Face to Face
The Maven of Midlife
June LaValleur, M.D., is making men and women pause to consider the health of middle-aged women.
By Miriam Karmel
June LaValleur, M.D., pauses mid-sentence, then snaps her fingers as she tries to retrieve a word that is stuck in her memory bank. Finally, conceding defeat, she shrugs, smiles, and confesses, “I’m having a menopause moment.”
LaValleur, an associate professor of obstetrics and gynecology at the University of Minnesota, should know. She is, after all, the woman who brought menopause to the attention of the university’s medical school faculty. Not that the condition was unknown. It simply wasn’t part of the curriculum in the mid 1980s when she was a student.
For LaValleur, who entered medical school at age 41, women’s mid-life health issues were more than just an academic interest; they were the reality she was living. Determined to learn more about a subject that wasn’t on anybody’s radar screen here, she traveled to Philadelphia, where she did a rotation as a resident with Dorothy Barbo, M.D., who ran one of the first menopause clinics in the country.
Upon returning to the Twin Cities, she said to her department chair, Leo Twiggs, M.D., “You’re doing a @#!%* job of teaching residents about menopause. And there are 40 million women out there. You’d better do something.” Two months later, he offered her a teaching job.
Although LaValleur hadn’t contemplated an academic career, she grasped that she could reach many more women by teaching residents than she ever could by working one on one with patients. Since she began teaching at the University of Minnesota in 1991, LaValleur has mentored dozens of students, sharing her expertise on such topics as menopause, hysteroscopic surgery, sexual dysfunction, osteoporosis, and hormone therapy.
But one of the most important lessons she tries to impart is to love what you do. And this she teaches both by word and example. “I advise students,” she says, “that you really have to be passionate about what you’re going to be spending a huge amount of your time doing. If you’re not, it’s a drag.
“There’s never been a day that I haven’t looked forward to my work.” For emphasis, she adds, “Not one. I love what I do.”
Reading Between the Lines
Much of what LaValleur teaches can’t be found in medical texts. She tells her students: “If you can learn anything from me, it’s how to be with your patient. How to listen. How to have a second sense about something.”
Some would call that the art of medicine, which LaValleur agrees is trickier to teach than how to do a procedure or an exam, or how to prescribe medications. She encourages her students to work with women to help them manage the changes to their health and sexual lives that come with maturity. She teaches by example, “by being a role model in how to be with patients.” Then she adds, “You have to teach them [students] how to read between the lines.”
And that means knowing what to do when the patient who has answered “fine” or “great” to questions blurts out, just as the exam is ending: “I feel great during the day. But when I come home at night, if my husband’s pickup is in the driveway, I get nauseated.”
It means being prepared for the patient who says, “You’re the first person I ever told about my sexual assault.”
“Every day you make it up,” she says of how to handle those situations. The 63-year-old LaValleur attributes her ability to “make it up” to age and life experience. “I think it has to do with starting medical school at 41, being mature,” she says. “It’s just common sense.”
Unflappable
LaValleur has acquired such common sense and a common touch while navigating an uncommon life path. As she tells the story of finding her life’s work, it becomes clear that she has told it many times before. She hits the high notes in rapid succession: engaged in high school; married at 19; X-ray and lab technician for 10 years after high school; got bored and returned to school; physician’s assistant for six or seven years. Then through what she calls “a series of life events,” including the loss of a job, she made the decision, at age 39, to go to medical school. Two years later, after completing the requisite pre-med courses, she became the oldest student to enter the University of Minnesota Medical School in 1983.
When LaValleur began her training, the youngest of her three sons was a sixth grader in Osakis, Minnesota, a small town 120 miles northwest of the Twin Cities. She remembers how she had to borrow money to hire someone to stay with her children after school. On weekends, she went home to clean and cook. In spite of that delicate balancing act, she graduated four years later in 1987.
Sitting with LaValleur in her cluttered Moos Tower office on the Minneapolis campus, it is easy to understand why her patients open up to her. She is friendly and approachable and appears so unflappable that it is hard to picture her as a woman who once was nervous about coming to “the big city.” She is comfortably dressed in a soft velour shirt, loosely draped slacks, and Birkenstocks. It is the Christmas season, so she is sporting a Christmas stocking pin and sparkly tree earrings. These disarming touches momentarily lull a visitor into thinking that she is chatting with a neighbor at a holiday tea, and not a woman whose curriculum vitae is more than 40 pages long and whose schedule is so jammed that although she knows she is traveling to Chicago on Friday to deliver a talk, she won’t even bother with the details of the trip until she picks up the folder with her ticket the night before.
