Hot Flash Havoc: fear and loathing in the menopause
Author Louise Foxcroft, writing in Hot Flushes, Cold Science, points out that “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”
We have also been victims of the fact that menopause has been “thoroughly medicalized in Western Culture.” The result?
Our bias is to think of menopause as a disease, something that needs to be fixed, treated and eliminated. The solution is inevitably hormone replacement therapy or HRT.
Supporters of HRT will fight tooth and nail against evidence from the Women’s Health Initiative Study that showed that the risks associated with hormone therapy may outweigh the benefits. Their argument lies with the contention that the findings relate to women who were on average, 63 years of age, considerably older than the average age that women start menopause, and that the data are not applicable to younger women. Moreover, had these very women been given hormones earlier, they would have had protection against a multitude of diseases, including heart disease and osteoporosis. Critics of HRT, on the other hand, point to data showing that length of time on hormones, timing of hormones and genetic disposition can increase or decrease a woman’s risk for disease, that HRT doesn’t protect against heart disease or stroke and may in fact, significantly increase disease risk, in particular, breast and ovarian cancer, and death from lung cancer.
Last weekend, I sat through Hot Flash Havoc with a group of female friends. Together, we range in age from 47 to 57. Two of us have had multiple bouts of cancer while three of us have lost loved ones as a result of cancer. Our mothers have had hysterectomies, mastectomies, hot flashes or no flashes. Some are still alive and others have passed. In composite, we are representative of the modern woman: savvy healthcare consumers, avid data hounds, curious, communicative and sometimes outspoken. As one of my friends stated, we are “rolling into a new phase” or have already rolled into it: menopause.
I couldn’t think of a better, more objective way to screen Hot Flash Havoc, “the most provocative and revealing film ever made about menopause.”
Provocative? You bet!
Revealing? Yes!!!!! But not in the way that the director, producers, writers or underwriters intended. Rather than debunk myths about menopause, they have produced a documercial that the women in the room described as:
“Condescending.” “Patronizing.” “Not very well done.” “One-sided.” “Unhelpful.”
And my favorite: “a giant estrogen dildo.”
Hot Flash Havoc promises to “set the record straight about the Women’s Health Initiative study released in 2002, which misrepresented that the hormonal replacement therapy being used by millions of women to treat the symptoms of menopause could actually increase the risk of heart attacks and cancer” and further, “shed insightful light on the confusion stemming from a decade of misguided facts [through] poignant personal stories shared by real women and in-depth interviews with the world’s most noted experts.”
However, the reality is somewhat different. This film of “menopausal proportions” is a meandering, sometimes cartooned montage of HRT hype and bias. Attempts to turn ‘women’s anatomy 101’ into humorous animations of talking vaginas, vulvas and ovaries begs the question: have we somehow stumbled onto a grade school class on menstruation? (By the way, the only thing missing were the tampons and sanitary napkins, which of course, would have no place in the menopause medical cabinet. )
Along with a dash of failed humour is the film’s dose of intrigue, not about the mysteries of a woman’s body but rather surrounding accusations of a government conspiracy underfoot to undermine decades of evidence supporting the use of HRT. Indeed,the National Institutes of Health, which halted the hormone arm of the Women’s Health Initiative study is blatantly accused of attempting to rob women of HRT in a selfish quest fueled by self-promotion.
Wait! The government is conspiring against women who need their hormones???!
The circus-like atmosphere of Hot Flash Havoc is beautifully orchestrated by pro-HRT doctors disputing evidence, ‘enlightened experts,’ and of course, a bevvy of Botoxed babes who went through terrible withdrawal when their doctors made them stop taking their HRT. The message? Women: you’ve been duped!
Hot Flash Havoc misses the mark because it robs the viewer of any objectivity or information about how women and practitioners in different cultures and countries address menopause. Moreover, with the exception of a token naturopath thrown in for good measure, alternative strategies are portrayed as ineffective shams and their proponents, as greedy blood suckers who care more about profit than the women they serve.
One of my friends asked if the film’s intention was to provide enough information to make an informed decision. If so, she said, it fails terribly. Another friend commented that the film portrays menopause as an illness and said that she thought that the film’s underlying message is that menopause is not natural and needs to be cured, that there’s something wrong with you.; ‘it makes me angry,” she said. The overriding complaint was the clincher: this film is really about instilling a fear of aging and illness and the need for a remedy, a ‘miracle’ drug: estrogen.
