Talk health to me, baby…on ePatient Conference, Seduce Health and menopause
When was the last time talking health was considered sexy? Or creative? Or passionate? Well, if you are a long time reader of Flashfree, you know that I don’t mince words and I don’t attempt to turn menopause or aging into a steamy soap opera (unless we’re talking steamy as in night sweats and hot flashes). However, I do try to approach the ‘what you need to know’ with humor, integrity and candor and stay away from fear mongering. That’s why I was excited to meet a lot of people last week who not only shared my passion for healthcare but more importantly, for conversing about it.
If you have not heard of ePatient Conference, you may want to check it out next year. It’s two solid days of engagement, exchange and networking. But if you take away the buzzwords, you are left with an opportunity to put creativity back into the way that healthcare is approached, managed and talked about.
Among the many incredible experiences — from hearing Seth Godin’s keynote to witnessing the VGo Robot take photos of the audience — none were quite as inspiring as meeting Google’s Chief Health Strategist, Roni Zeiger. And while Roni is undoubtedly doing some very cool things with Search and Trends over at the Google Headquarters, I was most impressed when he started telling me about Seduce Health. Along with co-founder Alexandra Drane, Roni started the site “to get a public conversation started about how we can reframe how we ask people to change their behavior, to live healthier and therefore happier lives. To move from fear and lecturing to passion and dreams, hope and beauty.”
It’s not a bad goal. But is it achievable?
It’s fairly clear that health messaging often falls on deaf ears and that sometimes, the individuals, experts and organizations leading the charge are the ones who are also misleading the very public they seek to educate. Take overweight and obesity for example, problems affecting an estimated two out of three American adults and at least 17% of all children. Obesity is the elephant in the room, acknowledged but rarely discussed without fear or lecturing, under- or misestimated and frequently inadequately addressed. Menopause is also a good example, a natural transition in a woman’s life that has been turned into the disease of the 21st century, medicalized by many health practitioners, manufacturers and the media, and mongered to the point where we have a burgeoning Menopause Industrial Complex based on greed, profit, fear and self-loathing rather than empathy and education.
When it comes to women’s health, I do believe that can be sensuous and passionate, not dry and stale. Along these lines, I recently wrote that:
taking control doesn’t have to mean that the aging process is denied, stopped or obliterated, medicalized or industrialized. Rather, it means taking charge to feel better, more vibrant, healthier so that you/we/I can live the best life I can live while we are alive. For me personally, that doesn’t mean hormone replacement or botox or lipo; it means trying to make more healthier decisions, control or address my symptoms with evidence-based alternatives and accept the transition as a natural part of my journey. I consider this time an opportunity for shifting priorities and interests that open all sorts of possibilities. And, I want to take the experience out of the closet and foster discussion and sharing. Ultimately, I’d like the see a more natural course driven by women themselves, as opposed to societal expectations and stigmatization of the aging process and as opposed to the Menopause Industrial Complex.
I’ve said it before and I’ll say it again. Let’s crowdsource menopause. Let’s make it a goal to seduce our peers and practitioners into talking about it, embracing it and not trying to change it into something its not: a four letter word. Aging can be a hopeful, positive experience.
What do you say? You in?
p.s. If you are curious about ePatient Conference, organizer Keven Kruse has graciously posted presenter slides here.
Read MoreMenopause: the symptom? Or, the disease?
A few years ago, I ran across the following story on the BBC:
“Woman’s Death Blamed on Menopause.”
“A woman who refused to take hormone replacement therapy died while suffering a menopausal episode, an inquest had heard. Margaret Drew…was killed when she walked out of her family home on to a nearby railway line and was hit by a train…There is no trigger to this at all, except hormones making her do things that she normally wouldn’t do, Dr. Carlyon [Cornwall Coroner) concluded…”
Menopause. The silent killer. Oh really? Drew’s husband claims that his wife was “delightful, lovely and friendly” 99% of the time; the other 1% she’d become “totally irrational.” Yet, she refused to try HRT, he says. On the day of her suicide, he said that his wife was “clearly angry about something.”
Something.
Obviously, the conclusion is that that the “something” is hormones. This reminds me of vintage advertising copy that conveys the simple message that a pill a day can cure all that ails, wipe away the tears, mood swings and instability so that women can “transition without tears” (or better yet, without killing themselves).
Notably, a search in the National Library of Medicine’s PubMed database turned up only one recent study specifically dealing with suicide ideation across reproductive stages. In it, researchers compared data in 8,794 women, and found an increased risk of thinking about suicide among women during perimenopause, not before or after entering menopause. These findings remained after controlling for risk factors such as anxiety and mood disorders. HOWEVER, the researchers noted that the study design did not allow them to form any definitive conclusions about the specific reasons for thinking about suicide.
