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
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
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
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
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
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
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
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.