Hot Flash Havoc is an infomercial of menopausal proportions, a messy mash-up of HRT hype and fear and loathing, a big estrogen dildo just waiting for an opening. Do yourself a favor: don’t let it wreak havoc on your psyche. This one’s a dud.
A huge thank you and love to my Roller girls and partners in crime — Turn A Head, Wendy Wildstar, Biker Babe and Red — for their comments and insight. Couldn’t have written this one without you!
p.s. Bob Dylan wants his album cover back.
Wednesday Bubble: Time to debunk the hype about traditional Chinese Medicine
This week is dedicated to the debunk – debunking the absolute need for anti-anxiety medications (it may be your flashes, not your mood), debunking the myth underlying the lack of published data supporting the use of traditional Chinese Medicine (TCM, e.g. acupuncture and herbal medicine) and debunking the one-sided, endless loop about hormone replacement therapy.
Because Wednesday falls in the middle of the week, I want to focus on traditional Chinese medicine, which is considered part of the offerings that fall under the umbrella of “complimentary and alternative medicine.” As a practice, TCM was created roughly two thousand years ago and refined in the centuries that followed. And yet, Western practitioners continue to question its value because they claim that there is no real evidence supporting its therapeutic effectiveness. No evidence? A quick search on Google yields countless databases, with one example housing over 400,000 studies and abstracts, many of which have been published in reputable Chinese biomedical journals over the past several decades.
The challenge and the solution
Unquestionably, the evidence doesn’t look quite as strong when strict Western methodology is applied to Eastern philosophies without addressing their distinctions. In fact, a prime example of what happens when the paradigm shifts is the ACUFLASH study, which as I reported earlier this year and late last, demonstrated the benefits of acupuncture when the investigator practitioners were allowed to incorporate some invidualized therapy into the mix.
So what exactly does that mean – to incorporate individualized therapy into the mix?
A unique aspect of the ACUFLASH study was the ability of the practitioners to work within a defined framework but with the addition of directing therapy to each participant’s specific needs. In other words, the practitioners met before treatment and agreed on the specific symptoms or conditions they would include in the study as well as the specific acupuncture treatment points they could work on. This organized system meets some of the strict criteria of Western scientific study. However, they could then choose which of the the treatment points would most benefit a given participant’s system imbalance as well as provide possible diagnoses and self care recommendations (e.g. soy, herbs, physical activity and relaxation techniques) which participants were free to add at their own discretion. This ability to work within the confines of both Western and Eastern practice resulted in significantly beneficial results.
TCM versus Western Medicine
TCM and other similar philosophies emphasizes various body systems that together, form a network or grid connected by a meridien, if you will, as well as the relationship of the body to its social and natural environment. Its primary focus on maintaining health and enhancing the body’s ability to fight off disease. TCM will not focus, for example, on treating specific pathogens but rather, on addressing non-specific factors that create disturbances or imbalances within a certain network. TCM also examines how these imbalances may occur in unique parts of a specific system, such as the heart and blood vessels and small intestine (all of which are part of the heart system) and how they change over time. Western medicine, on the other hand, focuses primarily on treating morbidities, or symptoms related to various conditions and diseases.
Another point of distinction is that while Western practice is geared towards treating specific causes and symptoms of a disease, it doesn’t do so well when the causes or influences are less specific or more importantly varied. Sexual desire, or lack thereof, is a perfect example. It’s been demonstrated time and again that certain aspects of menopause or aging, for example, sexual desire, are not only related to physiology but also to environmental factors. And while the addition of estrogen can certainly help to keep vaginal juices flowing, so to speak, it can’t address social, psychological or behavioral factors that might also be influencing that desire.
I have said it before and I’ll say it again: my dream will be fulfilled when East meets West. I’d like to see greater integration of of the two philosophies and less push back from the Western Medical Establishment against TCM. Calling it a ‘sham,’ because it doesn’t fit into the traditional mold, calling it snake medicine because it isn’t based on medical school learnings, and refusing to examine published scientific papers that have been translated, however roughly, into English, does a disservice to the patients who might benefit from the integration of the two.
Since when are hot flashes and mood swings ‘pathologies,’ symptoms of a disease that requires drug treatment?
