Menopause is the great equalizer. It doesn't care what your occupation is, which political party you identify with, what your religious background is, what the color of your skin is, or whether you are in the 1 percent or 99 percent economically. Everyone in it is facing the same fundamental challenging symptoms and health issues regardless of social and financial standing, where they live, or any aspect of where they were raised. Got a vagina or know someone who does? Welcome aboard! We are in the same big boat together, and I want to share my story with you.
My story began in my 40s. I couldn't sleep, my mind would freeze mid-sentence, and my emotions were out of control -- I was a total bitchface! As if that wasn't enough, in the middle of my business meetings I would stand up to find that my entire outfit was suddenly drenched. My libido was crashing and for some reason my shmirshky (vagina) had taken a trip to the Sahara Desert. It was parched and dry. On a scale of 1-10, I was functioning at a 2, which left me scared, mortified and depressed.
After many sleepless nights of researching my symptoms and reaching out to the sisterhood, I figured out I was in perimenopause -- a word I had never heard before. Perimenopause is the 6- to 10-year symptom-laden time before you reach menopause. You have reached menopause when you have not menstruated for a full year (the average age of menopause is 51). Back it all up and you find that perimenopause generally begins between the ages of 38 and 48 years young! Some women, like supermodel Karolina Kurkova, find they have a thyroid condition that can cause them to go into early menopause at the age of 24! Early menopause can happen to anyone.
Why had no one ever told me about this?
Are you experiencing any of these symptoms? Has your lover, mother, aunt, sister, friend or coworker encountered them? Did your mom ever sit you down and tell you about what happens when the period starts to pack up and leave?
Three letters changed my life: HRT. No, it is not an abbreviation for heart, although I do love my heart. HRT (hormone replacement therapy), also know as HT (hormone therapy) comes in many forms and styles, but more than likely you will not read much about this in the fashion magazines.
In the 1990s, researchers began a large U.S.-sponsored study focused on women taking Prempro (a combination of non-bioidentical estrogen/progestin) as well as a study on women taking just Premarin (non-bioidentical estrogen only). The Prempro study was stopped in 2002 as it was linked to higher risks for heart attacks and breast cancer. As you might expect, the major news outlets made a very big deal of this, and news headlines were broadcast everywhere warning of the horrible side effects. These media flashes caused most women to flush their synthetic hormones down the toilet! Then in 2004, the Premarin study was halted after researchers detected stroke and blood clot risks in that group. The same thing occurred at that point -- headlines and more headlines!
Most women are too busy to read the actual studies, or too overwhelmed by the nature of their content. Instead, they respond to media soundbites and often mistakenly let these small bits of information determine the course of their health care. Here are a few from back in 2002:
Telegraph -- July 10, 2002 -- "HRT raises cancer and stroke risks"
NIH -- July 16, 2002 -- Increased Risk of Ovarian Cancer is Linked to Estrogen Replacement Therapy
For about 10 years now, these headlines and the "common knowledge" regarding the use of HRT scared untold numbers of women away from any form of HRT. Of course, in our lawsuit-crazy society, many doctors ran away from prescribing HRT even faster than their patients.
Now in 2012, revised research and interpretations of that research has finally come to light. We find ourselves with a whole new set of headlines and media flashes very different from those 10 years ago.
Here are some of the latest soundbites:
Bloomberg -- March 6, 2012 -- "Estrogen-only therapy may protect against breast cancer"
LA Times -- March 7, 2012 -- "Estrogen taken alone is linked to lower breast cancer risk"
PhysOrg -- Feb. 27, 2012 -- "North American Menopause Society (NAMS) reassures many women"
Endocrine Today -- March 5, 2012 -- "HT safe during menopause when tailored to individual patients"
Right about now, you may feel like you've had your fill of soundbites and are so confused and frustrated that you want to "bite" someone!
Many of the principal investigators of the WHI now agree that they did not do such a great job reporting the outcomes of the study in 2002. Shockingly, there are many doctors out there that are not aware of the new studies, their findings and revised guidelines. Dr. Henry Burger, a consultant and endocrinologist at the Melbourne clinic, Jean Hailes for Women's Health, said few doctors other than specialists were aware of newer research indicating HRT was safer than previously thought: "The regulatory authorities act as if that was never published.'' Professor Burger said menopause was not trivial: ''At least 10 per cent of women will have symptoms for 10 years or more and they're very disabling. It's a huge threat to women's quality of life. One of the major problems is interrupted sleep, which makes people tired, irritable and depressed. People with bad flushes get them every half an hour.''
