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Menopause is not an illness.
If you subscribe to the standpoint currently held by the conventional medical profession, you'd be forgiven for thinking it was. Women in many other cultures do not experience menopause as a crisis demanding medical intervention. Many of them simply do not suffer the physical and emotional symptoms that women in the West are programmed to accept as inevitable. In our society the focus of menopause is one of loss. Women are programmed to dwell on loss - the loss of periods, the loss of the ability to create life, the loss of hormones, the problems of the 'emptynest' syndrome. In other societies this time in a woman's life is seen as one of gain, a time of great wisdom. It is a time when the emphasis shifts away from doing the chores and working to the role of lawmaker and counselor to younger couples. It is an opportunity to let maturity and experience make a significant and valuable contribution to the family and society.

What is Perimenopause and Menopause?
Perimenopause is the transition time between a woman's reproductive years and menopause. Typically, perimenopause occurs between the ages 40 to 51(average age is 47), but hormonal changes may start as early as the late 30s. As women age, the supply of eggs in the ovaries is depleted. In the 40s, the supply is very low, and menstrual cycles without ovulation become more frequent.

Due to the increased frequency of non-ovulatory cycles, perimenopausal women often have low levels of progesterone, with high or fluctuating levels of estrogen. High estrogen, low progesterone or an imbalance of estrogen to progesterone may be associated with many of the symptoms that perimenopausal women experience including hot flashes, night sweats, anxiety, depression, irritability, insomnia, headaches, palpitations and irregular, prolonged or heavy menses. These symptoms are often worse before the menstrual period, so many women may think they are having PMS when it may be the beginning of perimenopause. Natural menopause is defined as the cessation of menses as a result of the normal decline in ovarian function. With declining hormone levels, women may experience a wide range of symptoms in varying degrees of severity, or they may experience no symptoms at all. Some of the signs of menopause include, but are not limited to: hot flashes, sweating, fatigue, nervousness, irritability, dizziness, numbness, palpitations, insomnia, mood swings, vaginal dryness and/or pain, nausea, gas, urinary incontinence, pain with urination, constipation, diarrhea, joint pain and muscle pain.

Although there are similarities in what happens hormonally, each woman's experience can be very different. Genetics may play a role in the timing, but lifestyle can certainly influence a woman's experience of menopause. Traditionally the medical community has endorsed Hormone Replacement Therapy (HRT) as a cure all for menopausal symptoms and it was also thought that this course of treatment protected women from heart disease, breast cancer, osteoporosis and even Alzheimer's Disease.

Can you say no to Hormone Replacement Therapy? Months after federal officials halted a groundbreaking study on hormone replacement therapy, doctors around the country were still trying to make sense of it all for their patients. Post-menopausal patients remain in a quandary. Since news broke that taking hormone replacement therapy for years at a time wasn't such a great idea after all, post-menopausal women have been wondering what to do. If you are experiencing symptoms of menopause, you are not alone. Some obstetrician-gynecologists have held seminars to help sort out the anxiety and confusion. Some lectures drew only several dozen patients while others attracted 500 women or more who crowded into stuffy conference rooms at hospitals and community centers around the country.

Once there participants share common complaints of hot flashes, night sweats, memory loss and much more. Many of the women have already decided to quit taking their hormone replacement pills, and now are desperate to know one thing: How do you manage menopause when your drug of choice has just been deemed a danger to your health?

What is HRT?
Hormone replacement therapy (HRT) typically means the combination of two hormones, estrogen and progestin. Progestin is actually a synthetic product made in the lab. Pharmaceutical companies were unable to patent natural progesterone, so they added two chemical groups, acetate and methyl, to the progesterone molecule and called it progestin. Estrogen is a different story. Scientists first isolated estrogen from human pregnancy urine way back in 1929. A year later, a researcher named James Collip came up with something called Emmenin made from the urine of pregnant women. This was the first hormone replacement product sold in the United States. By 1939, Emmenin could not be made fast enough to keep up with consumer demand.

Pharmaceutical researchers then discovered that pregnant mares' urine contained large quantities of estrogen. In addition, horses produce a gallon of naturally concentrated urine every day, meaning this could be the answer to the supply problem. In 1942, Premarin, technically known as conjugated equine estrogens, was introduced to the U.S. market.

Technically Incorrect
Because of the way both estrogen and progestin are produced, hormone replacement therapy is actually an incorrect term because nothing is replaced. Women take a pill that's not the same as what they had before menopause. It isn't the same dosage and it isn't the same substance. Even so, last year some 67 million prescriptions, more than $2 billion worth, were filled for Premarin and Prempro, the same drug with a progestin booster. These are the two top-selling forms of hormone replacement therapy, according to industry tracking firm IMS Health.

