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 MoreWomen, O, pause! The book
If you’ve ever visited the ‘About’ section, you know that a key reason I started this blog was that I took a look around the interwebz to see what was being written about menopause and it gave me “pause.” I felt that there were voices that were being ignored or talked down to. And, I felt that the information was too limiting, too medical, not broad enough.
Hence, when I was approached by the publicity folks at Planned Television Arts/Ruder Finn to examine a new self-help book on menopause: Womenopause: Stop Pausing and Start Living (Authors Lovera Wolf Miller MD and David C Miller, MD), I thought, “sure, why not?”
Womenopause has an interesting approach in that it encourages women to be proactive rather than reactive to menopause. This philosophy is one that I’ve long ascribed to because I do believe that prevention is often the best medicine. In fact, when younger women tell me that this blog is not for them, I usually tell them that there are steps that they can take now to prevent some of the challenges that accompany the transition, such as weight gain/redistribution, bone loss and heart disease.
Moreover, I love that the authors acknowledge menopause as a milestone, not for its finality but for the fact that is simply another stage that “transforms women within the context of an already convoluted life and within the complexities of a marriage and/or dynamic relationships.” I love that Womenopause offers thorough, readable information about the processes that are going on in a woman’s body to cause various symptoms of menopause, an area that I’ve been hesitant to approach simply because I feel that there is a lot of good information out there, if you know where to look (for example, check out the Flashfree Blogroll on the home page). And I applaud the authors for their inclusion of real-life cases.
However, this is where my love affair with the book ends and the questions begin.
The authors of Womenopause ask their readers to chart their baseline symptoms and basic health and then record their course through four weeks using something they have named the ‘ωScore.’ Theoretically the goal is to help identify health problems, for example, the severity and emotionality of hot flashes, sexual or skin issues or sleep problems to raise awareness and potentially, spark conversations with their healthcare practitioners. Each of these areas is thoroughly discussed in the book in both a serious and thoughtful fashion, accompanied by an attempt at a lighter side. Although I think that records can help identify issues and promote helpful dialogue, I know that personally, I don’t want to take a quiz, keep a journal or score a “hot dread.” Huh? Hot dread is defined as emotional components – aura and anxiety, that may accompany a hot flash. The overall tone of the Womenopause interactive program — “fit, feminine and fabulous in four weeks,” feels a wee bit touchy feelie, “woo woo” to me, and frankly, when I am night sweating or flashing, I’m really not feeling my fabulosity or my femininity. As I’ve mentioned time and again, this ain’t no tropical vacation and I’m not really interested in ‘Menopauseland,’ the theme park.
When it comes to physical information, Womenopause is truly, a great guide. However, buyer beware! The majority of solutions to the common problems of menopause are medically/pharmaceutically-based and in fact, the authors repeatedly dismiss alternative and complementary therapies as unproven and no better than placebo. As someone who is well-versed in reading and analyzing data, and who has devoted the past two years to examining and sharing the evidence behind alternatives to hormone replacement, I take great issue with this approach and it makes me pause; by not taking adequate time to thoroughly explore studies on alternative approaches, the authors have truly done a huge disservice to women who are hungry for information and need to be empowered to make the right decision for themselves, even if that decision does not involve HRT. Moreover, for a book that devotes more than on thorough discussion to sexual desire and other menopausal issues, I am very surprised not to find Christiane Northrup, MD, listed in the Recommended Books section.
Overall, I would encourage readers of this blog to take a look at Womenopause, with the full understanding that this may not be your cup of tea. It certainly is not mine. However, if you are looking for concise medical information about the changes that are occurring in your body during the transition, and a wee smattering of helpful advice, Womenopause is a great resource. Just be mindful that fab, fabulous and fit in four weeks sounds like a dream, not a reality.
Tell me, what are your favourite resources or reads?
[Disclosure: I was not paid to review Womanopause. However, the publicity folks did send me a free copy of the book.]
Read MoreLooking for the Big Sleep?
Those of you who are going through hormonal shifts, night sweats or hot flashes knows exactly what I’m talking about. Sleep. Sleep, the elusive gold ring that plagues many of us going through the transition. How many sheep have you counted this evening? Or last night? Or last week? Heck, I’m ready to start my own version of Farmville. Any takers?
Experts say that as many as 63% of postmenopausal women have insomnia. Frankly, I’m tired.
So, before you let another sleepless, toss and turn type of night go by, you might want to pay attention: isoflavones may just take away the awakenings that go bump in the your night. Say what?! Mind you, this is a very small study, enlisting only 38 menopausal women. However, I can dare to dream (or think about dreaming), can’t I? Participants were selected on the basis of their sleep complaints, meaning that they had to have difficulty initiating or maintaining sleep, or constantly experience nonrestorative, insufficient sleep to avoid fatigue and lack of alertness during the day. They were given a lecture about sleep hygiene, menopausal symptoms and general healthcare and then had a general checkup, after which time, they were asked to take an 80 mg soy isoflavone (estrogen-like plant compounds tablet (containing mostly of a type of soy isoflavone called genistein) or a sugar tablet daily for four months. Thereafter, they were assessed for sleeping habits, general complaints and any changes in their condition.
The researchers say that not only did use of isoflavones decrease the frequency of moderate and severe insomnia in the women studied by more than 60%, but they also increased sleep efficiency, that is, the degree of alertness the women felt the day following a night of sleep and their ability to perform everyday activities and feel good while doing it. They attribute improved sleep patterns to a significant decline in the number and intensity of hot flashes.
