently we've settled on 25.8. I couldn't quite figure out what the Australians think. All of this is to say, it does sound like perhaps New Zealand has a lower threshold.

Can you reach out to your doctor back home? If you're not having any more pain, and you could do telemedicine, might it be worth a conversation?

I don't see what you need to go back to this doctor if you're not experiencing any more symptoms. He sounds like an ass. But also... headaches can be a symptom of menopause, and you are skipping periods. It sounds like you are in perimenopause and maybe in a tiny bit of denial about that. I get it. I started having hot flashes and had no idea what was going on and thought I had some weird Covid fever that would come and go. Except I didn't have a fever. None of us wants to get old, and dealing with thinking through all this, especially if you're on the younger side (early 40s?), really does suck. But I don't see what's to be gained by arguing with him. Good luck.
posted by bluedaisy at 1:09 AM on June 20, 2020 [1 favorite]

I'm a doc and I got angry just reading this. What an a-hole.

I would get my file and change doctors. If he is working for an org, I would consider submitting a matter-of-fact complaint to whoever employs him, focusing on him providing inappropriate advice and inaccurate documentation (if you find the info in his charts mischaracterizes your symptoms).

Not sure if that's feasible in your situation.
What I wouldn't do is talk to him further or give him any more of my time or money.
posted by M. at 3:14 AM on June 20, 2020 [13 favorites]

After reading this, I am extremely angry on your behalf. You do NOT need to be polite to this worm. There are so many red flags in his behavior that he shouldn't even be practicing medicine. I would complain to whatever governing body there is, and make an appointment with a new doctor.

He denied your lived experience from square one (" He also said that the pain was probably psychological. "). Can we seriously not BELIEVE WOMEN in 2020?? A doctor who hauls out the ol' "hysterical" label, on a single teleconsult no less, is someone to be shunned. The fact that he would actually state "you probably have cancer" instead of simply doing the required testing to see if that's the case or not is an awful terrible no good human being and again, to be shunned.

I personally won't see a gynecologist who is male. YMMV and a female can suffer from some of the same problems of having been trained in a patriarchical society and in an especially patriarchical profession, but in my experience the invalidation you experienced here is somewhat less likely with a female doc.
posted by nirblegee at 5:55 AM on June 20, 2020 [6 favorites]

This is nuts. I would not interact with this doctor again except to get my file.

I am also not in NZ, but I am in ZA, in a particularly small and socially incestuous city, where I switched gynaecologists away from a well-respected local "rockstar" gynaecologist to another one recommended by my friend -- not because I had any complaints about his care, but because his rockstar status meant that he was booked up for months and months in advance and I didn't want to wait that long for an IUD (also, the new one was more conveniently located). IIRC the new gynaecologist didn't even care why I had switched.

From the outside looking in, it can often seem that everyone within a small community is the best of friends with everyone else, but as anyone who has been in one of those communities can attest they are full of bitter disagreements and rivalries, even if everyone is well-behaved enough to be polite in public. I would not assume by default that you will experience any negative attention if you go to a new gynaecologist (if there is even a reason for you to go to one right now) and summarise your medical history with Dr Rockstar in a neutral and factual way while expressing your scepticism towards his diagnosis and asking for a second opinion.
posted by confluency at 6:22 AM on June 20, 2020 [1 favorite]

To add to what confluency says above, chances are good other women, as well as women gynecologists, have had issues with this arrogant asshole. Find yourself a female gynecologist and get a second opinion, or go to one of these clinics. They are like Planned Parenthood clinics in the US as far as I can tell and will likely treat you better.
posted by mareli at 7:43 AM on June 20, 2020 [2 favorites]

If you're frustrated, and won't be dealing with this Dr again, then no reason not to report this, to whatever level feels appropriate :
posted by Elysum at 8:10 AM on June 20, 2020 [1 favorite]

ugh this sounds so annoying! I'm sorry you had to deal with this clown, but I am sure glad he finally got in there and removed your polyp!

I used to be really subservient to doctors because they're well educated, and I was a young woman, but now I disagree with my doctor all the time and tell him I think he's incorrect about things (I always say "what you're saying can't be right, maybe I'm explaining what's happening wrong on my end" even though that's not whats going on, he's just bad at listening.)

but my point was that I LIKE my doctor and I don't do half the tests he recommends. You don't have to do anything for this guy who isn't even your GP! I just say "I've decided against doing this test right now, we can re-assess at my next appointment if it's still relevant" if they call me about it.
posted by euphoria066 at 8:47 AM on June 20, 2020 [2 favorites]

I stopped reading the second time he told you that you have vaginal dryness when you do not. Ditch this doctor. I’m sorry you’re dealing with this.
posted by sevensnowflakes at 9:01 AM on June 20, 2020 [2 favorites]

" It sounds like you are in perimenopause and maybe in a tiny bit of denial about that. I get it."

she says, I am quoting her, "all evidence points to early perimenopause." That's her own theory you're telling her she's in denial about. Peri vs. post is the whole point of contention here.

OP: somewhere here is a clue about what happened with the doctor who closed his ears at a certain point early in the appointment. It isn't just doctors who do that.

The best thing you can do in face-to-face visits, whether in person or via video or via email portal, is to condense your concerns down to a short paragraph. Not because all problems are simple enough to fit in such a space, but because that's when people stop listening.
posted by queenofbithynia at 7:27 PM on June 20, 2020 [8 favorites]

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