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.
________________________
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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Follow-up comment rss or Leave a TrackbackHello Nancy,
Your site is very informative and I greatly enjoyed the picture of the menopause symptoms.
I’d like to share with a new advancement in menopause treatment options — Elestrin (www.elestrin.com) — it is the lowest effective dose of estrogen therapy for the treatment of hot flashes associated with menopause. With all of the news recently about the NEJM study and the U-turn on the WHI Study, this is the kind of news your readers need to hear to reaffirm that HT is safe and effective for women in their 40s and 50s.
Please let me know if you’d like any additional information - thanks.
- Brian Wendel (212) 829-0002 ext. 103
New, Effective Low Dose Estrogen Therapy
Introduced to National Media
Elestrin Represents An Effective Low Dose Treatment Option to Treat Hot Flashes
New York (June 20, 2007) – Bradley Pharmaceuticals, Inc. (NYSE: BDY) today introduced Elestrin™ (estradiol gel 0.06%) to the national media. Elestrin is an effective, low dose transdermal estrogen therapy approved by the Food and Drug Administration (FDA) in December 2006 for the treatment of moderate-to-severe vasomotor symptoms associated with menopause. Elestrin was launched last week by the Company’s Kenwood Therapeutics division and is now available by prescription at pharmacies nationwide.
An editors’ launch meeting was held today in New York City led by Marie Lugano, founder of the American Menopause Foundation. Dr. Michelle Warren of Columbia University, a key opinion leader on menopause, provided an overview of the menopause marketplace. Dr. Michael Snabes, an expert in the field of reproductive endocrinology, provided information on clinical studies about Elestrin.
“Every woman is unique, and so is the way she experiences menopause,” said Ms. Lugano. “It is critical, therefore, that women research the issues, understand the various treatment options available, and discuss them with their doctor. Armed with the right information, women can better manage their menopause symptoms effectively.”
“Menopause therapy is shifting toward low-dose regimens, and Elestrin™ offers women a new, effective low dose treatment option,” said Daniel Glassman, President and CEO of Bradley Pharmaceuticals. “Elestrin™ addresses the guidelines set forth by the FDA, American College of Obstetricians and Gynecologists (ACOG), North American Menopause Society (NAMS), and the New England Journal of Medicine that hormone therapy should be used at a low effective dose for the shortest duration of time.”
In addition to being an effective low dose estrogen therapy, Elestrin™ dries quickly within five minutes and is applied once-daily over a small area of the upper arm and/or shoulder.
Dr. Michael Snabes, co-author of “Low Dose of Transdermal Estradiol Gel for the Treatment of Symptomatic Postmenopausal Women,” which was published in the March 2007 edition of Journal of Obstetrics & Gynecology, noted that “During the 12-week clinical trial, Elestrin was proven to significantly reduce the frequency and severity of hot flashes. Reductions in both the frequency and severity of hot flashes varied depending on the dosage.”
“We now have the option to prescribe a new, low effective dose of estrogen therapy to patients,” said Dr. Michelle Warren, Medical Director of The Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University. “Elestrin™ will provide physicians with an important treatment option for patients who choose to manage their hot flashes.”
Important Product Safety Information About Elestrin:
Close clinical surveillance of all women taking estrogens is important. Adequate diagnostic measures should be undertaken to rule out malignancy in cases of undiagnosed persistent or recurring abnormal vaginal bleeding.
Long-term continuous administration of estrogen, with or without progestin, has shown an increased risk of endometrial, breast and ovarian cancers.
Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia. An increased risk of developing probable dementia in postmenopausal women 65 years of age or older was reported with estrogen-alone use, as well as, in combination with progestin.
Estrogen-alone therapy has been associated with an increased risk of stroke and deep vein thrombosis. Estrogen plus progestin therapy has been associated with an increased risk of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli and deep vein thrombosis. Estrogens should be discontinued immediately if any of these events occur or are suspected.
Estrogen with or without progestin should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the patient.
An increase in gallbladder disease requiring surgery in postmenopausal women receiving estrogens has been reported. Estrogen therapy may lead to severe hypercalcemia in patients with breast cancer and bone metastases. Retinal vascular thrombosis has been reported in patients receiving estrogens.
Estrogen products should not be used in women with undiagnosed abnormal genital bleeding; known, suspected or history of breast cancer; known or suspected estrogen-dependent neoplasia; active or history of deep vein thrombosis or pulmonary embolism; active or recent (within the past year) arterial thromboembolic disease (e.g., stroke, myocardial infarction); liver dysfunction or disease; known or suspected pregnancy.
Blood pressure should be monitored during estrogen use. Caution should be exercised in patients with hypertriglyceridemia, impaired liver function or a history of cholestatic jaundice, conditions that might be influenced by fluid retention, hypocalcemia, asthma, diabetes mellitus, epilepsy, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas. Patients dependent on thyroid hormone replacement therapy may require increased doses of such therapy. The addition of progestin should be considered in patients with residual endometriosis post-hysterectomy. Concomitant application of sunscreen and ElestrinTM to the same site for more than 7 days should be avoided.
For additional important information about Elestrin™, please view full prescribing information at http://www.bradpharm.com or request full prescribing information by contacting Bradley Pharmaceuticals at 973-882-1505.
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