There are several unanswered questions left by this information, such as whether or not soy will have this effect on a majority of women (remember, the study was small), how soy might affect lifelong insomniacs who also have menopausal symptoms, and if other soy compounds might provide equal benefits. I’d love to see more on this before drawing any conclusions. However, it’s good to know that eventually, tossing and turning might be a thing of the past.
Want more information on sleep and menopause? Check out these posts and please, share your experiences as well!
Read MoreOne a day…takes the menopause away
Did you know that One-a-Day has a menopause formulation that theoretically reduces hot flashes, improves mood and addresses energy issues? Interestingly, if you compare it to One-a-Day for Women 50+, the ingredients and the amount of each vitamin and mineral are almost identical.
So, what makes the menopause formulation so much more effective for menopausal symptoms? Evidently, the addition of soy isoflavones, which, studies have shown, may help alleviate hot flashes or promote bone health. However, increasingly, researchers are focusing on S-equol, the compound in soy isoflavones that actually appears to make soy effective in addressing menopausal symptoms. So, based on the evidence, it’s fairly unlikely that soy extract in a multivitamin is going to provide the relief you seek.
I’m not certain that their sponsored blog, Menopause Live, is going to either. Granted, sharing experiences via Menoplay (a video blog) is an empowering approach, but you have to wonder about the fact that the site reserves the right to edit the videos. Or the subtle implication that these women are not taking medications but rather, a vitamin everyday to cure what ails.
Look, I’m all for multivitamins and supplementation, physical activity, emotional support and sharing. But I don’t appreciate the veiled messaging or false claims that are not backed by research and data. I don’t like to be hyped, duped or taken advantage of. And I don’t support the idea of using women “just like you/me/them” to push product.
Do you really think that your symptoms are going to go away when you take a vitamin and push “play?” Doubtful.
Don’t believe everything you read, see or hear.
Read MoreWorking through the transition? Or is the transition working you?
I ran across an interesting study examining how work affects menopause and visa versa. Initiated two years ago by Professor Amanda Griffiths of the Institute of Work, Health & Organizations at the University of Nottingham in the UK, the study aims to identify challenges that women face while working through their transition and also help raise employer awareness.
I contacted Professor Griffiths to learn more . Although she is still compiling her final data (culled from 900 women, ages 40+), she did share some interim nuggets that are pretty interesting.
The fact that menopause, or more specifically menopausal symptoms might affect life quality and work is not a novel idea. Numerous studies have shown that hot flashes in particular can significantly impact daily activities, especially when they are severe. In turn, hot flashes, night sweats and hormonal swings can significantly affect sleep and coping mechanisms. Hence it’s not surprising that among an initial group of 941 female police officers surveyed*, most agreed that the primary factors affecting their ability to function in their job were fatigue and insomnia. Nevertheless, about 2/3rds said that they wouldn’t or didn’t disclose the fact that they were going through menopause to their managers, either because their managers were men, were younger (and therefore unlikely to understand or have much empathy) or because they felt embarrassed. This point of view only changed if the symptoms were so obvious that they felt they had to explain, if they felt that their ability to cope with their symptoms was less than stellar, if their performance was somehow being affected by their symptoms or if they felt the need to justify a change in their behavior at work. However, I was heartened to read that many of the women felt comfortable sharing their experience with other colleagues who were similarly in the midst of menopause or had already gone through it.
Griffiths reports that a clear majority of women surveyed that expectations of their physical capacities did not change as they aged. Yet, less than half believed that their contributions were valued as much as their younger peers.
When asked what changes they’d like to see in their jobs to ease their way through the transition and challenges of growing older, most pointed out greater flexibility in working hours (e.g. flex time, no night shifts or since this was a police force, shifting from the front line to a desk job), access to workplace-focused health promotion, such as regular check ups and fitness program), improved awareness among managers of health-related changes in midlife and improvements in the physical working environment.
Griffiths says that more recently, she and her colleagues have surveyed women from all walks of career life, including education, administration and journalism and the final write-up of the study** will include these opinions as well. However, based on our correspondence, it appears that the difficulties that women face in the workplace during the transition are fairly universal. She explains that menopause is ‘taboo’ yet happens to 50% of workforce (I imagine that this number will only continue to grow as the population ages and we are forced due to economic constraints, to work well into retirement years.) “Evidence suggests that some women do experience a lot of difficulty – largely tiredness – much of which can be resolved with sensible line management and flexible work,” says Griffiths. However, “as with any other long-term health condition, employees should feel empowered to discuss health conditions with their line manager/supervisor, otherwise the latter are not in a position to help.”
Isn’t it time for change? Rather than let the transition work us, shouldn’t we be looking for empowering ways to work through it? In the early days of this blog, I wrote that science has confirmed what women have known all along: social support networks are one of the strongest weapons we have against the aging process. Griffiths’ research confirms that by engaging female peers who are going through similar experiences, we have a stronger experience overall. Yet, she also points out very clearly that men need to be brought into the equation as well. The only way to foster understanding is to share and educate, right?
The research shows that women want their managers to be more aware the menopause doesn’t simply affect their personal lives but also their occupational health. Although sharing may be risky, we really need to ask ourselves how much we are risking by allowing the transition to work us. Time for change, don’t you think?
*The initial research was funded by the British Association of Women in Policing. **Dr. Griffiths’ larger study is funded by the British Occupational Health Foundation.
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