In this episode of "Healthcare on the Rocks: Employee Benefits with a Twist," Dr. Nora Lansen, Chief Medical Officer at Elektra Health, discusses an often overlooked but crucial aspect of women's health: menopause.
Dr. Lansen, a board-certified family physician with extensive experience in women's health, sheds light on the complexities of menopause and its impact on women in the workplace. She explains that menopause is not just a moment in time, but a journey spanning 20 to 25 years of a person's life, including perimenopause and post-menopause.
The conversation reveals staggering statistics from Elektra's workplace survey, such as "one in three women reported that menopause negatively impacts their work performance" and "20 percent of women have left or considered leaving a job because of menopause symptoms."
Dr. Lansen describes how Elektra Health is working to "smash the menopause taboo" by providing comprehensive, virtual care for women experiencing menopausal symptoms. The episode explores various ways employers can support their menopausal workforce, from hosting educational events to offering Elektra's services as a covered benefit.
Key Takeaways From The Episode Include:
- Menopause is a long-term journey, not just a single moment, affecting women for 20-25 years
- Common menopausal symptoms like brain fog and memory issues can significantly impact work performance
- Many women feel unsupported by their employers during menopause
- Employers can benefit from supporting menopausal employees, who are often at the prime of their careers
- Addressing menopause care can help prevent other health issues that become more prevalent during midlife
Stay in Touch!
- Connect with Nora Lansen on LinkedIn
- Visit Elektra Health
- Learn more about the Springbuk Activate Partner Marketplace and get other related resources
- Get the complete 2024 Employee Health Trends report and other related resources
- Connect with our co-hosts Brittany Hardaway and David Pittman
--
Episode Transcript
[00:00:00] David: Welcome back to Healthcare on the Rocks, Employee Benefits with a Twist. I'm David Pittman, Vice President of Marketing at Springbuk.
[00:00:07] Brittany: And I'm Brittany Hardaway, Director of Strategic Partnerships here at Springbuk. Today, we're bringing attention to an important topic in women's health with our special guest, Dr. Nora Lansen, Chief Medical Officer at Elektra Health. Nora is a board-certified family physician with extensive experience in women's health and preventive care. Before joining Elektra, she provided care at One Medical and Galileo Health, and led a team of over 100 clinicians at Galileo. Welcome to the show, Nora.
[00:00:39] Nora: Thank you so much, Brittany and David. Thanks for having me.
[00:00:43] Brittany: Of course. So, Nora, you've had a fascinating career journey at the intersection of healthcare and technology. Can you tell me more about what drew you from primary care to more specialized menopause care at Elektra?
[00:00:57] Nora: Absolutely. I am a primary care physician first and foremost, and I always will be. I'm a family physician. I did my training at the Institute for Family Health in Lower Manhattan. It was a federally qualified health care center, and so I really have my roots in serving the underserved and trying to optimize prevention, and navigate our very, uh, complicated healthcare system. Um, in the beginning of my career after residency, I worked at One Medical providing primary care in person. And, I had a sharp focus on women's health. I did a lot of reproductive health, um, at that time, and some mental health as well, uh, and also helped to support my team with people management, and then I moved on, after about 8 years seeing patients in New York at One Medical, I moved on to Galileo where, uh, I, I explored virtual primary care, so Galileo Health is a primary care solution, um, for, for women in the virtual space.
And after about five years I was missing women's health and starting to experience my own symptoms of perimenopause that didn't even dawn on me to be attributable to hormones and started to think about if it wasn't dawning on me, probably there are a bunch of people, um, not in the healthcare sector who are also wondering what these new symptoms are. So I decided to try to bring some of what I had learned in the virtual space back into, uh, the primary care and reproductive health space, and so that's why I joined Elektra.
[00:02:38] David: Really interesting background and I'm glad that you found your way over to this, this space. I think you'll be very helpful to a lot of women. So how about you start by giving us just kind of a back to basics view, high level, of what menopause is?