Leave the soundbites behind, save the bites for dessert and arm yourself with the latest accurate information. Together with your perimenopause and menopause specialist, evaluate your own risks and benefits and get the help you need and deserve.
A lot has been discovered over the past 10 years. Here is a CliffsNotes version:
(To read more, here is the full 2012 Position Statement from NAMS.)
Hopefully, one day, talking about perimenopause and menopause will be in style and regularly addressed in all women's magazines.
I am always here for you at www.shmirshky.com if you have any questions or simply need a virtual hug! Reaching out is IN! Suffering in silence is OUT!
Ellen Dolgen is the author of Shmirshky: The Pursuit of Hormone Happiness -- a cut-to-the-chase guidebook on perimenopause and menopause.
Follow Ellen Dolgen on Twitter: www.twitter.com/@EllenDolgen
However, we'd like to warn your readers about so-called 'bioidentical' hormone preparations:
The FDA and international specialist societies (links below) do *not* agree with Dr. Trutt that these are "safer than the patented alternatives". The FDA ruled in 2008 that 'bioidentical' is a "marketing term that carries no scientific or medical merit".
The hormones in these preparations are manufactured synthetically, as Trutt admits. They're made from yams, the same source as most traditional HRT, and the main active ingredient (oestradiol/estradiol) is identical to that in most forms of HRT. It's misleading to refer to them as 'natural' or 'non-synthetic'.
The difference is that ‘bioidentical’ preparations are made up by 'compounding pharmacists'. As they prepare formulations individually for each patient, these pharmacists are not bound by FDA (or, in Australia, TGA) quality standards. Dosage is set by a prescribing doctor based on hormone levels in saliva or blood, but this practice is not based on evidence - there's little correlation between blood hormone levels and menopausal symptoms - and is discouraged by academic specialist societies internationally.
Jean Hailes - www.managingmenopause.org.au/management/other-therapies/bioidentical-hormones
FDA - www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm049312.pdf
International Menopause Society - www.imsociety.org/downloads/patient_information_sheets/biodentical_hormones_for_menopausal_symptoms.pdf
North American Menopause Society - www.menopause.org/bioidentical.aspx
Australasian Menopause Society - www.menopause.org.au/consumers/information-sheets/34-bioidentical-hormones-for-menopausal-symptoms
Jean Hailes for Women's Health
I’ve asked Dr. Josh Trutt of PhysioAge Medical Group to respond to your comment. He writes:
The above post is misleading and warrants clarification.
The term “bio-identical hormones” doesn't mean hormones that are made by compounding pharmacists. It means hormones that are identical in structure to what the human body produces. Many of these are produced commercially by pharmaceutical companies; examples include Prometrium (bio-identical progesterone) and estradiol patches such as Vivelle-dot or Climara (though not Climara-Pro, which also contains a non-bioidentical progestin). We often use commercial bio-identical preparations in our practice, as insurance will pay for them.
However, it's also the case that bio-identical hormones can be compounded as creams. One significant advantage to such creams is that in perimenopause, a woman can fine-tune the dosing of estradiol to her own symptoms on a daily basis, rather than being tied to a standard daily dose during a time of her life when her hormone levels are anything but “standardized.” It's probably true that not all compounding pharmacies are created equal. In our practice, we check serum hormone levels on all of our patients; therefore, we have no doubt whatsoever about the quality control of the pharmacy we use. We have also toured their facilities a number of times and are very impressed with both their ethics and their production standards. I would encourage anyone using compounded creams to learn more about the pharmacy providing their medications. (cont.)
Jean Hailes also states “The FDA and international specialist societies (links below) do *not* agree with Dr. Trutt that [bio-identicals] are ‘safer than the patented alternatives’". I again disagree, though in this case my wording may have been unclear. Transdermal (bio-identical) estrogen and bio-identical progesterone confer a significantly lower risk of blood clots, heart attack and strokes than Premarin or Provera; I believe all of the relevant societies concur with that assertion. To wit, here is a direct quote from the 2012 North American Menopause Society’s position statement on Hormone Replacement Therapy: (cont. 2)
Laura, Let's start with the good...
