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WOMEN’S WOMEN’S
HEALTH HEALTH

Does Having a “Y” Chromosome vic floor disorders and prolapse, incontinence, recurrent UTIs and its impact on women and providers' thinking persists. What I know
At that time, my practice had a large number of women with pel-
Ultimately enough light was shed on the flaws of the WHI, but
Make Being an Expert in Women’s interstitial cystitis, all of whom had significant improvements in their for certain is that every single woman that comes in my office has a
clinical conditions and symptoms with HRT. Within weeks of stop-
unique experience with peri-menopause and menopause, and their
ping their hormones, they began coming in with worsening symptoms care must be approached with an individuality that reflects that
Health an Oxymoron? and prolapse. I struggled to find a provider locally sympathetic to the experience. Each woman is an N=1 in my practice. That unique
plights of these women. I found two organizations, North American approach has privileged me to be able to discover a number of
Menopause Society (NAMS) and International Society for the Study
It is not at all uncommon to find the condition in women in their
of Women's Sexual Health (ISSWSH), that were doing independent women with premature ovarian insufficiency. The youngest is 21.
By Timothy C. Hlavinka, MD
data analysis of the WHI and countering the clinical recommenda- 20s currently.
tions made from the findings. The controversy continued despite evi- I have daughters now, thus initiating the third phase of my keen
to believe her that it was possible; her mother having gone through the
The year was 1982. I was a sophomore med student. We were in Cor- same process at the same time did not seem to register at all with any of dence of the flawed data analysis and recommendations made from interest in women's health. One can only hope that First Lady Jill
pus Christi visiting my in-laws when my mother-in-law sat me down at the providers. Thus, began what became an all too familiar pat on the same by the NIH. Biden's initiative on research in women's health begins to overcome
the kitchen table early one morning before anyone was awake. "Tim, I hand moment, with the statement, "It must be something else, but we What happened next is best summed up by the referral of a patient that lack of gender appropriate and pertinent research. It is far past
think I'm going through menopause (she was 41 at the time), but the don't know what it is exactly." From me, "Could it be menopause? Her from a local internist, "Go see Hlavinka, he's the only one I know that time for it.
doctors say I'm crazy and it won't happen for another 10 years!" She mother went through the same thing at the same age?" Another tsk tsk will give you THAT STUFF!" As if I were prescribing anabolic ste- For additional reading: www.whitehouse.gov/briefing-room/
listed her symptoms ... night sweats, hot flashes, vaginal dryness, low moment, "Doctor, why don't you focus on being a husband and not a roids, or worse. I studied. I researched. I learned. I attended meetings statements-releases/2024/03/18/fact-sheet-president-biden-issues-
libido, lack of energy, difficulty focusing — so from me, "Gretchen, it doctor, and let us be her doctors?" I will not communicate what went of ISSWSH and NAMS. I documented outcomes. Those were lonely executive-order-and-announces-new-actions-to-advance-womens-
sure sounds like menopause to me. Let me research it and get back with through my mind at the time, but it was not pretty. days for HRT prescribers. health-research-and-innovation/
you." I have noted that it is a wise practice to listen very carefully to one's
mother-in-law, and pay close attention to what is being said. This was my National Institutes of Health (NIH) began the Women's Health
first and most critical introduction into the uniqueness of the menopaus- Initiative (WHI) studies in 1991. The studies would proceed for 15
al experience in women, and in the need to provide assiduous personal years. 160,000 women ages 50-79 were studied. The cost was enor-
research, data analysis, and draw my own conclusions. mous at the time. The findings were first released in 2002. The hubris
I researched it. The contemporary Ob/Gyn textbooks and journals and bias of the members of the NIH panel that leaked the findings
were not much help. There was little there to guide me in counseling about breast cancer increases in women on HRT to the Washington
her. It would be decades until the dearth of high-quality research into Post have been well-documented. Wanting no part of scientific analysis
women's health issues came into public awareness. Fast forward to absent their own interpretation of the data, the results exploded in the
1996, my fifth year in practice. My spouse (also 41 at the time) began media and frightened women stopped their hormones immediately
having symptoms of early menopause. We struggled to find someone without consulting their doctors.

Timothy C. Hlavinka, MD, is the Medical
Director of Vidamor Medical and has been
a member of the Bexar County Medical
Society for three decades. The father of five
and grandfather of four, he firmly believes that the
power of collegiality among physicians has great
potential to bring us lasting and effective changes in
healthcare. Dr. Tim is anxious to hear your stories.

30 SAN ANTONIO MEDICINE • May 2024 Visit us at www.bcms.org 31