Another search yielded information that the risk for a major depression increases during perimenopause, primarily as the direct result of vasomotor symptoms. The same does not hold true for women before menopause begins or once they enter menopause. Note that while major depression is a risk factor for suicide, not everyone who is depressed will actually kill themselves.
So, are hormonal fluctuations the sole cause of such deep unhappiness that women want to kill themselves?
Interestingly, just a week after the menopause/train suicide story hit the interwebz, a rather controversial set of data also emerged: since 1972, women’s overall level of happiness has dropped. These findings held true regardless of child status, marital status and age. Researcher Marcus Buckingham, writing in the Huffington Post, said that women are not more unhappy than men because of gender stereotyping and related attitudes, due to working longer hours or because of the inequality of housework/responsibilities at home, but rather, the hormonal fluctuations of menopause may be to blame. What’s more, he leaves us hanging so we’ll tune in for part two of the piece to learn the true cause of our declining happiness or better yet, read his book (which evidently guides women through the process of finding the true role that they were meant to play in life).
Importantly, reactions to this study (and various pundits’ assessment of it) have been mixed. One of the most poignant comments I’ve read asks the question “how is happiness measured? What does it mean?”
I have no idea what caused Mrs. Drew to walk into a train and kill herself. Perhaps she was depressed. Clearly she was suicidal.
I have no idea why research shows that women are less happier than they were three decades ago.
However, is menopause the cause? Aren’t these conclusions an example of how the Menopause Industrial Complex perpetuates societal myths that menopause is a disease that requires treatment? That as women, our attitudes, belief systems and actions are hormonally-based and driven? That we are hysterical beings who need guidance on how to find our way and fulfill our dreams, realize our paths, but only if we calm down?
Feeling angry? Blame it on menopause. Unhappy? Blame it on menopause. Not realizing your dreams? Blame it on menopause. Overworked, overstressed, undervalued? Blame it on menopause.
Blame it on menopause.
I don’t know about you but I’m tired, tired of hearing that menopause is not the symptom but the disease. Isn’t it time we start fighting back?
Read MoreDo women lie when they act perfect? A guest post by Kathy Korman Frey
Ain’t no Wednesday Bubble but some inspiration. And I’m certainly inspired! Every now and then, you run into a person who is creating a new paradigm, one woman at a time. That woman is Kathy Korman Frey, aka @chiefhotmomma on Twitter, entrepreneur, educator and founder of the Hot Mommas Project and #sisU: Sisterhood University project. Kathy’s focus is to raise the self-efficacy of women and girls through exposure to role models. This approach echos the approach to our healthcare that I’ve been trying to impart since starting Flashfree: by talking to one another, sharing experiences, creating lasting support networks and crowdsourcing, women are better able to care for themselves (and those around them) and make decisions about their health that are not only sensible but also, make the most sense for them.
Hence, when I read the following post written by Kathy, I knew that it needed to be reposted on here We are always trying to be superwomen, aren’t we? Whether it’s our career or health, Isn’t it time to create a posse of empowerment?
A post by Athena Vongalis-Macrow and Andrea Gallant on the blog of Harvard Business School Publishing is entitled: Stop Stereotyping Female Leaders. The myth of the “superwoman” is discussed, and how this myth continues to be perpetuated by women themselves. This is sad not only because women feel pressure to appear or be perfect, but also because this is what we are teaching the next generation. Expectations are killing women across this great nation of ours…both expectations of ourselves, and those from others whether actual or perceived.
Many articles and books have been written on this topic, such as Michele Woodward’s “I am Not Superwoman” and Tal Ben-Shahar’s “The Pursuit of Perfect.” But are we listening? And, furthermore, how can we turn that listening into action?
A little story: Between the ages of one and one-half and six, my son had a “posse.” An occupational therapist, a behavior consultant, and various and sundry experts that would come into and out of our lives in between “special” parent-teacher conferences. My son would do everything he could to hold it together at school, and then have outbursts at home which included banging his head on the floor or wall. It’s shocking, isn’t it? Just imagining a child doing this. There isn’t even a word to describe how it felt to me as a parent. It turned out that his brain was ahead of his ability to express his feelings. So, well, he freaked out. Today, we have a happy boy on our hands. But I’ll never forget those days.
So, how does this relate to women being authentic leaders? Two things:
Get a Posse
During that time of crisis with our son, we had a “posse.” This was our group of experts to whom we could turn for advice and counsel. The posse helped. And my point for women is: Get a posse. More women are working, more dual income households, more masters degrees than men, more PhDs then men…I mean, hey, we’ve got it going on. But, some things don’t change…like our caregiving responsibilities or fundamental female neurology as brilliantly described in Louann Brizendine’s “The Female Brain.” Are you not worthy of a posse of experts? We’d do it for our kids. We’d do if we were diagnosed with an illness. So, why not now? As mentioned at the recent Sisterhood University (#sisUdc), we all need a personal board of advisors. The problems will come and go. The questions. The challenges. Even the celebrations. But the personal board of advisors – the “posse” – remains.