You are having your ovaries removed. That sounds like a bummer. However you are reducing your risk of developing ovarian cancer by 95%.
The price you are paying for this is a surgical menopause. Ouch!
While its true that menopause is the Great Equalizer... the side effects and potential issues associated with it are not equal for everyone...
So while some women have every horrible side effect that's out there others do not...
With a Factor V deficiency you are correct... No estrogen for you... This is where you and your Doctor need to work closely to help alleviate and diminish any menopausal symptoms you might experience..
For hot flushes.. Yes wear layers and peel them off, carry a fan, drink tons of water. No wine, alcohol, or spicy foods. These can exacerbate those hot flushes..If you require something stronger. Some natural progesterone creams can help. Remifemin, an over-the-counter natural oral tablet has been shown to be helpful. Effexor, a prescription medication, was studied and shown to be effective for flushes.
(cont.)
Osteoporosis... Get a baseline bone density to start. Make sure you are getting enough Vitamin D3 and calcium. Treatment is recommended if you have osteoporosis. I personally at the age of 55 had to do daily tiny injections of Forteo.. I wanted to rebuild my bone. I do not want to look like my Aunt Marion who shrunk to a height so low she was basically under the table. A urine NTX test tells you how much bone activity you have. If its significantly elevated and you are losing bone then You might require antiresorptive therapy. (cont. 2)
This article sounds to me like nothing but a shill for big pharma and a vague ("might be", "seems so") testimonial to the "benefits" of drugging women. I recommend women take a look at naturopathic perspectives on this natural life cycle period by reading the works of authors Gladstar, Weed, and Sharan on natural menopause and solutions to comfort. The very real changes during this time may be understood with greater wisdom as a result.
More importantly, you are missing the larger picture: While it is true that some natural remedies will improve the SYMPTOMS of menopause (primarily hot flashes), they will do very little to prevent osteoporosis, heart disease and Alzheimer's disease. In addition, they will do essentially nothing to restore the libido of a woman whose testosterone has disappeared. Decades of study have shown the benefits of restoring your natural hormone levels in preventing the common diseases of aging, as well as restoring your overall sense of well-being.
The Endocrine Society released a position statement on Hormone replacement therapy in 2010, and the following line from that statement should not be overlooked:
Menopausal Hormone Therapy was associated with a 40% reduction in mortality in women in trials in which participants had a mean age below 60 yr or were within 10 yr of menopause onset.
Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. JCEM July 1, 2010 vol. 95 no. 7 Supplement 1
Reducing hot flashes is one thing—important, to be sure. But a 40% decrease in all-cause mortality is another matter entirely. Women should be aware of their options.
(cont. 2)
Thank you for your concerned response. Two points of clarification:
One might debate whether calling the natural hormones that your body produces "drugs", but what should not be debated is whether this is a boon for "big pharma". Their patents and profits are based primarily on sales of Premarin and Provera, which are not bioidentical and which I would never recommend. There are some bioidenticals that are now manufactured by pharmaceutical companies as well (as opposed to compounding pharmacies), and if that allows a woman to get those hormones through her insurance and therefore afford them, I certainly won't begrudge big pharma their profit. My concern is getting women the help they deserve.
(cont.)
You are absolutely right! There is no one-size-fits-all approach to menopause – everyone has a totally different experience. Deciding whether or not to take HRT is an individualized conversation that every woman should have with her perimenopause and menopause specialist, going over all the symptoms and important blood tests prior to making a decision. In my book I include a Menopause Symptoms Chart women should fill out and take to their doctor to properly explain their experience, as well as a list of blood tests women should consider.
It is also important to discern between synthetic (non-bioidentical) and bioidentical hormone therapy, which you can do with the Hormone Brand Chart in Shmirshky, too. And if you do not have a perimenopause and menopause specialist*, we have a directory for you on Shmirshky.com!
I am so sorry to hear about your friends but I'm glad they have recovered. Thank you so much for your input!