March 2012

Let’s Talk Menopause

Let’s talk menopause. Some people think of it as a disease. However, it is a natural consequence of aging. Many make the assumption that we know all there is to know when it comes to treatment. However, it is a relatively new phenomenon. Think about it. In 1900 the average life expectancy for women was 43 years. Menopause has only been something we have had to deal with for three generations. My grandmother was born in 1900 so she was amongst the first to make it beyond menopause, then there is my mother and myself following in suit.

In the past, those suffering from hot flashes, fatigue and mood swings were started on Premarin and Provera. Premarin is made from pregnant mare urine and Provera is a synthetic progestin not to be confused with natural progesterone. Most women were kept on these hormones and common medical opinion was that they prevented osteoporosis and heart disease.

All that changed in 2002 when the results of the Women’s Health Initiative study were released and the study was stopped because it was found that the risks of these particular hormones outweighed the benefits. Instead of putting almost every menopausal woman on hormone replacement, the majority of women were not started on them, were pulled off of them, or stopped them on their own.

Needless to say there were and are a lot of hot women running around who are a little testy because they are not sleeping and are sick of having to deal with their menopausal symptoms. Let’s talk about the study and what was found and who was studied. Then we can talk about alternative hormone therapy.

The study (started in 1997) involved over 16,000 women who were on average 63 years old, had a uterus and had never had a hot flash. They were either treated with Premarin (0.625 mgs) and Provera (2.5 mgs) or a placebo. Over 10,000 women who had a hysterectomy were either treated with Premarin alone or placebo. Many women in both groups had high blood pressure and high cholesterol that was being adequately treated.

The study was stopped early when it was found that those on combination hormones were more likely to have a stroke, heart attack and breast cancer than those on placebo. In those treated with Premarin alone there was no increased risk for breast cancer or heart attack but a slight increased risk of stroke.

Younger women (ages 50-59) who were treated within 10 years of going through menopause had a slightly decreased risk for developing heart disease. Women over 65 who were treated had an increased risk of developing dementia.

Here are some things to consider. When one looks at the group treated with Premarin alone, there were fewer associated risks. Provera seems to be the more dangerous medication when it comes to heart attack and breast cancer risk. In addition, most physicians would not start a 63-year-old woman with high cholesterol and high blood pressure on high dose hormones. The reason being that we know that hormones can increase the risk of clotting which would potentially precipitate a heart attack and stroke. Perhaps the increase in dementia was due to this as well.

I think it is important to know what the decision to stop hormones was all about. Knowing this, you can decide for yourself if hormone replacement is for you. To do that you need to know what else is out there. Premarin and Provera are rarely prescribed anymore. There are newer options called bioidentical hormones. These hormones are recognized as natural hormones by the body. Are they for you? Stay tuned!

More on these options in the next blog.

Menopause Treatment For Those Who Do Not Want Hormones

For those who are going through menopause and would like to avoid hormones there are many things that may help. Here are some suggestions for how to deal with the problems that I call the big three; hot flashes, insomnia and weight gain.

Hot Flashes

Two thirds of menopausal women suffer from hot flashes. Twenty percent find them insufferable. Hot flashes actually make you feel like you are igniting from the inside out. You can soak your shirt in the blink of an eye. This can be quite embarrassing and downright uncomfortable. What to do?

• Believe it or not there are certain foods that may help stop the hot flashes. A recent study found that eating a half-cup of soy nuts and dividing them up into three or four portions a day cut hot flashes in half. Another study found that keeping a steady blood sugar by eating frequent meals during the day decreased flashing.

• Exercise can reduce body mass and that can decrease the number of hot flashes.

• If these measures fail, there are medications such as SSRI antidepressants that may reduce hot flashes. Herbs such as black cohosh are a popular remedy. Study results have been equivocal. It has helped some of my patients but not others. Certain alternative therapies such as acupuncture and meditation also can help you beat the heat.

Insomnia

Many women find that during and after menopause they have difficulty falling asleep and/or staying asleep.

• The key is to avoid caffeine and alcohol several hours before bedtime.

• I have found that hypnosis is very effective for helping people get to sleep and fall back to sleep if they wake up in the middle of the night.

• Supplements such as theanine and tryptophan may also be useful.