These days, LaValleur wears so many hats and is involved in so many projects that it’s hard for even her to keep track of them all. In addition to teaching, conducting research, and seeing patients, she directs the University of Minnesota’s Mature Women’s Center, which was established in 1991 to conduct research into osteoporosis, hormone therapy, and pre- and post-menopausal symptoms and treatments. She serves as course director for the Advanced Rotation in Women’s Health, which focuses on many of the leading health issues for women as they age, including contraception and unwanted pregnancy, heart disease, management of menopause, osteoporosis, breast cancer, obesity, and Alzheimer’s disease. LaValleur also is an instructor in the Rural Physician Associate Program, a nine-month elective in which third-year University of Minnesota medical students live and learn alongside physicians in rural communities. And she serves on several advisory boards, including the Minnesota Women’s Physicians Advisory Board, Women’s Health America, and the medical advisory committee of Planned Parenthood of Minnesota/South Dakota. On top of those activities, last year she found time to organize her Ashby, Minnesota, high school’s 45th class reunion.
Teaching and Treatment
Since 2002, LaValleur has often found herself in the center of the fray surrounding hormone therapy. As a longtime investigator for the Women’s Health Initiative, she took part in the now controversial hormone therapy (HT) study. After the HT study was halted in light of preliminary results that associated the treatment with increased risk of heart attack, breast cancer, blood clots, and stroke, she’s been looked to as an expert on the topic. In a fall 2004 publication of the Department of Obstetrics, Gynecology, and Women’s Health at the University of Minnesota, she stated that the way the HT information was presented to the public incited fear in many women. “Since 2002, how women manage some of their menopausal symptoms was turned upside down,” she said. “A big piece of what I do in my clinical practice is to try to help women interpret data from the studies and inform them of the real risks of estrogen therapy.”
LaValleur has always favored taking a more personal approach to HT, treating every woman who walked through her door as in individual, rather than prescribing a one-size-fits-all regimen. Today, the treatment she offers includes plenty of reading material for patients and plenty of discussion.
“It takes a lot of time to sit down and inform patients about menopause,” she says. That’s one reason why LaValleur enjoys working in an academic setting, “Nobody says I only get to spend 10 minutes with a patient, she says, adding that it’s difficult to have just a 10-minute conversation about menopause or any women’s health concerns, for that matter.
In her research, LaValleur is also exploring common-sense approaches to treating problems such as hot flashes and decreased libido. Recently, she joined a team that’s conducting a 13-week study of a 1,800-year-old Japanese formula for treating hot flashes that could prove to be an alternative to HT. The nonhormonal treatment is the No. 1 therapy for hot flashes in Japan, where more than 400 million doses have been prescribed since 1994.
In addition, LaValleur is conducting two studies using testosterone patches to improve low libido in women. As with HT, she does not regard it as a one-size-fits-all treatment. And she fears that too many women will be clamoring for testosterone, given the media hype that has dubbed it the female equivalent of Viagra. “It doesn’t work at all like Viagra,” she says, adding that many factors affect libido, and testosterone isn’t the magic bullet for all of them. But that won’t stop women from demanding it. “Many women in this society want something to make them better yesterday,” she says. “They want a pill to do it.”
Low libido is just one of her concerns about women’s health. “There are so many,” she says, citing obesity, contraception, and access to health care as tops among them. “If I could change anything, it would be that women have equal access. Women often put themselves in second place,” she says, explaining that so many women fail to get mammograms, Pap tests, or prenatal care.
Although LaValleur is adamant about access to care, she is less concerned about women having access to the kind of specialized care she has been so instrumental in creating than she is about women receiving quality care. “They [women] should be seen by someone who understands the difference between men and women.” And those physicians must be willing to listen. Although more of her colleagues are paying attention to the needs of middle-aged women, she says this is still an area where physicians need education. If LaValleur has one piece of advice for her colleagues it is this: “Listen to your menopausal patients and help guide them through this period of their lives.” MM
Miriam Karmel is a Minneapolis freelance writer.