By Michael Brodman, M.D.
Professor and Chair of OBGYN at Icahn School of Medicine at Mount Sinai
While many women sail through menopause with minimal or no side effects, others can suffer from debilitating symptoms such as unpredictable menstruation, hot flashes, sleep disturbances, mood changes, weight gain, excessive skin dryness and painful intercourse just to name a few. Deciphering the truth about menopause is a lot like the old Abbott & Costello routine "Who's On First, What's On Second" -- confusing and contradictory.
Called "the change of life" by many, menopause is quite simply the cessation of menses. In middle age, the levels of estrogen and progesterone, the two female hormones made in a woman's ovaries, start to decrease leading to menopause. Some symptoms of menopause can last for months or years. The average age of menopause is 51 according to the National Institute on Aging, but some women have their last period in the 40s and some have it in their late 50s. Women who have hysterectomies where their ovaries are removed go through immediate surgical menopause. Whatever the reason, once a woman loses her main source of estrogen, menopause symptoms can begin.
Post-menopausal women are at increased risk for osteoporosis -- weakened bones -- and heart disease. Women who smoke have an even greater risk. So in addition to the annoying quality of life symptoms of menopause, there are very real health concerns as a woman ages.
We hear a lot about whether women should use hormones to help relieve menopause symptoms. Before 2000, practically every practicing OBGYN thought that hormone replacements should be given to every woman who had even the mildest menopause symptoms. Take a pill and feel great. Then in 2002, the Women's Health Initiative (WHI) published the results of a study which showed that women were at an increased risk for breast cancer when using estrogen and progesterone. Panicked women called their doctors and were immediately taken off hormones. It was like the pendulum swung all the way to the other side overnight. The problem was that while the WHI study was the largest one to date, the average patient in the study was over 65 and obese, and fifty percent of the patients in the study smoked. A very unhealthy group who were at increased risk for breast cancer without taking hormones.
A more recent study was done on women between the ages of 45 and 55 who took estrogen only hormone replacement for five years and in this study, there were fewer breast cancers, fewer bone fractures, a decreased risk of colorectal cancer and heart attacks. Menopause is not a disease that has to be treated, and while there is still more to be learned about hormones, hormone use for prevention may be appropriate for some women.
Have a conversation with a physician who is knowledgeable, takes into account everything that is going on in your body and knows your family history. If everybody in your family dies of heart disease, that's important. If everybody in your family gets breast cancer, women need to factor this into their decision about whether to take hormones. And most importantly, adopt a healthy lifestyle no matter what your age. Don't smoke. If you smoke, stop. Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables and whole-grain foods. Make sure you get enough calcium and vitamin D. Maintain a healthy weight and exercise. Set yourself up for healthy aging.
There are always risks and benefits in life, and hormone replacement therapy is no different. I like cooking, so I like to use a food analogy with my patients. You follow the recipe and at some point, you taste the food and you adjust the seasoning.