Does NHI fail older women?

I feel like I’m going as crazy as this tiger

I know I seem to have abandoned Lao Ren Cha for a bit. I didn’t want to, but I had a bunch of other (paid) writing work, and my job situation changed slightly. One employer did something that’s difficult to forgive, so I went full-time with the other. What’s more, I’m in the throes of (somewhat early) perimenopause. It’s important to be frank about women’s health and the challenges we face, so I want to talk about it.

I haven’t been writing as much because it’s really hard to do so in the throes of a hot flash. Contrary to the name, they are not flashes, they are long, uncomfortable periods of feeling like every part of your body that has an angle or curve is emitting heat and sweat like a polyester-clad buttcrack in a Taipei August. Like I’m trapped on Mount Doom and just can’t chuck the ring in.

As for how long they’d last, well, you know how sometimes when you get on public transportation and there’s that weird sweaty person with messed-up hair that you try to avoid? That was me a few times, riding the blue line from Nangang to Tucheng, one class to another. Practically melting the plastic seat under me for the entire ride.

It’s also made me more sensitive: I’m still not over Carrefour, which had fantastic, affordable own-brand items, turning into the Greater East Asian Co-Prosperity Dystomart or whatever the fuck it’s called these days. I just haven’t been in a great mood.

To combat these changes, I’ve of course been seeking treatment. I’ve relied on, and mostly been impressed by, Taiwan’s National Health Insurance for the past twenty years. I’ve never felt the need to seek supplementary insurance, although it hasn’t always covered what I’ve needed it to. My tooth implant is a prime example. I hope I never need another, but I probably will.

With perimenopause, however, it’s been a different story. I’m very loyal to my OB-GYN because she speaks English (I do speak Mandarin but past experiences have resulted in me saying things like “我的妹妹很癢” so maybe it’s better if I just don’t). Plus, she’s a straight-talker. I once wore a t-shirt with a picture of Jesus that said “Disappointments, All of You” to an appointment, only then noticing that she was wearing a little crystal cross, and she tactfully ignored it. She’s a good one.

However, what she’s been able to offer me, and what it costs, has in fact been a disappointment that would make Jesus weep. Perhaps I need a second opinion, but according to her, there aren’t many treatments for perimenopause that are covered by NHI. Unfortunately, none of the covered options worked for me.

First, I was given Tibolone, which is a popular treatment for symptom alleviation. Google says this is not covered by NHI, but I could swear I paid very little for it. In any case, it induced a period so bad that it ruined one day of my Vietnam trip in January. We’re talking floodgates. Honestly, you don’t want to hear more than that. Absolutely not, no thank you, next.

Oh yeah, and like the covered medications, it didn’t actually work. I still got frequent hot flashes, which are my worst symptom, and I was still depressed for no good reason. (Or many good reasons, if you’ve been watching the news at all).

Now, I’m on an estrogen gel and progesterone pill, neither of which are covered. The gel costs NT$1000 or so per bottle, and a bottle lasts a month. Some women can reduce their dose to make it last two months, but I can’t. One pill is NT$50, and on my treatment plan I need 42 of them to last two months.

These are working. At least, I don’t have hot flashes every day, and they don’t last as long as they used to. They’re now triggered by specific things instead of randomly coming on, and if I can avoid those things I’m generally fine. I’m just not used to having to pay over NT$1500/month just for the basic treatment I need to live my life.

I complained about this when I got my tooth implant and will complain about it again: a proper NHI system, which Taiwan mostly has, shouldn’t just cover what you need to survive and cheaper elective treatments (like acupuncture) because they’re popular. It should cover what a doctor actually says you need, even if you could technically survive without it. I needed a tooth; not having one put my dental health in jeopardy as missing a tooth can cause problems with the teeth around the gap.

Likewise, I can survive without treatment for perimenopause, but I can’t really live. This isn’t the United States; Taiwan is capable of covering a range of medications so that every woman can find one that works for her. If none of the covered medications work for some people, the only sensible response is to expand the list of what’s covered. I’m lucky that I can afford to pay out-of-pocket for the only thing that stopped my hot flashes and bad mood, but not everyone has the cash. Are poor women just supposed to suffer? Again, this isn’t the United States where suffering because you can’t afford medical care seems to be the norm. That shouldn’t have to happen in Taiwan.

This is true in many areas of medicine, not just women’s health. I only happened to run up against it when I hit my forties.

I’m very grateful that other treatments I need are covered at reasonable rates. I see an endocrinologist every three months — covered. I see a psychiatrist, too, for the ADHD and insomnia (and recently, mood swings) — covered.