Isn’t it time to separate fact from fiction, hype from hope and myth from truth. TCM isn’t a sham. And menopause? It can truly be addressed without drug therapy.
Read MoreFeeling anxious? It may be those hot flashes!
Researchers say that there may be a link between hot flashes and certain types of anxiety. In fact, hot flash symptoms — increased heart rate and feeling flushed — have been shown to mimic feelings associated with somatic anxiety, i.e. butterflies in the stomach and tension (as opposed to affective anxiety, which people feel panicked or afraid or nervous).
Importantly, data have shown that as much as 8 months before premenopausal women start experiencing or reporting hot flashes, their scores on an anxiety index are off the charts, which means that constant butterflies or tension may be predictive of the move into menopause. The reason this is important is that they may be steps you can take now to address symptoms as they start to emerge, yoga and deep breathing for example, which not surprisingly, are often recommended to address anxiety symptoms.
The latest bit of information to hit research circles involves a study of 80, healthy, well-functioning menopausal women who were asked to keep a daily diary on hot flashes or night sweats (defined as a feeling of warmth or heat accompanied by sweating, pressure or rapid heartbeat occurring while awake or during sleep). In the diary, participants were asked to record how often hot flashes occurred over a one-week period as well as their severity. They were also asked to rate any symptoms of anxiety based on how often they occurred.
The results?
Higher scores of anxiety related to tension and butterfly-like feelings but not to panic or nervousness were significantly associated with more severe and frequent hot flashes or night sweats, even when factors such as sleep quality, age and education levels, all which might affect anxiety levels, were factored in. Age in particular is important because hot flashes tend to wean through the menopause as women grown older.
The reason this preliminary research is important is that it is possible that anxiety that women experience during menopause is actually related to hot flashes, rather than a specific mood disorder. By shifting the viewpoint to the true culprit, healthcare practitioners and women alike, might be able to better diagnose and more appropriately address anxiety symptoms, rather than leaning towards prescription mood treatments that are uncalled for.
At the same time, more research is needed. This was a small group of healthy, white women who were asked to self-report hot flashes/night sweats and anxiety symptoms. Although most of the research on hot flashes does rely on self-report, objectivity can be lost. What’s more, because these women were psychologically healthy, it’s hard to apply any conclusions to older women who might be seeking assistance specifically for anxiety.
So, are you feeling anxious? Depending on your age and menopausal status, it might be a harbinger of the flash or due to the flash. Either way, it’s worth considering.
Read MoreBouquet-Worthy, a guest post by Dr. Barb DePree, M.D., Menopause Care Specialist and founder of MiddlesexMD.com
I recently had someone comment that I write about sex often.
I wasn’t aware of that.
In fact, I don’t really. But reader impressions are always welcome; who knows what people see or read or think or interpret, right?
So, on the heels of the write about sex comment, I thought it would be appropriate to include a post about sex, more specifically a website geared towards sexual desire, function and expectations in mid-life. I liked what I saw when I perused the site, so much so that I felt that this post would be most appropriately written by MiddlesexMD.com’s founder, healthcare provider and menopause care specialist, Dr. Barbara DePree.
A big bouquet of roses waited for me at the front desk of my clinic. It wasn’t my anniversary or my birthday. When I saw who sent them, I smiled that special “good sex” smile, even though the sex I was smiling about wasn’t my own.
I’ve been a women’s health doctor for more than 20 years, focused on midlife women for the past four. These flowers were not from a new mom or a patient with a difficult disease. These came from a patient who got her sex life back. That may not seem like a big win in the scheme of things, but it was a wake-up call for me.
My patient, now in menopause, was distraught that her sex life seemed to be over so soon — too soon. Sex was effortless for most of her life. It had been very satisfying. And suddenly, it wasn’t any more.
We talked about sexual response with her hormonal changes, all of the many factors that could be influencing her experience. Then we talked about her options for managing these changes. She tried different routes, but when I introduced her to a device — she had not used them before — that made the difference for her. With the help of a simple tool, she was able to adapt to her new reality, and enjoy sex again.
It was a fairly straightforward doctor-patient exchange, but not a common one. Women rarely talk to their doctors about sex. As a menopause practitioner, though, I know that changes in sexual response are a key source of distress for a lot of women and their partners at this age.