Most women start on these drugs in their late 40s or early 50s, when their ovaries are beginning to slow production of estrogen and progesterone. Hormone replacement therapy is designed to alleviate insomnia, heavy bleeding, rapid mood swings - all symptoms that set in when natural estrogen levels begin to lower.

Hormone therapy can make a big difference in eliminating hot flashes and night sweats as proven by thousands of women who have found relief. But over the years, some women on HRT with no history of breast cancer have been diagnosed with malignancies. They have wondered quietly to themselves whether hormone replacement drugs may have had something to do with it. But doctors have always felt safe in continuing the therapy even though sometimes cutting back on the dosage as much as half.

The national study
Little wonder then that millions panicked when federal health officials announced in early July that Prempro does significantly more harm than good.

For the first time researchers had proof that the hormones estrogen and progestin, when taken together for several years, can increase the risk of deadly heart problems and invasive breast cancer. The findings were so stunning that this portion of the national Women's Health Initiative study, which dealt only with Prempro, was stopped three years early. After observing more than 16,000 women for a little more than five years, scientists found that the hormones in Prempro raise the risk of heart attack, stroke, blood clots and breast cancer.

Immediately, letters went out to the study's participants: stop taking your pills. The conclusion was that statistically estrogen caused more harm than good, so the study doctors voted unanimously to stop the clinical trial. Analyzing the risks

However, this doesn't mean hormone replacement therapy necessarily poses grave risks to every individual woman. Doctors were concerned when they heard that invasive breast cancer was 26 percent higher after four years on Prempro. The heart-attack rate was 29 percent higher in the treatment group than for those taking a placebo pill, and the stroke rate was 41 percent higher.

But, the odds sound less frightening when you consider the rates at which these illnesses actually happen. In a typical year, taking Prempro boosted a woman's annual breast cancer rate from 30 out of 10,000 to 38 per 10,000.

The annual heart-attack risk rose from 30 to 37 out of every 10,000 Prempro users and the stroke rate increased from 21 to 29 per 10,000. The data has to be analyzed in perspective and correctly explained to women who are considering HRT.

What to do?
After reviewing the numbers, some women have opted out, especially in light of a family history of breast cancer, only to return to HRT weeks or even days later. For these women, stopping HRT left them depressed and anxious. The everyday physical and emotional consequences impacted them so negatively that the risk was worth it to them. Plain and simple, many women are just reluctant to toss their pills.

Some proven benefits

The study did show some benefits.
· Women on Prempro had fewer hip fractures and cases of colon cancer than those who weren't taking the drug.

· Short-term use also remains an option.

· The Women's Health Initiative did not turn up unacceptable risks among women treated for less than five years.

· Experts agree there is still no better treatment for hot flashes, mood swings and insomnia. For the 25 percent of women that are really troubled with these symptoms it seems acceptable to continue treating them with estrogen because estrogen treatment is what they opt for. The tricky part is figuring out how long women should stay on HRT and how best to taper them off the treatment.

Deciding to cut back
In the past women have learned about hormone replacement therapy from doctors who couldn't do anything but sing its praises. For the main symptoms of menopause, such as hot flashes or vaginal dryness, HRT is the usual recommendation. Unfortunately, if a women around the age of 45 goes to her doctor with any menopause-type symptoms, it will immediately be put down to 'hormones', and you can guess what the first line of treatment will be. Many women have been put on HRT because of 'hormone' problems, only to find that they were not menopausal at all. There are a variety of other health conditions that cause symptoms that are similar to those of menopause, so don't assume - or, more importantly, let your doctor convince you - that there may not be another cause. What's important is working out what symptoms are due to menopause, and what are simply symptoms of aging.

When the new WHI study results were published women realized that the hormone wasn't what it was represented to be. Many women felt like they'd been scammed. But to them it was a wonder drug and they didn't want to quit taking it. Even so, many have decided to taper off their daily use of the medication.

More questions
Now that the study's been halted, doctors are taking stock of what they don't know. No one is certain whether it's the mix of progestin and estrogen that increases the risk of breast cancer, heart disease, stroke and blood clots, or is it just the progestin alone.

Researchers are fairly sure it is not estrogen because a separate part of the study (still ongoing) has not found negative effects in women taking only estrogen. The frustration falls in not knowing what to tell patients. How could the doctors continue the study, allowing women to have strokes and develop breast cancer? How could they possibly have ethically explained to these women that they would sacrifice another 100 just to be sure? One would think, after a half-century of use, we would know everything there is to know about HRT. Clearly, the study tells us, we do not.