Have you gone through menopause?
I had my first hot flash at the age of 45, and it was flattening. I looked at my husband and said ‘Is it hot in here?’ I was as surprised as the next woman even though I’m an expert and should have been able to identify a hot flash. And I was dismayed and thought I was too young to go through menopause.
The treatment for this group of women, which I call the perimenopause crowd, is a low dose continuous birth control pill. We’ve always been taught to take a break every month, or every couple of months, when we’re on birth control pills, but that is completely unscientific and just causes our hormonal chaos to continue.
I started on this regimen at 45, and can stay on it till I’m 55, so I’ll never know when my official menopause begins. I don’t have any periods because the pill makes the lining of the uterus very thin. Most everyone has transitioned to menopause by 55. Then I will begin some kind of hormonal therapy. Other women chose different routes.
Millions of women have been afraid of hormone therapy since the Women’s Health Initiative came out with its 2002 study claiming estrogen therapy was responsible for breast cancer, strokes, blood clots, and heart attacks. How do you you address that issue?
We need to get women to places where they can get evidence-based, scientifically accurate information. The WHI report came out in 2002, and it’s now 2016, but unfortunately it’s done a generation’s worth, maybe two, of damage. The generation ahead of me didn’t have enough smart doctors to help them understand what to do when the WHI report came out. There was too much fear and confusion.
I give the analogy of when IUDs first got into trouble in the 70s, with the Dalkon Shield. It really spoiled all IUDs for everyone. IUDs are the safest and most effective reversible form of contraception that hardly anyone uses because they still remember back to the 70s, when that one brand caused some significant issues for women. The same thing happened with the WHI in 2002. It was poorly explained to women. Doctors also didn’t understand what it was all about. Yet, the negative message that hormone therapy isn’t safe still lingers in the minds of everyone 14 years later.
What specific advice do you give women in perimenopause and menopause?
The real message is this: If you’re a healthy, asymptomatic, younger transitioning menopausal women, in your 40s and 50s, and within 10 years of your last menstrual period, you are a candidate for estrogen therapy. There are different estrogen delivery systems and different doses, and we can pick and choose based on a woman’s age and on her symptoms. Most healthy women are candidates. We want to address the short term issue of menopausal symptoms, and the longer-term issues of heart health, bone health, cognitive health, sexual health, total health and wellness, and total overall reduced mortality from all kinds of causes.
If you’re a younger menopausal woman, and you don’t take estrogen, you’re putting yourself in harm’s way. Then, when the window of opportunity to take estrogen closes, 10 years after your last menstrual period, it is unlikely that estrogen will help prevent strokes, heart attacks, or blood clots. Older women are more at risk for these health issues, so beginning estrogen therapy at this point isn’t advisable.