[00:02:54] Nora: Yeah, it sounds like a basic question. It is complicated, and I think that there's this narrative around menopause being a moment in time that the medical community has not really done much to sort of unravel what that means.
And so menopause in and of itself is, it's like a retroactive categorization, which is weird. But you can't really call it menopause until it's over. So menopause is a final period and then 12 subsequent months without any bleeding. After that's over, we say, okay, you just went through menopause, now you're postmenopausal.
So that in and of itself is a little strange when you're in the middle of menopause you can't really call it menopause until it's over and perimenopause. Those are the years leading up to the final period. Those, uh, years are strife with hormonal fluctuation, as is the 12 months that you're not having bleeding and experiencing menopause as are the years after menopause. So menopause is really a continuum.
Um, it can start in the early 40s. For some people it starts a little bit before 40. The years of perimenopause can last, you know, for 10 to 15 years until that final period and then on the other side, 10 to 15 years of postmenopause. So we're really talking about, we're using menopause as kind of an umbrella term to try to capture, capture both what is 20 to 25 years of a person's life.
And so that's not just a moment. It's not just a pause It's a really big long journey
[00:04:35] Brittany: That was a wonderful explanation. As a woman, you know, in her 40s, I can certainly relate. There's some pretty staggering statistics out there about how menopause impacts women in the workplace. Can you walk us through some of them?
[00:04:49] Nora: Yeah, absolutely. So Elektra did a study called Menopause in the Workplace. It was a survey in 2022 and some staggering statistics resulted from the study. So it was a survey of 2,000 professional women, um, managers, directors, C suite executives. And what came out of the survey, um, was a general understandable and not accusatory, revelation that, we're not feeling that supported at work.
So one in three women reported that menopause negatively impacts their work performance. And I can dig into that a little bit more. But in addition to the hot flashes and night sweats that we classically associate with menopause, there are some neurocognitive symptoms like brain fog and short-term memory loss that really are not only scary, but obviously impactful on work performance.
Twenty percent of women have left or considered leaving a job because of menopause symptoms; 18 percent reported that they hadn't pursued a promotion because of menopause symptoms. And 44 percent said that they felt that their employer could do a better job of supporting them during menopause.
So our survey reflected that we could do more to support people going through those 20 years of, um, of symptomatology related to fluctuating hormones.
The good news is that it's not like employers have tried so hard and failed. It's more that I think employers haven't known how to have the conversation. It's a sticky issue. It's, you know, there are issues of, um, gender equity and also what I think sometimes is even harder to navigate is, uh, issues of ageism.
And that comes in part from just the, the challenges of aging in Western society. It's difficult, right? Like, it is a whole host of complexities. And so, as women aging too, we have to, um, just sort of come to terms with how we're feeling about getting older. And so, understandably, how our employer may be communicating with us surrounding those issues is, is important.
It's, you know, it's fragile, it can be a fragile conversation. So what we're trying to do at Elektra is help to empower employers and women experiencing symptoms to have this conversation, to have it in a way that feels safe and supportive and not to, uh, not to, to make anyone feel anxious about having, you know, a reasonable conversation about, about symptoms.
So, our CEO and founder wrote an op-ed for Fast Company in 2022 and had some suggestions for making things feel a little bit more reasonable and making the topic feel more approachable. Um, her first recommendation was to embrace transition and I think that's true at any age, um, of any gender that we do not stay in one spot in our whole lives that, um, that we don't stagnate and therefore it's important for our employers, if we're with an employer for a long time, it's important for them to support us through whatever we are experiencing and change is a part of life. So for a long-term employee, that means embracing change, um, create thoughtful confidentiality was another recommendation that I do think is really important.
You know, making sure that there's a space to go to have a conversation, which may be with HR or maybe with, uh, you know, a trusted resource. Um, but just making sure that that door feels open and also that the employees know where to go and how to access that space. And to commit to environmental changes and plans for the future.
