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.
Hormone therapy and bones – fuggedaboutit
Another HRT-busting post…straight from the archives of the Ahead-of-Print edition of Menopause. I’m afraid to say that yet, another analysis of the now infamous Women’s Health Initiative Trial, you know, the one that was halted due to links between HRT and significant increases in breast cancer, suggests that hormones might not be so great after all, especially when it comes to bone protection.
The loss of lean body mass as we age contributes to redistribution of fat and apparently contributes to falls and fractures in the later years. This is one reason why many physicians prescribe hormones. However, in the latest nail in the HRT coffin, it appears that despite earlier reports of significant reductions in fractures among women taking HRT based on body mass index, age and bone mineral density, the ability of hormones to preserve lean body mass is a fallacy. In fact, when researchers looked at almost 2,000 women who had been enrolled in the trial who were assigned estrogen plus progestogen, estrogen alone or placebo, they were unable to find any differences in lean body mass after six years, even though there was some indication of protection at the three year mark. What’s more, the researchers say that although women who took most of their hormone medication before the trial was halted seemed to fall less, it wasn’t because their lean body mass was preserved.
The main point in relaying this bit of information is experts want us to believe that HRT is the panacea for everything that ails as women age –from bone health to heart disease to dementia. And despite evolving evidence to the contrary, they continue to seek reasons why the data are wrong and look for ways to question every negative finding. Some Associations whose mandate it is to defend women’s health, like the Society for Women’s Health Research, take money from companies whose hormone products have been found to cause significant adverse effects in certain populations of women and yet, they continue to lead the charge favoring hormone therapy.
In general, I take no issue with Western medicine or pharmaceutical companies. If you look at my background, I have spent years writing favorably about many products and the research that backs them. But I maintain a standard of transparency and don’t choose to hide who’s paying the bills, And, when it comes to hormone therapy, I continue to smell a rat. Be assured that I will continue to write about what’s really going on until more women understand how fucked up HRT really is.
If you choose to take HRT and it works in alleviating your flashes, sweats, mood swings, headaches, sex life and the like, more power to you. I support your right and decision to take HRT. But like any drug, be sure you know the facts before you believe the hype. Be certain to be diligent and ask the hard questions, even when the information comes out of seemingly expert sources or associations. Always, always, follow the trail. You might be surprised at what you learn.
This particular trail, the lean body mass trail? It’s a dead end. Fuggedaboutit.
Next.
Read MoreFDA: Keep children away from topical hormone spray
Do you remember the post back in June about topical hormones, i.e. transdermal sprays, lotions, gels and patches harming your pets? Evidently, they may also be harmful for your children as well. In fact, the Food and Drug Administration has just issued a warning that children should not come in contact with any skin area where Evamist®, a low dose estrogen spray for menopausal symptoms, has been applied.
Similar to reported side effects in animals, the FDA is review reports in children between the age of 3 and 5 years of age who have developed signs of premature puberty following unintentional exposure after a caregiver uses Evamist (the spray is applied on the skin on the inside of the forearm between the elbow and wrist). They include:
- Nipple swelling and breast development/mass in young girls
- Breast enlargement in young boys
The FDA is now saying that exposed pets, especially small animals, who lick or rub their owners’ arms while being held may develop similar symptoms aw well as swelling of the vulvar.
To quote the FDA: “Keep kids and small pets away from skin sprayed with Evamist.”
Yet another reason to stay away from use of hormonal agents and drugs during menopause.
Read MoreWednesday Bubble: HRT – wait a moment!
Back in early May, I wrote a post about the difficulties in stopping hormone replacement therapy (HRT) and the disturbing fact that doctors have no guidelines to follow in order to advise their patients on the best strategies. Today’s Bubble is a perfect companion to that piece, as it addresses the fact that research now shows that women who start HRT and then stop it have a tendency to have significantly greater and more severe menopausal symptoms than had they never started HRT at all.