• It is important to discuss this problem with your doctor. Make sure that any supplement you take is safe with other medications you may have been prescribed.

Weight gain

At menopause, women start to lose muscle at a precipitous rate. This along with slowing metabolism can contribute to weight gain. However, this does not mean it is inevitable.

• Aerobic exercise, strength training and healthy eating can keep menopausal women from gaining weight.

• Hypothyroidism occurs in a large percentage of women at menopause. It is important to have your thyroid function checked if you are gaining weight. Many of the symptoms are similar to menopause so it can be missed.

Menopause can be very manageable without hormones. The key is to eat well, exercise and find a physician who can work with you in partnership to help relieve your symptoms. And remember,

“There is no more creative force in the world than the menopausal woman with zest.” Margaret Mead

It is time to go out there and get some zest!

Love And Loss Remembered

I wrote this blog almost four years ago. I think it is appropriate to republish it as I see my friends going through similar experiences. Here goes.

As a baby boomer, I have joined the ranks of many of my brethren and can say I am part of the “sandwich” generation. I have children who are teenagers and I am helping them to leave the nest. I had a parent that needed my help to fly and leave his nest as well. How many of you have similar stories to the one I am about to tell?

On June 19, 2008 I lost my father. I would say that he died, but he wouldn’t let us use that term. He preferred that we say he “transitioned”. My father was an amazing man. He lived life with integrity and purpose. He was 84 years old and his mind was as sharp as ever. He had renal failure and had been on dialysis. His body was getting weaker and weaker and he finally decided to stop the dialysis. This allowed him to “transition” on his own terms. Once again his strength and dignity prevailed.

Having now gone through the experience of losing a parent and being there for the transition, it has caused me to look at how we see and experience death in our culture. I realize that each person needs to be allowed (whenever possible) to die on his or her own terms.

My father had expressed his wishes to my family and me well in advance and we were able to discuss them with him and understand what he wanted. He also put these wishes into a legal document known as a living will. In his, he put me in charge. At the time, I didn’t realize how important that was. But, when the time came, I had to act.

I felt like Shirley MacLaine in the movie “Terms of Endearment” when she was fighting for pain medications for her daughter who was dying. I had to scream for morphine for my father when his lungs started to fill up with fluid. Fortunately, after quite a bit of drama, he was able to get what he needed and I honored the promise that I made to him. His transition was peaceful and I am happy that he got what he wanted. In the wake of all this is a massive amount of grief, which is a natural part of life.

I share this story so that it will allow you to pause and think about whether you have a living will. Have you discussed the issues of death and dying with your loved ones? Although many of us live as if we will never die, that is one of those things that is inevitable for all of us.

Although death is never easy, knowing what my dad wanted and knowing that we were able to provide it both with the living will and details of his funeral that he planned ahead of time, made things better somehow.

Death is a natural part of the cycle of life. It is okay to talk about it and to address it when it is staring you in the face. But, it is also important to say all the wonderful things you want to say and understand the wants and needs of others before an emergency situation develops.

Hug your children, your parents, your brothers and sisters and your friends. Tell them you love them as often as you can. That is what my father taught me. I am glad I was able to tell him that many times before his grand transition!

Where Do Broken Hearts Go?

Valentine’s day is over and it may have been a great day for you. For others it may have been stressful as a result of a traumatic break-up or the loss of a loved, which could literally cause a broken heart. What do I mean?

Broken heart syndrome occurs when there is a sudden trauma, and due to the stress the body releases a huge amount of adrenaline that acts like a stun gun to the heart. As a result the heart muscle fails to work properly and patients appear to be having a heart attack. They may experience chest pain, shortness of breath, sweating, nausea, and fatigue, and they can develop congestive heart failure. That is the bad news.

The good news is that they do not suffer a true heart attack. The heart muscle is not damaged permanently and the patients usually recover within a few days. Once back to normal the chance of it happening again is slim to none.

No one knows why, but postmenopausal women around an average age of 60 are those at greatest risk. It is important to be familiar with this condition and to be alert to the women in your life who suffer the loss of a loved one or experience a traumatic break=up. Although they generally recover, if patients do not receive care and support quickly this condition can be life threatening.

Where do broken hearts go? Hopefully to the hospital where they can be nursed back to health and recover quickly!

 

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