So, you know, I think it's really easy for most of us to get accustomed to policies and protocols and sometimes they're great and they work well and they last a long time. And at other times you really, you know, we outlive the policies we put in place, uh, in the past. And so it's time to make a change. So mostly it's about embracing change, and I think, again, that's not just on the part of the employer and our culture, but also on the person experiencing that change as well. Just coming to terms with that, acknowledging it.
[00:09:51] David: You said 44 percent of the respondents in your survey They felt that their employers could do more to help them through this. So how, let's, let's explore how does Elektra work with, with the patients to help develop a care plan.
[00:10:09] Nora: Yeah, so Elektra is a digital-only, uh, health solution. So, uh, that means that we clinicians are seeing patients only virtually. And so, a patient can come to us either through their employer as a benefit or just find us online and enroll in clinical care services and then just as in a traditional outpatient in-person setting, an individual makes an appointment to meet with a clinician, so we are a team of menopause certified physicians and NPs.
And so we'll have a video visit with a patient and in some ways it feels like a traditional office visit. We're reviewing a patient's past medical history, anything that's relevant, as well as their current symptoms, coming up with a treatment plan that works for them, uh, and then meeting with them again to make sure that the treatment is working or to refine things or answer additional questions.
And then Elektra has a program, um, of guidance that offers patients the opportunity to have touch points with a menopause guide. We sometimes refer to them as menopause doulas, so as in the birth and pregnancy experience. It sometimes helps to have someone, a non-clinician, who's there to have open dialogue with you along the way.
And this is also true in the menopausal space, and so we have a team of guides available to work with a patient separately from the clinician, but sort of bridging the gap between clinical visits and to provide information because it's like there's never, you know, there's, we can't over discuss this topic, again, it changes, our symptoms change as we move along during this continuum of our hormonal journey and also new information is revealed as we've already seen in this space.
There's new science, new research, new treatment options, and so having a team, of care providers at Elektra is, uh, It's really the goal and to, to really be with the patient along the full journey and not just for, you know, one quick visit to prescribe a solution.
[00:12:30] Brittany: Okay, so besides being virtual, how does the philosophy of care at Elektra differ from a traditional OB/GYN or PCP experience?
[00:12:41] Nora: What I found as a traditional PCP, you know, as I mentioned earlier, I've always been really passionate about women's health. Um, my training, uh, did not, and this, this is very, uh, representative of the broader training of PCPs and GYNs did not encompass in a meaningful way any sort of education about menopause treatment.
And part of that is because, at least when I was in training, we were still, you know, kind of suffering from the aftershocks of the women's health initiative. It was a huge study launched in the late 90s, tens of thousands of women.
The study has been ongoing actually, but there was a particular arm of it that studied hormone therapy for women in menopause and the study was called off early because the initial data was so concerning. It revealed major questions about the safety of estrogen replacement. It seemed to suggest that there were some really deleterious adverse outcomes associated with estrogen replacement like heart attack, stroke, breast cancer, and so we quickly stopped prescribing estrogen even though it had been a pretty common place to use it to treat symptoms of menopause prior to the Women's Health Initiative.
Once those early findings were published, the medical community sort of removed estrogen as a treatment option. And so all of this to say that when the next generation of healthcare providers was being trained and hormone replacement was not an option, it became marginalized as a topic. So because there wasn't much definitive treatment to offer, it was sort of like, well, you can exercise, sleep better, make sure your nutrition is good, meditate. And those things are important. There are basic building blocks of optimal health, but if you are someone who is experiencing really concerning symptoms, like brain fog or memory impairment, and you think that there's really something wrong with you, having, you know, the advice to get more sleep feels, it doesn't resonate.
So, the traditional community clinicians, traditional PCPs and OB/GYNs just haven't had as much menopause-specific training as I think they would have wanted to have at this point with an established practice. If you're in the community and it's up to you to try to learn menopause medicine, how do you, how do you carve that out in your day?
