By: Red Hot Mamas
Published: July 14, 2010
I had the honor of making a presentation at the First Global Summit on Menopause-Related Issues held in Zurich, Switzerland March 29-30, 2008. My presentation was entitled “Perceptions From The Woman’s Point of View: Altered, Bewildered and Confused”. It covered women’s perceptions before and reactions after the unforeseen negative findings of the Women’s Health Initiative Study findings (WHI), in July 2002.
Hormone therapy (HT) has been used since the 1930’s and it certainly has had a bumpy history. The constant flow of medical research beingreleased by the media is oftentimes contradictory and creates a dilemma for women, as well as their clinicians regarding the use of HT.
Besides the data being conflicting, it is often presented from a sensationalist point of view. This has caused women’s opinions to become jaundiced and they are questioning – should I, or should I not use HT? Women are demanding answers from their clinicians, developing an increased sense of personal control, and exploring all options to alleviate their menopausal symptoms. They are looking for clinicians to provide them with information on all options and to be treated with an individualized approach.
To better understand the change in thinking, I will take you back to 1997. That year, Phil Sarrel, M.D. Yale University School of Medicine, and I conducted research at several Red Hot Mamas program sites. This research was entitled “Healthcare Delivery and Hormone Therapy Experience and Effects of HT Continuance”. Two hundred fifty two women participated in this study. The results were presented at the North American Menopause Society’s Annual Meeting. Our study asked women why they were using HT. Here are our 1997 results:
Women’s reason for using HT (several choices possible) …
- To control symptoms 77%
- To prevent osteoporosis 73%
- To prevent heart disease 55%
- To maintain sex life 41%
- To prevent stroke 37%
- To prevent Alzheimer’s 32%
This was in line with what women were told by their clinicians prior to Women’s Health Initiative Study (WHI):
- They would feel better after taking HT
- It would set the stage for better health
- The benefits were greater than the risks
- They could be on HT for the rest of their lives to prevent disease.
These facts were reassuring to women and caused them to have a greater sense of well-being when taking HT.
The “bombshell” dropped on us in July, 2002, when the unforeseen negative WHI findings were released. The news shocked millions of women causing them to become frightened, angry, bewildered and confused. Many clinicians were overwhelmed by phone calls from women as they did not take the news too lightly. Red Hot Mamas programs became filled to capacity with women looking for advice and support.
Suddenly women looked at HT with skepticism and not only the use of HT declined, but their confidence levels in their clinicians rapidly fell as well. Suddenly, clinicians were toppled from their thrones. Women became disenfranchised from their clinicians because of the uncertainty of the risks involved in taking HT, in contrast to what they were told before. They became more reliant on friends, relatives and their peers for information on menopause and treatment options, rather than seeking the advice of their healthcare providers.
Amid all the controversy, women still remain symptomatic and are hormonally challenged. Obviously, it’s hard to maintain your sanity and equilibrium if you are sweating profusely, suffer from vaginal dryness, not sleeping and having mood swings. As a result, the choice whether to take HT has become increasingly more complex and difficult. After deciding to take HT, the next decisions to make are which estrogen, which progestin, which route of delivery and for how long. Therefore, it is one of RHM objectives to provide you with the information needed to guide you in the decision making process and with the key questions to ask your clinician.
If your ovaries have been surgically removed (oophorectomy), like me, your symptoms may be more acute and severe – so there may be different considerations and different answers for you.
It is not surprising that women feel confused, because they also perceive their clinicians are equally confused. Some clinicians continue to advise using HT, while others don’t advise at all leaving it up to the woman to ask for it.
Because of the new skepticism about HT, women are trying other lifestyle modifications like exercise, dressing in layers, meditation, staying cool by lowering thermostats. They are also spending more time in health food stores seeking herbs to lesson their symptoms (i.e., soy, black cohosh). Some have even resorted to using celebrity promoted bio-identical hormones. Many women are also changing their state of mind, coping with their symptoms, while still having heat waves – flushing and night sweating.
Even amidst the controversy about HT, it certainly may be the right choice especially for women experiencing troubling menopausal symptoms. And, there should be some consideration to use it on a short term basis for moderate to severe symptoms in early menopause years.
Women need to have an in-depth discussion with their clinicians about all options available to manage of their symptoms. If HT is recommended, women need to understand the rationale behind taking it, the length of time they need to be on it and what to do if they want to stop taking it. They also need to be able to put into context the findings of these clinical study results and how these pertain to their individual benefit/risk assessment.
This discussion will require more time from the clinician and his/her team, to discuss individual symptoms and individual treatment options. This discussion is critical since women not only want to know the benefits and risks of HT, but they want answers about what could happen to them 10 to 15 years from now. They need to make intelligent and comfortable decisions regarding treatment options. Red Hot Mamas encourages women to become educated consumers of their healthcare and active participants in decision-making with their clinicians.
In upcoming articles , I will share with you The 1 st Global Menopause Consensus on HT as well as other key findings that came out of the Summit. I will also provide you with information about The International Menopause Society of which I am now a proud member.