Monday, April 26, 2010

Menopause My Way

I am a physician. However I am also a woman. I have experienced hot flashes, etc. and for my money, they are unnecessary. I look at life pretty optimistically, so here it goes.


That's right. Most women will die of something else. Like heart disease, or the #1 cancer killer, lung cancer.
The fear of breast cancer is probably the biggest reason symptomatic women do not get adequate relief from symptoms. They are symptoms, just that. It becomes a quality of life issue. So, it's time to discuss in whom hormone replacement treatment is appropriate, where the risk lies, and how to do it.

My reference is the 2010 Position Paper from the North American Menopause Society,

It appears that when you start is crucial to receiving the maximum benefit and the least risk.Women who are recently menopausal and symptomatic are prime candidates. After 10 years  post menopausal without hormones is where you get the minimum benefit and maximum risk. This was the rehash of findings from the WHI study, mentioned in a prior blog entry.

In addition, if you don't have a uterus, your risk for breast cancer was not increased at all in the WHI study.
Lots of addtional work is going on to test varying compounds and different methods of administration, such as transdermal ( ie patch, cream, gel, vaginal ring ) vs oral meds. This infomation shows a tendency towards less risk of blood clotting complications using transdermal administration, but only slightly.

As I mentioned in a prior post, sleep disturbance is one of the all important symptoms to manage in menopause. It will typically appear as frequent waking rather than difficulty falling asleep.Daytime grouchiness tends to be related to poor sleep, so I like to manage this important symptom.

So do I take hormones, yes I do. Why, because it is my choice. How long will I continue to take them? Don't know. So far every time I try to go off, headaches reappear and I don't sleep well . So for now, I'm sticking with the plan. The concept is to use the least  EFFECTIVE dose of hormone for the LEAST time that you are symptomatic. About 2 % of women have hot flashes into their eighties, so we'll see.

How do I do it? I use the Femring vaginal ring. It is simple and unobtrusive. It has estradiol, the predominant premenopausal ovarian hormone. It comes from plant source. No uterus so no progesterone needed.

YOU may need something different. Due to preference, finances, or you have a uterus.  Anyway, most of you will not need to spend a fortune on custom formulas or look for bioidenticals or plant source hormones.
The FDA oversees manufacture of many plant based, bioidentical hormone products. Ask your doctor. She/he can give you a long list. The funny thing about compounding, is that the regulation of giving a patient the papers with the information regarding their medications is not required, so many women think it is not a medication, or that it is safer, or that it is "more natural". I guarantee that the compounding pharmacist is not grinding up nuts and berries in the back. They are using the same precursor medications as big Pharma.

until next time

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