You've got a busy practice and plenty of patients to take care of and, uh, addressing symptoms that don't feel as urgent as other clinical conditions, you know, if someone comes to me and I've got a busy practice and they are prioritizing their incapacitating hot flashes, I may reassure them that they're not going to die from them, but I really have to talk about their cholesterol or their poorly controlled diabetes.
That's how we continue to sort of push menopause into the sidelines. And so while a busy GYN or PCP might not have time to really, in a comprehensive way, address their patient's menopausal symptoms, at Elektra, that's all we do. We are really focused on midlife and menopause care. And so, uh, we know how to treat, we know how to listen, we know how to prioritize, and we mean to partner with a patient's care team.
So if they have a PCP and a GYN whom they love and have a great relationship with, we honor that, and we want for them to continue that, and we can collaborate with their in-person care team, um, and make sure that they continue to have a fruitful relationship with those providers. But we are providing menopause, midlife-specific care at Elektra as opposed to what PCPs and OBGYNs in the community are trying to do.
[00:17:16] David: Yeah, let's explore that just a little bit more. Elektra is, as you said, a virtual option, so it's not designed to replace the in-person care. A little bit more about how you do work with those providers?
[00:17:30] Nora: Always we are really first and foremost just prioritizing to the patient that it's important that their entire care team know what's going on, if we're adding any prescriptions, that they are notifying their, their care team, and then we are also sending, you know, any relevant information back to the PCP or GYN. And if a person doesn't have a PCP or GYN, then we're helping them to establish care with someone in person. Because again, we don't want to replace the in-person providers.
We really want to make sure that a patient is covering all of their preventive health needs, uh, and ideally they have a person whom they trust and see regularly to go for in-person stuff.
[00:18:19] Brittany: So, in addition to serving as Elektra's CMO, um, you mentioned that you're also still seeing patients and providing care and that's, you know, one of your, your great passions. Uh, we understand that from this conversation, menopause is typically underdiagnosed. What are some of the common themes that you see during your visits?
[00:18:39] Nora: I would say probably the most common conversation that opens a visit with a patient is the patient telling me that they've heard so much about menopause They don't know who to listen to. They don't know what's for them They don't know what's legitimate.
And so we often start there. I think it's amazing that menopause is having a moment or hopefully it's more than a moment that it is really risen to a much more central position in the public consciousness and that we're talking about it more freely and that we're prioritizing it for, you know, like half of the adult population of our, of our country.
And so patients are following people on social media who have one recommendation or another. Their primary care physician may or may not have a recommendation. Their cousin, sister, auntie, grandmother, mother may have their own advice, um, or I once heard a patient say that her mother told her, “oh, I didn’t go through that. I didn’t have menopause.”
So, you know, we’re coming at this from a variety of cultural standpoints too, where sometimes it's not even spoken about and so a patient has done their own research online and so usually we'll, we'll start by talking about what information the patient is coming with and what particular questions she may have and then talking about, you know some of what I've already mentioned here, and trying to figure out for the patient what her priorities are, what is bothering her the most, because what may be tolerable for one person may not be tolerable for another, figuring out the spectrum of concerns that a patient has and how best and to treat them and what the most appropriate treatment options for them are, what the patient is a candidate for.
The other thing that most patients come in with is this concern, as I said earlier about going crazy or feeling like I don't feel like myself. I had one patient tell me she felt like she was lost at sea. Um, just feeling like I haven't done anything different in my routine. My exercise is the same. I'm eating the same. Yeah, I'm stressed out, but that's about the same. And yet, I feel totally different and I feel like there's something wrong and so just providing reassurance and validation often gets us really far into the conversation of, okay, what do we do next? I think that's a huge relief for most people to know that they're not going crazy and they're not alone.
