Menopause Blog

A study, recently released in the Annals of Internal Medicine, found that combination hormone therapy increases the risk of heart disease in healthy postmenopausal women. Researchers report a trend toward an increased risk of heart disease during the first two years of hormone therapy among women who began therapy within 10 years of menopause, and a more marked elevation of risk among women who began hormone therapy more than 10 years after menopause.

The study was conducted by the Women's Health Initiative, which is sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health.

"Today, most women who take hormone therapy for menopausal symptoms begin therapy shortly after menopause. Based on today's report, even these women appear to be at increased risk of heart disease for several years after starting combination hormone therapy," Susan B. Shurin, M.D., NHLBI acting director told ScienceDaily. "It is clearer than ever that women who are considering postmenopausal hormone therapy for menopausal symptoms should discuss their risk of heart disease and other risks -- such as breast cancer, stroke, and dangerous blood clots -- with their doctors before starting therapy."

Combination hormone therapy includes progestin in combination with estrogen. Adding progestin is known to prevent endometrial cancer in women with a uterus. These new findings do not apply to women who have had a hysterectomy and take estrogen-only hormone therapy. Similar analyses on the results of the clinical trial of estrogen only therapy are planned.

Think about it: Menopause is the other parenthesis around our fertility, the first being puberty. We should find a way to mark the occasion for ourselves and our friends. It’s a biological and developmental rite of passage, so let’s get creative about how to celebrate September. You could:

• Have a “Take a Meno- Pause” party, pausing in your hectic life with some of your women friends. Go out after work, have an afternoon party at your home, or invite fellow "flashers" to sit around the back yard with your feet up, sharing menopause remedies.
• Get together with women who are past menopause and with some who are not yet there. Share what fertility means to you, or what you like (hate?) about menopause and this time of life.
• Go to a museum, art gallery or movie that celebrates something about being a woman.
• Write a letter to your daughter about what you hope she will experience when she goes through menopause and then tuck it away where you can give it to her later. (Or send it.)
• Sit down with your partner or spouse and make a “beyond menopause” plan for the next 10 years – hopes, dreams, and how to get there.
• Get tickets for Menopause the Musical and plan on an evening of pure hilarity
• Schedule a spa day – alone or with female buddies

Whatever you do, pause this month to mark your transition to the next phase of your life. Share your ideas about the best thing about menopause in the forum. Do you have more ideas about how to celebrate? Share them here.

Menopause is a perfect time to think about what's ahead and make it exactly what you want it to be. Use September to mark the transition. Cheers!

(Photo: Barry Austin Photography/Getty Images)

During and after menopause women (and their partners) complain that libido seems to be the collateral damage of slumpng hormone levels. Sorting out the “why” and “what to do” is a confusing ride through the research. Most recently we’ve learned that low libido is significantly associated with depression, night sweats, and sleep disturbance. But “associated” does not equal a cause/effect relationship. So while sleep disturbance or night sweats may not cause depression or low libido, women do seem to suffer from them simultaneously.

Teasing out the details of love and libido during menopause and beyond will contribute significantly to the quality of women’s lives and relationships. Whether low hormones turn out to be the common culprit, or whether one symptom provokes or intensifies others, it can only help us if we understand the connections -- treatment could be individualized once we have discovered how one symptom relates to the others. Even knowing that flashes, depression and insomnia travel in the same pack as low libido may lead us to some relief. If you are experiencing this little triad – with or without a drop in libido -- check with your doc. Successfully treating one worrisome symptom may lighten the others.

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One of the most distressing menopause symptoms that women report is anxiety (you can check the forum if you want the gory details). A study comparing neroli aromatherapy and Xanax to a no-treatment control group showed that both the aromatherapy group and the Xanax group showed significantly less anxiety than the controls. Unfortunately the test subjects were not menopausal women but gerbils, so how far the results can be applied to your own symptoms is still up in the air. Let’s hope they repeat the experiment – well maybe not that forced swimming task – with menopausal women.

