When I was in private practice, I tended to see a lot of women.

And my nurses used to laugh that when I would do a Pap smear (usual appointment time 20 minutes) I would often end up in the office an hour with a crying lady.

Yup. Another middle aged lady going through menopause.

They often would come in and start crying, saying I don’t know what’ s wrong with me, and I would hand them this and say:

Do you cry all the time? Get headaches? Feel tired all the time? Stressed out? Backaches? Bloating? Yell at your kids? Breast sore? Constipation? Hot flashes? Gaining weight?
Then I’d show them a picture similar to this:
And give them THIS handout.
Ah, the glories of Menopause. Fun, ain’t it, I’d say, and usually they would laugh.

Because most of them sort of knew the problem, but weren’t sure what to do.

Actually, about 80 percent of women get through menopause with some herbs, some TLC, and just plain common sense: Exercise, cut back the coffee, eat properly, get enough sleep, and try not to be superwoman.

There are lots of herbs that claim to help, and about 75 percent of women say they took herbs or minerals. The herbal medicine that makes most sense is soy, which has estrogenic properties. Does it work? No one is sure. And if it works it’s probably in higher dosages that have the same side effects as other estrogen/female hormones.

There are also a lot of medicines that work. All have pros and cons.

If you just are very irritable and can’t sleep, a small dose of Valium (benzodiazepam or other mild tranquilizers) might be all you need to help you sleep.

What also works is a low dose of anti depressive medicine. I tended to use Sertraline (Zoloft) because it didn’t make people as irritable as Prozac, but any of that family of medicine will work.

Yes, I know all those scare stories. But when 20 million people take a medicine and the suicide/homicide rate is the same or lower than the rest of the population, it may not be the medicine, but an exacerbation of the mental illness (depression, bipolar, untreated anger) that was behind the mood swings. And for menopause, we tend to use a smaller dose, and caution our patients they might get irritable if they stop it suddenly.

The real story is female replacement hormones. Good or bad.

The secret is: it depends.

If you have “early” menopause, you need them. If you are 65 you probably don’t.

In the last 30 years, the fad has been to put everyone on them, then everyone off, then on, then off.

Actually, a lot of it depends on the woman. HERE are the latest Guidelines.

If you have early menopause, you need the hormones until the regular age your own body would stop producing them. If you don’t take them, you’ll develop thinning of the bones, thinning/shrinkage of the vaginal area, and have an increased chance of heart disease.

If you have the hot flashes from hell, use the hormones.

If your tushie is too dry, use the hormones: Local creams work fine.

For most other people, they don’t need hormones.

With all the scare articles about strokes and heart disease, the main problem with hormones is that they make the blood more sticky, so you not only get blood clots (Phlebitis) but if you have hardening of the arteries you could end up with a stroke or heart attack by a blood clot in the narrow area of the blood vessel.

There is also the question of cancer, if the hormones cause it or just make it grow faster once you have it.

On the other hand, what might be a major problem now that we are no longer using hormones is osteoporosis.

Theoretically, the higher risk of getting a heart attack on hormones is about the same as the lower risk of getting a hip fracture. OK. You are 75 years old. Do you prefer to have a heart attack or hip fracture?

Like all stories, the actual differences between the groups on or off the medicine are low.

On the other hand, good diet, weight bearing exercise, and calcium often will prevent osteoporosis, and there are new medicines for those who are at high risk of thinning bones.

There are fancy expensive tests to screen who needs these expensive medicines (and the medicines can cause ulcers, so are not harmless).

So what should you do?

Well, just remember, life is risky. I would remind patients that even driving the car to the doctors office had some risk, and so we have to make an intelligent choice.

Female hormones up to age 55, and then only if you really need them. Medicines to be able to cope, only if you really need them.

And a healthy lifestyle never hurt anyone.

Which is why my “One hour” pap smears took so long: The important part was not handing out pills, but doing the history and the examination, arranging tests to make sure it wasn’t something else causing the symptoms, and then discussing all of the above and teaching about a healthy lifestyle.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket and she posts medical essays to HeyDocXanga Blog

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