And then, finally, again, people often will come with a strong relationship with the PCP or GYN, and yet they have no information about menopause. Usually people have tried to speak to their doctor about it a few times, um, and sometimes the doctor says, well, I just don't know menopause medicine, which, you know, as mentioned, there are reasons for these knowledge gaps.
Often patients will come after having tried a few different avenues and sometimes they'll hear, you know, you're my last stop before I, I go to the neurologist to make sure I don't have a brain tumor or dementia. Um, so people have, uh, again, a variety of symptoms, a variety of level of understanding, but usually those are the common themes.
[00:22:22] David: Quite the range that you have to deal with. I love your, your motto at, or mantra at Elektra. It's, uh, to smash the menopause taboo. And so you were alluding earlier to how that has come to be. How do you think about this taboo of menopause in the workplace and what do we need to do to get past it?
[00:22:46] Nora: Yeah, I do think that we have come pretty far in smashing stuff. The menopause conversation is, I mean, I don't know if you guys feel this way, but I feel like it's kind of everywhere I look right now. Maybe that's because it's my job, but also I feel like I'm seeing it all over social media and in conversations in the media.
So, that's great. I feel like the taboo is pretty well on its way to being smashed, but then comes the next step, which is, okay, well, it's okay to talk about it, how do we talk about it? I think there are these intertwined aspects of, um, gender considerations and age considerations that we do have to take very seriously and ensure that we are meeting, individuals in menopause where they feel comfortable.
I would not recommend that an employer, um, approach an employee who often is like, you know, waving a fan in front of her face and say like, gee, it looks like you're having some hot flashes, what can I do for you? But really just opening the door to a conversation and making sure that, uh, employees know at the outset where to go when they're ready to have the conversation.
You know, it's not like the HR, the head of HR needs to have the conversation about whether a patient or an individual is in perimenopause or menopause, but giving them the resources to further explore what they're experiencing.
And so ensuring that everybody has a general amount of information, um, from the get-go and then offering a safe space to talk further and, you know, not making someone feel like they're at risk of losing their job or that there is something wrong with you, I think you like need to take some time off to go figure that out.
And really just supporting a conversation in a nonjudgmental way.
[00:24:54] Brittany: So we talked a bit about how Elektra works directly with patients and members, right? But how does Elektra work with employers and their health plans?
[00:25:06] Nora: There are a lot of different ways that, uh, an employer and their health plan can partner with Elektra. So there are non-committal ways, like Elektra can come and speak at an employee resource group event.
So that's just like one way to get the conversation going. We've done that in the past with a variety of employers, including Reddit and Estee Lauder, um, and Guidewire software. So people really love that event. So that's one way to, to just, you know, figure out if there is even, uh, interest.
I think there is this perception that, well, you know, I don't think any of our employees are interested in that. That's because the topic hasn't been brought up and that's probably not because they're not interested but really because they don't know how to speak about it or are afraid to bring it up. And so hosting an ERG is a great way to demonstrate that there's interest.
Employers can also offer Elektra as a covered benefit. I've seen many patients that way, actually, they'll come to me and say, yeah, I, I, I, my employer offered this and I wanted to come and check it out. And then I will even have patients who don't know much about perimenopause and menopause and do just want to check it out because it's an employer benefit, and then when we start talking, they honestly can't believe how much a description of these symptoms resonates with their experience.
It makes sense given that over 50 million women in our country are navigating this journey. And so there are probably many more people at work who are, um, experiencing some of these symptoms than, than might be super obvious. We offer the opportunity for employers and health plans to partner with us just for our guide based services, so as I mentioned before, for non-clinical services, we offer the opportunity for, uh, partnerships for individuals to become members.
It's like a, a nuanced distinction, but members have access to thousands of hours of vetted content on our member platform. They have access to one-to-one sessions with our menopause guides. Um, they have access to a community of, uh, of people also experiencing symptoms of menopause, so the membership component of Elektra can be a standalone. It does not have to include the option of clinical care provided by a clinician.