Neroli oil is made from the blossoms of the bitter orange tree, and is used in many perfumes. It is available as an essential oil and 3 or 4 drops can be mixed with a cup of sweet almond or wheat germ oil to make an aromatherapy treatment. (The mixture should be diluted by half for a child or pregnant woman.) Or, as recommended by Cathy Wong, the About.com guide to alternative medicine, you can make a room spray by mixing neroli and lavender and spritzing it in the air. Not a bad idea for your cubicle at work, either.

The great thing about this research is that it is happening at all. Collecting evidence on the natural coping supports available to us makes it possible to manage symptoms without prescription medications or hormones. What harm in trying something as lovely and sensual as aromatherapy? Heck, it’s even recommended for canine types, so put your feet up, invite the pup, and take a deep, deep breath.

Adding to the speculation about the benefit of estrogen therapy, a study published in the British Medical Journal this week tells us that even when started well after menopause, combined hormone therapy can improve the quality of life for women with certain symptoms. The most improvement was in hot flashes, sleep quality and sexual function. Women also noticed less body pain after starting the hormones.

This is not exactly news for women who have found relief with hormone therapy. I know women who would break the arm of any doctor who tried to talk them out of using estrogen. I also know women who stopped taking it immediately when the Women's Health Initiative study showed an increased risk of stroke and breast cancer for women taking combined hormone therapy. The question has never been, "Does it help?" but rather, "Is it worth the risk?"

This new study out of Australia is yet another piece of the puzzle, and probably will not change any of the current recommendations. What it does underline is the need to consider each woman individually and plan treatment based on her unique set of symptoms and risk factors. If hot flashes, insomnia and vaginal dryness are making her life miserable, and if she is not at particular risk for a blood clot or breast cancer, hormone therapy may be worth a try.

Some of the side effects suffered by women in the Australian study, such as breast tenderness and vaginal discharge, are common with estrogen therapy. Since the dose used in the study was on the high side, and was not adjusted for each participant, it is possible that side effects could be minimized by adjusting the dose and type of hormone therapy depending on each woman's response.

The study also makes it obvious that we need good research on various dosages, various ages, and various types of hormone therapy. It would be nice to know about low dose therapy for women at each stage of the menopause transition. And what are the risks of the patch as compared to oral estrogens? Are bioidenticals as risky as conjugated estrogens? I'd like to see a dollar of research funding for every hot flash suffered. Now there's a proposal for the NIH.

A procedure that has been proven very effective for management of pain is also showing promise for treating debilitating hot flashes. A stellate ganglion block (SGB) is a shot of anesthetic into nerve tissue in the neck, and one study showed some pretty remarkable results.

According to the lead researcher, Eugene Lipov, MD, “Nineteen out of twenty patients had at least an 80 percent decrease in hot flashes for a period of two weeks to a year, following SGB.” Dr. Lipov said that many of the women also saw marked improvement in insomnia and sexual function.

For women who suffer from debilitating hot flashes, this may be the answer. It is a non-hormonal treatment that lasts from two weeks to a year. That’s a pretty good payoff for one injection. The sleep factor alone is priceless if those middle-of-the-night sweats could be reduced or eliminated. Imagine eight straight hours of sleep with no nighttime flashes -- heaven.

This procedure is not yet widely available, but the pilot is promising. Although it was done on breast cancer survivors, the Dr. Lipov and co-researcher Jaydeep R. Joshi, MD have used the procedure on menopausal women who did not have cancer and got the same dramatic results. They are currently continuing their research in this area.

This is one to watch. One injection, months of relief. Cool. Very cool.

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Nothing in these pamphlets will surprise you. They suggest that your “Daily Steps to Health” should include no smoking, more exercise, a healthy diet, moderate alcohol consumption and keeping your weight within reason. You knew that. But the value in this handy sheet is that they’ve boiled down lots of evidence-based research, reminding you of the few basic things you need to do to stay in touch with your health status. In addition to the daily steps, there is a quick list of preventive medications you might be wondering about (like aspirin, hormone replacement therapy and immunizations) as well as a list of screening tests and how often you need to have them done. Luckily, they include testing for HIV and sexually transmitted diseases, depending on your risk factors. (Yes, people over fifty are still having sex and still taking risks, so a little reminder about staying safe and getting tested is a nod to our continued sexual health.)

