Midlife and Menopausal Options: Trumping Fear With Facts

That said, here are the fears…and the facts.

FEAR: “Everyone I know has had a hard time with menopause. I am scared!”

FACT: “It’s not your mother’s midlife!” Even knowing that not all nurse practitioners or docs will take the time to guide you, there are a plethora of things out there to safely and effectively help, including botanicals, bioidenticals and other forms of hormone therapy (“HT”), nonhormonal medications, etc. Much more is now known and available in every therapeutic area. THERE IS NO REASON TO SUFFER!

 Do not, however, let your doc just give you a prescription for “Premarin and Prozac” and an appointment in three months. Demand to know all of the options and different delivery systems if prescribed HT.

 Also beware of the “selling of menopause” and of unscrupulous practitioners who promise to “use only something natural” (they are trying to sell you something) who say that “BHRT is an alternative to the risks of HT” (BHRT, or “bioidentical hormone replacement therapy, IS HRT) or who try to tell you that estrogen is bad and then prescribe large doses of progesterone. In point of fact, there is every scientific indication that estrogen is no less safe than progesterone and progesterone probably has the same potential risks as estrogen.

FEAR: Hormone therapy is dangerous.

FACT: …Compared to what?? Yes, there is a very small risk with estrogen therapy. Compare, however, the relative risk of estrogen of 1.25-1.5 for breast cancer, with a relative risk of smoking of 15-30 for lung cancer. Also compare this with a much lower risk of hip, vertebral and wrist fractures, of heart disease, and of colon cancer and Alzheimer’s if HT is started around the time of menopause, and you put things is perspective.

In 2004, results of the WHI clinical trial of women with hysterectomies indicated that estrogen, given for up to seven years, was not associated with increased risk of breast cancer; it was adding continuous progesterone that made matters riskier. Did you see that in the newspapers? Of course not: scary news makes front page; reassuring news is relegated to page 17…

Also important is the delivery system. Simply stated, transdermal delivery (patch, cream, gel) is safer than a pill (less blood clots, stroke, liver problems). The safest mode of therapy? Transdermal estrogen and, if you still have your uterus, using a short course of progesterone every two-four months. The riskiest? Continuous estrogen and progesterone by pill form (especially if that progesterone is “Provera”).

FEAR: “I am going to grow unhealthy and fat.”

FACT: If you are a couch potato and eat poorly, your fear is well founded. Basal metabolic rate slows at menopause, so it is imperative that you take measures to counteract this. Importantly also, if you have “metabolic syndrome” you have a ten-fold risk of early death from cardiovascular disease. If you have three of these things, you have metabolic syndrome: Waist 35 inches or more for women, 40 inches for men; abnormal lipids (especially low HDLs and high LDLs and high triglycerides); abnormal glucose metabolism; hypertension; insulin resistance.

More women than men die from cardiovascular disease; it kills more women then all cancers combined! Three things are of absolute importance: (1) You have to exercise! There is no substitute. It has nothing to do with having fun–exercise is a necessary job. (2) Eat healthily: five-seven multiple small complex carbohydrate/protein meals are best. (3) Practice stress reduction. Stress kills! However, beware of any practitioner who “puts your on a diet” without first working with you to change your lifestyle and dietary habits.

FEAR: “All of the good sex is behind me…”

FACT: Au Contraire! With the increased knowledge and time you have, there is no reason that sex can’t be as good or better than it has been. What are the prerequisites for a satisfying sexual relationship? Adequate estrogen and testosterone levels; good vaginal health (a tiny amount of vaginal estrogen cream can work wonders here!); a healthy relationship; sexual continuity (use it or lose it!); intimacy and trust!