DR. JUDITH REICHMAN : Redefining Change

When Dr. Judith Reichman gets on her bandwagon, she sounds more like a political crusader than a clinical gynecologist. “We are the trailblazing baby boomers,” she declares. “There are 40 million of us today and our numbers will increase by 10 million in the next decade. We have redefined adolescence, having babies, working and parenting. And now we are going to redefine menopause.”

And, in Dr. Reichman’s view, menopause is overdue for some serious redefinition. As a symbol of aging in a youth-worshiping society, she says, menopause has been a taboo subject, loaded with negative expectations and clouded by ignorance.

“Most women are surprised by menopause and unprepared,” says Dr. Reichman, a vigorous advocate for women’s health issues who has been a practicing physician at Cedars-Sinai Medical Center for 13 years.

To correct that gap, she researched, wrote and narrated “Straight Talk on Menopause” as a PBS special. Taped before an audience in Santa Monica by HB Pictures’ executive producers Patricia Perini and Nancy Hult Ganis, the two-hour show explains what happens during menopause and how women can deal intelligently with the transition.

Staff writer Connie Koenenn talked with Dr. Reichman about the subject.

Is this a project you’ve had your eye on doing for a long time?

Yes, there has been a lot of demand. Women’s groups have avidly approached me to give talks about menopause, and I’ve seen the need from my own patients. I’m 48 and I have aged right along with many of them. Even though I am a gynecologist, I was taken by surprise when I first had hot flashes. I think women have just viewed menopause as something they just had to endure, without questioning the mythology.

Who are menopausal women anyway? There seems to be a notion that women just get old overnight.

Yes, that’s one of the myths--that once menopause occurs, a woman suddenly gets old and loses her identity as a feminine, sexually active human being. That’s how it has been put to us, even by our doctors--like something beyond our control.

What’s the reality?

The average range for women to start the symptoms of menopause is between 45 and 55, and the transition lasts for several years. Menopause can mean anything from having great sex to devastating depression, depending on who’s talking. One reason I got interested was that I have patients who breeze through this. They are doing great things in their 70s and 80s and are so busy they hardly have time to schedule an appointment for a check-up. There are others who live up to the negative expectations--they seem depressed and down and old. I think it is both attitudinal and how they take care of themselves. Women spend so much time caring for others, we tend to debase our own potential frailty.

How can the trailblazing baby boomers change this?

First, by making demands for more research on women’s health, and we are getting more aggressive about that. Since hot flashes occur in 80% of women, you’d expect a tremendous amount of research, but there is very little. Somehow it seems to be a resetting of the thermostat in our brain that’s regulated by estrogen levels. We really do have female diseases that are unique to us and medical science is just starting to acknowledge this.

Second, by making available the information we do have, and that’s a lot. I take this very seriously. I’ve reviewed all the medical literature on menopause for the last 10 to 15 years. As far as depression goes, we know that a woman is more likely to be hospitalized for mental illness in her 30s, when she has young children at home. On the other hand, we are just learning the important link between menopause, with its loss of natural estrogen, and heart disease and osteoporosis. One in three women in menopause is developing severe osteoporosis, and it is a completely preventable disease. And heart disease is the No. 1 one cause of death in women over 55. Women are 10 times more likely to die of a heart attack than breast cancer.

Is there one major question women ask the most?

Yes, they want to know if they should take estrogen replacement. I spend about 20 minutes on this program talking about the ways estrogen protects you and the various ways you can take it. I’m very pro-estrogen and try to convince my patients to go on it. But for women who don’t want to, I also talk about other ways to prevent heart disease and bone-density loss. When you realize that, because of increased longevity, we now spend almost a third of our lives without the protection of ovaries and estrogen, you see how important this is.

So this program is for women of all ages?

Yes. In a sense, all younger women are pre-menopausal. The lifestyle habits you form early in life, such as a proper diet and exercise, are the preventive care for bone strength and healthy hearts down the line. It’s too late at 48 to discover your bone mass is low. Mothers should make sure their daughters get enough calcium from puberty on.

What do you hope this program will achieve?

To create informed consumers. This is a wake-up call to start taking charge of your own body and your own life. Unless you know what questions to ask, you’re going to be the same passive individual who lets the doctor pat you on the head and say ‘Honey, do this. I know what’s good for you.’ Young women should learn early on how to take care of themselves. And for women facing menopause, we want to make this a positive transition. It’s not the end.

“Straight Talk on Menopause,” Parts 1 and 2, airs Sunday beginning at 10:30 a.m. on KCET