Breast surgeon Mariela Vasileva shares how she, and other medical professionals in Bulgaria, wised up to the challenges of treating menopausal women
‘It is harder to crack a prejudice than an atom.’ About a year ago, I bought a magnet with this quote from a church in Stratford-upon-Avon, during my visit to Newson Clinic. I was seeking validation - for my thoughts, for what I had observed in my practice, and for the path I had already begun to take.
I am a breast surgeon. My career choice was driven by a personal desire to qualify in breast cancer treatment. Life eventually led me to work as the sole breast surgeon at the first IVF clinic in Bulgaria. There, I deal daily with hormonal imbalances, breast pain, fibrocystic disease and, of course, cancer.
As surgeons, we aren't typically taught about hormones. I used to believe that breast conditions - other than cancer - didn't require treatment. To a "serious" surgeon, seeing those patients felt like a waste of time.
The turning point
In my daily practice, I sometimes felt ineffective. If a patient had cancer, I knew exactly what to do. But what if they didn't? Year after year, patients returned with unresolved issues: premenstrual breast pain, recurring fibroadenomas, and extreme tenderness. At some point the questions I asked about symptoms and the responses I got expanded - insomnia, brain fog, vaginal dryness, and more. I needed to know how to help these patients, and my search for answers led me to Dr Louise Newson.
Our initial meeting was brief, but I left with her promise to visit Bulgaria soon.
Challenging the status quo
Bulgaria is not known for a well-organised or reliable healthcare system; we have one of the lowest life expectancies in the EU and the highest rates of avoidable mortality. In such an environment, even mentioning perimenopause or menopause feels like a major victory.
With the support of my team and hospital, we planned a spectacular event with a very special guest – Dr Louise Newson. For the first time, we invited patients and medical professionals to the same forum. We designed a comprehensive program, featuring a broad spectrum of specialists: cardiologists, neurologists, gynaecologists, endocrinologists, psychologists, and myself - the breast surgeon.
We learned so much from one another, but we learned the most from Dr Newson. She demonstrated what is possible when you combine immense passion with high-level professionalism. She was marvellous.
Breaking the prejudice
Before her lecture, I often heard skepticism from colleagues, comments such as ‘HRT is more complicated than you think,’ or ‘We can’t just give hormones to everyone’. Surgeons aren't always considered the intellectuals of the medical world, but this dismissive attitude still felt wrong. We are all reading the same papers so why was my understanding so different to theirs?
During Louise’s lecture, the audience hung on every word. I watched them quietly reconsider everything they thought they knew about prescribing hormones. By the end, the tension in the room was palpable, centred on one unasked question: ‘What happens next for menopausal women in Bulgaria?’ For some of the patients in the room, Dr Newson’s lecture was a long-awaited validation of their suffering; for some of the medical professionals, it was a bold disturbance of their professional comfort zone. For everyone, it was a challenge.
A new standard
What happened next was a transformation: we established a new standard for menopause treatment in Bulgaria. We are no longer looking for excuses; we are bravely providing solutions. As a breast surgeon, I have played my part, but this progress only happens with a great team and a visionary leader. I am lucky to have both, and I am deeply grateful to Dr Newson for leading the way.
Find out more about Mariela Vasileva’s work at raknagardata.com