Is it a Doctor’s job to help their patients have good sex? I think it is, absolutely. A healthy sex life sustains our overall health and well-being. Sex is good for us, and helps us to remain vibrant and strong. Menopause isn’t a disease. It’s a natural process. The more we understand this process, and discuss it openly, the easier it will be for us to make adjustments to accommodate our bodies’ changes.
The roses were evidence that my patient’s sex life had been restored.
How many women like her have never raised the question with their doctors. Their gynecologists? Or sisters? Or friends?
I founded MiddlesexMD.com for women who aren’t ready to close the door on sex, and who aren’t sure how or when to talk with their doctors about their experiences.
MiddlesexMD is organized around five “recipe” elements – Knowledge, Vaginal Comfort, Genital Sensation, Pelvic Tone and Emotional Intimacy – that are essential to sexual well-being. It provides a factual guide on how they contribute to a healthy sex life, how they change with menopause, and how to use different techniques and products to make up for those changes.
I hope that MiddlesexMD gives you a trustworthy (and hopefully bouquet-worthy!) resource to explore issues you might be having, conditions that could be causing them, and steps you can take to enjoy sexuality for life.
About the Author
Barb DePree, MD, is a women’s health provider in West Michigan, specializing in menopause care. She founded MiddlesexMD.com, a safe, comfortable place where women can learn how aging affects sex after 40, find advice and techniques, and purchase specially chosen aids such as a personal vibrator, moisturizers and lubricants.
Read MoreWednesday Bubble: Your bones, your health. The lowdown on bisphosphonates
For decades, physicians have been prescribing a class of medications known as bisphosphonates (e.g. Fosamax, Actonel, Boniva) to preserve bone health in menopausal women and prevent fractures in both men and women with osteoporosis at high-risk for them). Bisphosphonates are often offered as an alternative to hormone replacement therapy or HRT.
Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year. However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.
If you consider these statistics, it seems that using bisphosphonates is a good thing, right?
Well, not so fast. Earlier this year, I wrote a post highlighting reports of jaw bones collapsing among women taking bisphosphonates over a certain period of time. Included within the information were tips from the American Dental Association for protecting your jaw before any major dental procedures. This week, I want to add another facet to the bisphosphonate story, one that is definitely worth considering when weighing the benefits and risks of these drugs:
It is possible that use of oral bisphosphonates may increase the risk for developing cancer of the esophagus by as much as two-fold.
Here’s what you need to know:
- In this particular study, researchers compared over 15,000 men and women who had been diagnosed with esophageal, gastric or colon cancer over the age of 40 to five healthy individuals with similar characteristics. All study participants had been prescribed bisphosphonates at least once, with some receiving more than 10 prescriptions, which would imply that they used the drugs over time (over the 7-1/2 year period of times examined, a majority used bisphosphonates for at three years or more).
- Use of bisphosphonates over three years and having received at least 10 prescriptions was linked to a significant increase in cancer of the esophagus but not gastric or colon cancer. People who used bisphosphonates for five years or more had twice the risk compared to those who did not. Note that these rates of cancer held regardless of the exact agent used.
- An increased cancer risk remained even after actors for esophageal cancer, such as age, smoking, alcohol and body mass intake, were accounted for.
- This increased risk, may be due, at least partly, to drug side effects that affect the esophagus directly, such as irritation and inflammation of the esophagus (i.e. esophagitis).
Now, mind you, esophageal cancer is extremely rare, affecting roughly 16,000 people in the US in 2010. However, death from esophageal cancer, is high and the disease is often fatal. Moreover, esophageal cancer tends to affect three to four times as many men as women, which is why this latest bit of information is as critical for men as it is for women entering menopause.
One important thing to keep in mind when you consider the risk and benefits of bisphosphonate therapy is that this particular study compared actual cases of these three types of cancer to healthy individuals in the population. Sometimes, the information yielded in these studies is not considered as conclusive as studies that are conducted proactively, and not retroactively. Still, this is not the first time that bisphosphonates have been linked to cancer of the esophagus.
Maintaining bone health and strength as we age, particularly as hormones decline, is critical to our health in the later years. It’s important to make the right decisions now, while we are still relatively young. Flashfree has plenty of posts on bone health and osteoporosis, and I encourage you to peruse them. When it comes to your bones, it’s not just about ‘use it or lose it,’ but also, the three P’s:
Protection
Proactive
Prepared
Your bones, your health.
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