Lastly, there is a chart on which you can keep track of all your preventive screening tests – type, dates, results, etc. All in all, a compact, helpful reminder of what it takes to get and stay healthy after age fifty. Download your own copy of the checklist from the AHRQ website, and tuck it where it can gently remind you to head problems off at the pass.

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You answer questions about your medical history, menstrual history and current medications. (Have your prescriptions on hand when you fill out the questionnaire – it will ask for brand names and dosages.) There are some questions about menopause symptoms and risk factors, as well as a list of other questions you might like to ask your medical provider.

Once you finish the questionnaire, the information is compiled into a user friendly printout that you can take to your next visit. It summarizes your medical history and risk factors, and poses questions to your doctor at the end. All in all a very nice tool to get through your next doctor visit with all your questions answered and some help deciding whether to use hormone therapy to treat menopausal symptoms. Doctors seem to like it too, according to the website. Anything that makes it easier to get what you need from a medical visit is a plus. We menopausal women are notorious for the occasional memory lapse, so this is news we can use.

If you use the questionnaire, let us know in the forum whether you found it useful.

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The study followed the women from 1990 to 2000 and sent them a questionnaire every two years that asked for information on their dietary habits, smoking status, body measurements, medical history, use of hormone treatments and menopausal symptoms. What they discovered was that menopausal symptoms were associated with several factors, including some that were voluntary.

Women who smoked or drank alcohol were more likely to have symptoms, as were those who ate sugary snacks. They also found the risk of symptoms higher in women with benign thyroid disease, migraine and depression, but these are not modifiable factors. Since this was a large study done over a decade, it gave a lot of information about the cohort who participated. The more we know about risks, the more we can make choices that reduce them.

This research confirms what other studies have suggested – that women can, to some extent, lessen their risk of having menopause symptoms. At the very least we can quit (or cut down) smoking and drinking alcohol. We can find healthy substitutes for rapidly absorbed sugars in our diets, and thereby reduce symptoms or perhaps keep them at bay. While we wait for more good research to help us make right decisions, we can take matters into our own hands. Put down the drink, the cigarette and the doughnut – it may help you say "whoa" to menopause symptoms.

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A study from the Wake Forest School of Medicine in North Carolina has me wondering. A group of 56 women were selected for age (44-56), menstrual status (no period for at least 3 months), and menopausal symptoms (at least four hot flashes a day). The women were divided into three sub-groups, those who got:

• Regular menopause care,
• Traditional acupuncture, or
• Sham acupuncture

All the women experienced a reduction in their hot flash symptoms. The women receiving the usual medical care averaged a 10% reduction; those receiving traditional acupuncture had 40% fewer flashes; and those receiving sham acupuncture (shallow needles in non-therapeutic areas) also experienced 40% fewer flashes. Say what? It didn’t matter whether the acupuncture was the real deal or its imposter neighbor, women cooled down.

Was the success with faux acupuncture from the needles or was it placebo effect? And , more importantly, do we care? Instead of disdaining “placebo effect” as a therapeutic ugly step-sister, what if we embraced it as the best dang therapy since penicillin? It’s obvious that what we think has tremendous effect on how we feel. If our expectations can make us better or more comfortable, why not celebrate that and study it, as we would if it were a new drug or supplement?

Placebo effect is the Rodney Dangerfield of medical science. We give it no respect, and in fact point to it to justify that people are just silly little gooses for letting their brains do the work of the real heroes: medications.

What I don't get is why aren’t we studying the power of our expectations along with all the chemical boosters and concoctions? Let’s start by refering to it by a grownup name: “Expectation Physiology.” (That sounds pretty scientific, yes?) If I may borrow a phrase: A mind is a terrible thing to waste.

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