The Hidden World of Chronic Disease

Susan J. Baumgaertel, MD explains how chronic disease can often manifest without any external visual signs – an analogy to the menopausal journey!

Sometimes hiding things can work to our advantage: an early pregnancy, a disfiguring scar, public speaking anxiety…Easter eggs!

But, more often they are just temporarily hidden from public view and, in the grand scheme of things, it can actually be a relief when they are “found.”

Enter the world of chronic disease and things rapidly become much more complex. Chronic disease can often become manifest without any external visual signs, such that nobody really can tell what others may be experiencing.

And that, right there, is at the heart of the matter.

So many chronic health conditions come with baggage – pain, fatigue, work disruption, social impacts, to name just a few. Family dynamics are also often profoundly impacted.

The obvious conditions are from general disciplines familiar to most:

  • Endocrine – diabetes, thyroid disorders
  • Cardiovascular – heart disease, peripheral vascular disease, arrhythmias
  • Neurologic – Parkinson’s, multiple sclerosis, dementia, stroke, migraines
  • Rheumatologic & Autoimmune – rheumatoid arthritis, lupus, osteoarthritis, inflammatory bowel disease
  • Psychiatric – depression, anxiety, bipolar disorder, ADD

And the above group of conditions just serves as an example from a much longer list.

Here’s where menopause sneaks into the picture for most women. The hormonal journey starts long before “12 months without a period.” And, postmenopause essentially continues until the end of life.


When #menopause sneaks in: the hormonal journey starts long before “12 months without a period.” And, postmenopause essentially continues until the end of life. Click To Tweet


Is menopause a disease?

Absolutely not!

For most it is a natural transition women go through during their life journeys. Yet, it has many characteristics that mimic chronic illness – especially often the hidden parts:

  • The trip from pre- to post-menopause typically spans many years and sometimes more than a decade;
  • Many symptoms can be intrusive, hard to manage, impact daily life, impair mental and physical well-being, and sometimes are misunderstood;
  • Medical care is often sought, and not just from Western medicine;
  • Even in our current era, talking about menopausal symptoms can almost be taboo in some social circles and work places;
  • And – as if adding insult to injury – the incidence of other chronic diseases increases in the postmenopausal state.

But, back to the hidden part…

I will never forget one day when I was rounding in the hospital on-call, seeing patient on the cardiac telemetry unit. I was about 7 months pregnant (very visibly so) and had arrived at the nursing station to write a few notes. I glanced around but couldn’t see any open chairs.


“Is menopause a disease? Absolutely not!”


A lovely nurse leaped to his feet and offered his chair to me, much to the relief of my aching feet. The kindness didn’t stop there, however, as the same nurse dashed over to the staff break room and brought me some Jell-O. When I left the hospital a bit later on the way to my car to drive to work, I recall someone holding the door open for me.


Fast forward to now.

I have had a chronic illness – rheumatoid arthritis – for 22 years. Nobody offers me a chair or some Jell-O, or opens the door for me with the same courtesy as when I was in my third trimester. My feet are constantly on fire and I always struggle with door handles – good thing I don’t like Jell-O!


I have had a chronic illness – rheumatoid arthritis – for 22 years. Nobody offers me a chair or some Jell-O, or opens the door for me with the same courtesy as when I was in my third trimester. Click To Tweet


My chronic disease is not really visible. The struggle is real for so many others too. And, if we lump menopause into this category, it becomes quite clear that most women will experience some version of chronic “illness” even while enjoying perfect health.

I truly believe the onus is on BOTH sides to be more transparent and accommodating. Let’s strive for more kindness (I always try to hold the door open for others) and understanding, even if – and especially if – there are no visual cues that someone else may be having a difficult time.

More importantly, let’s work on demystifying the menopausal journey and make it normal to talk and ask about it. My MenopauseMenu website is an open attempt to share knowledge, ask and answer questions, and have a place that is supportive and nurturing.

It feels good to be seen – and heard!


Tweet this:

Earn CME credit:

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Leave a Reply

Your email address will not be published. Required fields are marked *

Subscribe To Our Newsletter

Get updates and learn from the best

The Beautiful Music of Balance

The Beautiful Music of Balance

Dawn L Baker MD, MS challenges us to think of work-life balance as an orchestra, where all the instruments represent your different roles in life.

Grace - A Gift or a Journey?

Grace – A Gift or a Journey?

Robert Saul, MD writes that to accept the grace of God and others might be our fate, but to make it meaningful requires us to be on a journey to accept that grace and pass it on.

Susan J. Baumgaertel, MD FACP

Navigating Your Health (with Dr. Susan Baumgaertel)

Dr. Baumgaertel draws upon her 30 years of experience as a physician in primary care internal medicine, and uses her personal story-telling style to communicate with you as if you are sitting right across from her. Pull up a chair and enjoy.

Doctors on Walks Getting Food

Explore casual conversation between doctors walking, & then grabbing a bite, in this light knock-off of a Jerry Seinfeld favorite!

My DPC Story

Their DPC Stories

Physicians are increasingly looking to different practice models, as burnout rates continue to climb. This series explores the DPC model.

Support A Platform that Celebrates Real Doctors

For just $10 a month, you can help keep this openly accessible site available to all & help us sposnor in more doctors.

I acknowledge that this site is not to be used for medical advice.

Play Video
Our Founder Answers Your BURNING Question


“Why should I become a member of SoMeDocs if I already have my own space online?”