Um, one of our first partners for this membership option was Mass General Brigham Health Plan, and it was so successful from the outset that in the first week, we had to expand the number of seats available right away. And that was before, you know, anyone had gotten any feedback about whether Elektra was any good or not.
And then the final thing I'll say is, I think one of the aspects of care, providing care at Elektra that I love the most is we're a very mission-driven company and we are really focused on increasing access to menopause care for all.
It's not meant to be reserved for only those who can, you know, pay thousands of dollars out of pocket to see a menopause expert. This is, again, care that is meant to span a number of years of a woman's life. So we really are trying to promote and facilitate increased access. And so we're partnering with a number of health plans including some Medicaid plans and Medicare plans and really trying to to ensure that everybody has access.
[00:29:14] David: Well, it's a great mission. Uh, My wife has gone through that phase already and I was there along with her. I wish that she had had access to some programs like this. It certainly could have helped
[00:29:30] Nora: Yeah,
[00:29:31] David: Both of us, I think.
[00:29:32] Nora: Absolutely, David! I think that illustrates a really great point, which is that partners, family members of women who may not be experiencing menopause symptoms themselves but their loved one is experiencing menopause symptoms. A lot of patients come to us that way, um, by their partners encouraging them and yeah, that's really meaningful, um, so yeah, I wouldn't discount the importance of that for sure.
[00:30:01] David: Well, let's get to the difficult part here. So employers have so many options these days of solutions, point solutions, vendors to choose from, and of course, limited budget. So why should they prioritize a menopause benefit?
[00:30:21] Nora: Yeah, hopefully I've made the point during our conversation that it is not just a single moment in time and that there are, you know, by virtue of the number of women experiencing perimenopause and menopause symptoms, by virtue of the many years that this hormonal journey evolves over, um, it is really in an employer's best interest to support a person during this lengthy, uh, phase of, of life.
And we're talking about people who are at the prime of their career often, you know? The average age of menopause in this country is 51. That's often the age at which someone is well established in their career, um, maybe high up in an executive level, uh, and companies generally want to retain people with that level of experience.
The other issue is midlife, not just menopause, um, but menopause is an inflection point for an increased risk of a number of health concerns.
We do know that estrogen protects against a number of conditions associated with, um, later age. So dementia, high blood pressure, cardiovascular disease, cardiometabolic illness. As estrogen starts declining during the forties and fifties, we lose women lose that protective benefit, and therefore we see spikes in cholesterol, in the incidence of heart attacks, in the incidents of stroke.
And so we want to make sure that, that patients are also addressing not just menopausal symptoms, but the conditions that start to increase in prevalence during that time of life. So I should note that at Elektra, the level of care that we provide is so comprehensive that we're making sure that a person is up to date with their preventive health screenings as well.
Have they had a cholesterol panel in the last few years? Have they had their blood sugar tested in the last few years, and if not, we will order that for them too. We will make sure that they're connected with the PCP to continue care as warranted for any of those issues, but, you know, we're really ensuring that an individual who is in the prime of their life can stay physically primed as well, um, and I think that that's something that any employer should feel invested in.
[00:32:59] Brittany: Nora, thank you so much for joining us and sharing your insights today. As I mentioned before, a woman in her forties, I can certainly resonate, you know, with all of what you've mentioned today.
If our listeners wanted to learn more about Elektra Health or connect with you, what's the best way for them to do that?
[00:33:17] Nora: You can find Elektra Health on LinkedIn and on Instagram and you can find me there as well, Dr. Nora Lansen, um, and I look forward to hearing from any interested patients, employers, as mentioned, always happy to continue the conversation in a more focused fashion.
[00:33:40] David: Wonderful. Nora, thank you again for joining us and thank you to all of our listeners for tuning in once again to Healthcare on the Rocks, Employee Benefits with a Twist. Please don't forget to subscribe, leave a review if you are so inclined, and we'll catch up with you in the next episode. Till then, stay healthy and stay informed.
.png)