Writing in the online edition of Menopause journal, researchers say that among 3,496 postmenopausal women who completed a pre- and post- stopping therapy survey during the Women’s Health Initiative study (a trial that compared estrogen/progestin to placebo and was subsequently halted when HRT was found to double the risk of breast cancer) :
- Those who had not reported having hot flashes at the start of the study were more than five times as likely to report moderate to severe hot flashes after stopping HRT compared with women with no symptoms who took sugar placebo pills. However, women who had reported having hot flashes at the study’s start were only slightly more likely to report hot flashes after stopping HRT
- A similar pattern was seen for night sweats, i.e. women who had none at the study’s start were almost twice as likely to report them after stopping HRT
- Age at stopping HRT was increasingly associated with more joint pain, i.e. the older the woman, the higher the risk for experiencing joint pain
The researchers say that although there have been previous reports of a surge in vasomotor symptoms like flashes and sweats after stopping HRT, these findings show that estrogen, either alone or with progestin, may promote symptoms when HRT is stopped, even if a woman was not experiencing them when she started therapy. More specifically, the risk for menopausal vasomotor symptoms and joint stiffness is four to seven times more in women with and without prior symptoms when HRT is stopped.
The takeaway message is that it’s not only important to consider the health risks associated with HRT but also, what happens when you stop it. Clearly, even if your symptoms disappear while on HRT, your risk for symptoms after stopping therapy is fairly high.
You should always weigh the risk benefit ratio before starting any type of therapy. HRT may not be worth the trouble. Or the multiple risks.
p.s. More on this study from my friends at Reuters Health.
Read MoreIs topical HRT hurting your pet?
File this one under “OMG.” I ran across a piece this past weekend that discussed the effect that topical hormones, particularly HRT, might be having on your pets. Although experts from the North American Menopause Association (NAMS) are quoted as saying that they’ve not heard of this before, the reporter uncovered five years worth of discussion on veterinary internet boards. Evidently, vets are seeing female animal patients with swollen vulvas and male patients with enlarged mammary glands and smaller than normal penises.
It appears that exposure occurs when owners apply topical hormone gels, lotions and sprays to the arms (i.e. elbows, wrists) and legs and then handle or snuggle with their pets. The problem has also been associated with pets unwittingly licking the areas where owners have applied the drugs.
Evidently, the Food and Drug Administration is looking into this as is the NAMS. In the interim, if you are using topical hormones, you might want to be more careful where you apply them (e.g. inner thigh or abdomen) and be sure to wash your hands before handling your pets.
And if your animal is exhibiting unusual signs? Bring them into the vet immediately.
Has anyone encountered this before? I’d love for readers to weigh in.
Read MoreWednesday Bubble: The HRT patch – is it safer?
Remember the diva and the doctor sitting on the roof espousing the benefits of the HRT patch? Well, it turns out that some of these patches might not be so safe after all. Results of a study of over 75,000 women published in the British Medical Journal, show that the use of high-dose transdermal (through the skin) HRT patches increases stroke risk by as much as 88%.
Granted, transdermal or through the skin delivery bypasses the liver, which typically makes patches safer than their oral counterparts. However, if the drug isn’t safe, well, then the patch might not be either.
In this latest bit of news, researchers evaluated women between the ages of 50 and 79 who had participated in the ongoing Study of Women Across the Nation (SWAN). Every woman who had had a stroke were matched for comparison to four women in the study, with similar characteristics, who had not. The women were further divided into groups based on their use and type (i.e. oral or patch) of HRT, including estrogen only, estrogen plus progestogen, progestogen only, and the estrogen alternative, tibolone (which is not available in the US).
The researchers say previous and recent studies suggest that oral HRT, including estrogen only or estrogen plus progestogen, is associated with a 30% increased risk of stroke. However, stroke risk differs between high- and low-dose patches. Overall, they report that:
- Low-dose patches do not appear to increase stroke risk, at least in the short-term (they say that they cannot rule out an increased risk with long-term use)
- High-dose patches, regardless of whether or not they are estrogen only or estrogen plus progestogen, appear to increase stroke risk by anywhere from 25% to 88%
- Risk was the highest among women who had used oral HRT before trying transdermal HRT, although this risk appeared to decline the longer the time period between stopping oral and starting the patch
- Findings remained even after adjustments were made for factors that might influence results, including age
What the findings mean
Despite claims to the contrary, it does not appear that HRT offers much protection against heart disease during and after menopause. What’s more, the HRT patch may not actually be safer than oral HRT, at least in so far as the high-dose HRT patch goes. Although the researchers state that they were unable to distinguish between types of stroke when evaluating the SWAN study data, they say that these data show the need to look further into how HRT is delivered, especially as use of the HRT patch becomes the norm.
As I’ve written previously, if your doctor suggests you try HRT for menopausal symptoms, it behooves you to ask the hard questions. While you may save your sleep, mood and a few articles of clothing, you may be placing yourself at a higher risk for cancer, heart disease and other serious conditions.
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