Margaret Nachtigall, MD: Big Picture OB/GYN Care


How women's health burdens touch genetics, psychiatry, cardiology, and whether physicians are equipped to manage it all.

Menopause management entails a wide spectrum of genetic risk, symptom prevalence, and comorbid conditions which frequently include psychiatric burden. There’s enough to wonder whether the field is capably resourced to address each of its factors.

In an interview with MD Magazine®, Margaret Nachtigall, MD, reproductive endocrinologist and clinical associate professor in the Department of Obstetrics and Gynecology at NYU Langone Health, discussed the greater aspects of OB/GYN care.

MD Mag: Is there a protocol in place to address a patient’s inherent risk for menopause symptoms prior to onset?

Nachtigall: Usually, the decision whether to test someone for those genetic factors would be based on their personal history. Have they ever had a blood clot; did they have any bleeding or any blood clots during the pregnancy; did they ever use oral contraception in their reproductive years, was there any reason why they themselves would be at an increased risk of clotting?

And then of course, their family history—did either of their parents or siblings, or first-degree relatives, have any blood clots? That would be an indication that that might be an individual who should be tested. But otherwise, it's not generally tested.

MD Mag: What issues in psychiatry and mental health are most common in relation to OB/GYN patients?

Nachtigall: Well, that's really a huge topic, so I hope you have like 5 hours, maybe more.

Anything in mental health or psychiatry can really be related to OB/GYN. I think what you're specifically getting at, is that with the change in the menstrual cycle, with estrogen and progesterone levels fluctuating, there's definitely an effect on mood. And again, here's where every person is different, because for some women the increase and decrease of estrogen doesn't make so much of a difference. But for others, it can be dramatic.

So, in the reproductive years, issues with premenstrual syndrome premenstrual tension, premenstrual dysphoric disorder—all of these factors can be at play. And manipulating the menstrual cycle, sometimes going on in a birth control pill, patch or ring, can be really helpful in that environment. Then getting into pregnancies—some women never felt better during pregnancies.

Sometimes, pregnancy is a sign where depression started. And of course, we all know about postpartum depression, where estrogen and progesterone levels plummet the first 3 days after delivery. Levels can go from up in the thousands down to less than 30, and so this is a time when postpartum depression is a very big issue.

We have to be prepared for it, and able to treat it. And then later in menopause, often the first presenting sign of menopause is a change in mood, sometimes depression, other factors that are involved with the mental health professions. So we definitely rely on our friends in the psychiatric and psychological worlds.

MD Mag: Do we have an adequate amount of therapies designated to treat OB/GYN issues?

Nachtigall: I mean, I think the great thing about the care of menopausal women is that this is a field that's ever-evolving. And as we said, it's a multi-specialty phenomenon, and what we want to do is keep women living longer, healthier, and more active.

And so, whatever we can do to take care of patients throughout this period of time, I think is effective. I think we could always use more help in any of these areas, but I think we're in a time where we're constantly doing new research, constantly investigating new ways of therapy. So, yes and no.

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