Things Have Changed in Treatment of Menopause
Not too long ago, women didn’t even talk about the M word and they rarely if ever thought about getting treatment for it. In recent years, things have changed. Once joked about and ignored, menopause has stepped onto center stage and many people are paying attention.
“Unlike their mothers who silently endured ‘the change’ and often didn’t understand what was happening to them, women in menopause today are well informed,” says Patricia Korber, a Newport Beach-based physician specializing in menopause and gynecology. “Many women talk openly about this time of transition and aren’t afraid to seek assistance.”
Today’s baby boomer in menopause expects to be taken seriously and treated with respect.
“Many women want to have an equal partnership with their doctor and make their own health decisions,” Korber says. “The days are gone when women will accept a pat on the head and a prescription.”
As the population ages and there are more older individuals than ever before, a greater percentage of the population is affected. “There are now 40 million women in menopause. Most women today can expect to spend one-third of their life post-menopausal,” says Korber.
The term menopause actually refers to the time when a woman stops having periods and is no longer fertile. It is the period of time before this happens, which averages two to five years, that causes women problems. At this time the ovaries begin tapering off their production of estrogen, which can lead to a variety of disquieting symptoms including hot flashes, night sweats, insomnia and vaginal dryness.
Other related symptoms include difficulty concentrating, fatigue, depression, altered libido, anxiety, tension, depression, crying and irritability. “It’s not clear if these later symptoms are a direct result of menopause or stem from the inability to sleep,” says Korber.
No matter what causes these symptoms, they can be very disruptive for women. “Before I got treatment, I had hot flashes morning, noon and night,” says Shirley, 52, owner of a travel agency. “I couldn’t sleep, which made me irritable, and I had a hard time functioning during the day. It was also really embarrassing to have a hot flash in front of customers, which happened quite often.”
Glenda, now 60, reports overwhelming bouts of fatigue during menopause. Since she was 52, she’s had periods where she has no stamina. “I feel like a feather could push me over at any minute, which is really unusual for me because all my life I’ve been really active,” she says.
In the United States the average age for the onset of menopause is 52, although it can start as early as age 45 and may not begin until the late 50s. Ten percent of women have premature menopause, which can start anywhere between 35 and 45. “There is no definite explanation for why some women start so early, although it looks like in some cases it may be genetic,” Korber says.
Menopause can last for just one or two years, or up to five years or more. “A minority of women will continue to have symptoms for the rest of their lives if untreated,” Korber says.
However long menopause lasts, health experts stress that it is a perfectly normal occurrence.
“Menopause is not a disease or an illness. It’s a natural event in every woman’s life,” says Mai-Anh Doan, a physician specializing in obstetrics and gynecology who is on staff at St. Joseph Hospital in Orange.
“Although this period can be uncomfortable, there are many things women can do to feel better,” she says.
Hormone replacement therapy
Many women find relief from menopause symptoms by replacing the estrogen their bodies have stopped making with estrogen pills, patches or creams.
“Estrogen often relieves the hot flashes and vaginal dryness, which leads to an improvement in the other symptoms,” says Doan. “Many women will say they feel better in general and have a sense of well-being.”
Replacing the body’s estrogen during menopause is also thought to help prevent heart disease and osteoporosis, a disease marked by a reduction in bone density.
Before menopause women have a much lower rate of heart attack than men, but after menopause this rate rises dramatically, says Korber. “Although they are still researching this, it seems that estrogen increases the good cholesterol and may help dilate the blood vessels, which will prevent clot formation that would cause heart attacks and strokes. Hormone replacement therapy decreases deaths from heart disease by 50%.”
Estrogen also plays a role in the prevention of osteoporosis, which is a significant, potentially debilitating problem. “Women sustain 1.2 million fractures per year due to osteoporosis, and it costs $7.5 billion a year in health costs,” says Korber.
When a woman reaches menopause, bone loss is markedly accelerated; estrogen therapy can help slow that critical loss, says Korber.
Because of the benefits of estrogen replacement therapy, some experts feel that just about every menopausal woman should be on hormones, including those women without symptoms.
Many estrogen deficient
Despite the benefits of estrogen replacement therapy, there are 72 million women in the U.S. who are estrogen deficient, says Korber. Only 15% of women who would benefit from hormone replacement therapy are actually getting it.
There are a couple of reasons why so few women are being treated, says Korber.
Hormone replacement therapy became popular in the 1970s until concerns were raised, later disproved, that it could cause cancer. Use of hormones dropped substantially until the 1980s, when new studies showed no link between hormone replacement therapy and cancer. Today estrogen is given in combination with progesterone to protect against uterine cancer.
Estrogen use is also low because some women feel that they are somehow failing by using hormones. “Because their mothers didn’t use estrogen, women think they should tough out menopause, too,” Korber says.
“The fact is, women are living much longer than ever before. At the turn of the century in the United States, the average life expectancy for women was 40 years, which meant many of them didn’t reach menopause,” Korber says. “It could even be possible that our bodies weren’t designed to live much past menopause.”
Alternative treatment
Although most women can take estrogen, there are some women who choose not to go that route and some who are advised not to take hormones, such as women who have had breast or uterine cancer.
To find relief, some turn to alternatives such as acupuncture and medicinal herbs.
Shirley, the travel agent, was advised not to take estrogen by her physician because she had had two transient ischemic attacks, which are similar to minor strokes but do no detectable lasting damage. She wanted relief from the nagging hot flashes, though, so she sought treatment from an acupuncture and herbal medicine specialist.
“After just a few treatments, my hot flashes disappeared,” she says. “I’m finished with treatment now and I feel much better.”
Good nutrition and exercise
Besides getting treatment for menopause, it’s important that women in menopause eat well and exercise. This will not only make them feel better but will help lessen the chances of osteoporosis and heart disease.
Healthy eating means eating on a regular basis. “Many women go all day without eating or skip meals, which leads to fatigue, irritability and loss of concentration,” says Korber.
She advises patients to eat a well-balanced diet by following the recommendations made by the USDA. Fats should be eaten sparingly and proteins and dairy products in moderation. The bulk of the diet should consist of whole grains and fruits and vegetables.
To prevent osteoporosis, 1,500 milligrams of calcium per day is needed. “Most women need a supplement, which should be in the form of calcium citrate,” says Korber.
Exercising four times a week is also important. “Exercise has a mood elevating effect which helps alleviate depression and reduces stress and anxiety,” she says. “Working out on a regular basis also reduces a woman’s risk of cardiovascular disease and osteoporosis.”
Weight-bearing exercises--those that require standing--are good because they put stress on the bones, which encourages new bone to form.
Good weight-bearing activities Korber suggests include walking, dancing, jogging, hiking, stair climbing and the treadmill.
Mind over menopause
The many physical changes that occur during menopause can cause some very real emotional reactions.
“As everything starts to go, including your estrogen, your eye sight, your hair color and stamina, you can’t help but think, oh, no, I’m getting old,” says Claire Lehr, a Newport Beach marriage and family counselor who regularly counsels menopausal women and holds a biweekly menopause support group.
To deal with the stress of menopause, Lehr tells all clients to take time for themselves. “Women are generally doing something for everyone else,” she says. “It’s really important they do something for themselves on a regular basis. Instead of worrying about what everyone else wants, they need to sit down and brainstorm about what they want and go out and get it.”
While menopause can be a sad time for women as they say goodby to youth, there’s a whole other side to the change that shouldn’t be missed, says Lehr.
“Menopause is by no means the end,” she says. “It gives women a new freedom. At this time they should stop to look back and celebrate their accomplishments and look ahead to what they still want to do.”
