When Medical Caution Becomes Patient Abandonment

Most doctors told her no.

Breast cancer survivor. Genetic blood clotting risk. Severe menopausal symptoms destroying her marriage, her sleep, her ability to function as a mother and professional. The medical system’s answer? Too risky. Nothing we can do. I had to abandon the assumption that menopause care is straightforward. Most physicians treat symptoms in isolation. Hot flashes get one treatment, sleep problems another, mood changes a third. This fragmented approach fails when patients arrive with complex medical histories. My patient couldn’t use estrogen. Standard hormone replacement was off the table completely. But her symptoms were devastating every aspect of her life.

Building Treatment Around Constraints

When estrogen isn’t an option, I sequence alternatives strategically. SSRIs become first-line for hot flashes, mood symptoms, and insomnia. For isolated hot flashes, medications like Veozah offer targeted relief. Vaginal dryness responds well to hyaluronic acid moisturizers as a starting point. Then comes the controversial decision: topical testosterone. Most physicians won’t consider testosterone for breast cancer survivors. The theoretical risk feels too high. But there’s no data suggesting testosterone directly causes breast cancer recurrence. Older studies actually suggest it doesn’t increase risk. Yes, some testosterone converts to estrogen, but that risk is low with careful monitoring. When a patient understands these risks completely and chooses to proceed, I support that decision.

Creating Medical Safety Networks

Supporting patient choice doesn’t mean practicing recklessly. I build collaborative safety networks before starting any high-risk treatment. I call her oncologist and breast surgeon directly. Most doctors practice defensively and send patients away. I create comprehensive monitoring systems with specialist buy-in. As a concierge physician, I have advantages traditional practices don’t. I spend one hour with each patient. They have direct access to my cell phone between appointments. I see complex patients monthly, sometimes more frequently. This intensive monitoring makes me comfortable treating cases where quality of life is severely compromised. Time creates the foundation for taking calculated risks safely.

The Human Cost of Undertreated Menopause

I’ve seen the psychological wreckage of abandoned patients. Severe depression, chronic insomnia, crippling anxiety, and physical pain because women haven’t gotten the care they deserve. My breast cancer patient had tried every recommended remedy. Her symptoms remained severe. Without sleep, facing the loss of her marriage, unable to care for her family or perform at work. She wanted to be heard. We made a treatment contract. Aggressive surveillance for abnormal symptoms. Perfect screening protocols. Close follow-up with all physicians. Her other doctors understood her perspective, even if they wouldn’t take the same approach themselves. They acknowledged her suffering and supported the collaborative monitoring plan.

Rethinking Acceptable Risk

Traditional medicine often conflates caution with good care. But when caution becomes abandonment, we’re not protecting patients. We’re failing them. Menopause affects every system in a woman’s body. The long-term health risks of untreated symptoms often outweigh theoretical treatment risks. Bone density loss, cardiovascular changes, cognitive impacts, relationship destruction, career disruption. These aren’t minor inconveniences. My approach requires more time, more coordination, more careful monitoring than standard practice allows. But it also prevents the human devastation I see when women are told their suffering is acceptable collateral damage for medical risk aversion. Every patient deserves individualized care that weighs their specific risks against their actual quality of life. The alternative is a healthcare system that prioritizes institutional comfort over patient outcomes. And that’s a risk I’m not willing to take.