Develop a Vocabulary of Honesty
This is not for everyone…but the strong ones of us must continue to develop a “vocabulary” of honesty around our challenges. Back to the example of my son’s time of crisis: One particularly gifted behavior consultant had a knack for tapping into smart and sensitive children. She encouraged us to increase our “feelings” vocabulary around the house. For instance, when I would say, “Mommy feels frustrated,” my son now had a word to place on his own feelings. It was calming. It was re-affirming. What started off sounding kind of corny to me actually healed us as a family. In addition to running our house in an incredibly structured manner, this single piece of advice worked. Thus, women need to increase and model the right vocabulary in this strange new world which feels like a kind of “life moon bounce.” But how?
I recommend the following:
- 1/3 challenge – Talk about the challenge. Make it real. Validate your concerns, or those of your “posse” members.
- 2/3 solution – Then, talk about how you solved it, or how you think about it, or – perhaps you’re still struggling with it and you’ve just decided to be in transition. The latter two thirds of the conversation should be about actions, and perspectives that help.
Women: This is your chance to act as teachers and mentors
Women, please take the time to do the hard work and the thinking on this. Be willing to communicate your experiences to other women and the next generation. Why do you think I’m putting all this stuff out there about my son…a deeply personal topic? To help, that’s why. And women, if someone asks you “Why do you seem so perfect?” Stop. Think. Remember: This is a time to perpetuate a myth, or join a member of someone’s “posse” as an expert who models the right behavior.
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About the author…Kathy Korman Frey is an entrepreneur, educator and founder of the Hot Mommas Project and #sisU: Sisterhood University. Frey teaches Women’s Entrepreneurial Leadership at the George Washington University School of Business, and is also one of the nation’s top business bloggers. She currently lives in Washington, DC where she struggles daily to cling to reality while raising her entrepreneur husband, Josh, their children Maxwell and Delilah, and dog Foxy Frey.
Read MoreRandom Roundup: news and tidbits picked just for you
[Credit: Special thanks to artist Darryl Willison of whimsicalwest.com. Please visit his site and support his work.]
I’ve decided to lose the monthly or quarterly Roundups and post them more sporadically. Moreover, since September marks the beginning of Fall, it seems like a great time to highlight some of the most interesting posts and news since July. Be sure to check them out and feel free, always, to send me a note telling me what you’d like to see included in the next Roundup.
- A Different Kind of Hot Flash – Powerhouse blogger Erika Napolitano takes us down an often uncharted road: need not flashes.
- Is S-Equol the Next Big Thing? – This metabolite of soy isoflavones may actually be the key to reducing hot flashes, improving mood and promoting bone health!
- Are You Working Through the Transition? Or Is It Working You? – Women want their managers to understand how menopause can affect their work. The first step? Education.
- “Age-Appropriate” Dress for Women Over 50 – Welcome to the dark ages. Not for me, nnuh-uh.
- The Mommy Factor – It’s Personal – I may be childless. But I am not without children. You?
Wednesday Bubble: HRT and the “Window Hypothesis:” Hope or Hype. Guest post c/o The Better Health Blog
HRT and the Window Hypothesis. Sounds a bit daunting, doesn’t it?
I was awed and inspired by this post on HRT, which was written by Dr. Peggy Polaneczky and appeared on the Better Health Blog on April 21. As the author states, Pfizer (formerly Wyeth), the maker of Premarin, is working furiously to frame the HRT argument around the Window Hypothesis, which refers to the time period in which a woman must start HRT in order to fully gain its benefits. Is the Window real? Or another mother of all inventions to convince women that HRT is as necessary as a daily vitamin?
So, dear readers, I’ll leave it to you to decide. Despite the length of the post, I am including it in its entirety because the issue is so important. I’d also like to state that I am grateful to Dr. Val Jones, the founder and CEO of Better Health, LLC, who has graciously granted me permission to repost the piece on Flashfree.
It’s only Wednesday, and so far three patients have come to their office visits carrying Cynthia Gorney’s article from Sunday’s New York Times entitled “The Estrogen Dilemma.”
The article explores the stories of three women who found relief from perimenopausal symptoms by using hormone replacement, framing the discussion in the larger context of what is being called the “window hypothesis” — the idea that starting estrogen replacement in the perimenopause and continuing it into later life may be neuroprotective and even cardioprotective, in contrast to beginning its use 10 or more years after menopause, where it can trigger heart disease, stroke and dementia.
The window hypothesis is one way of explaining away the findings of the Women’s Health Initiative, and goes something like this: “The WHI enrolled women who were too late into menopause to benefit from estrogen. If we had instead studied women starting estrogen at the right time, namely the perimenopause, we would have found that it protects against heart disease and Alzheimers.” Or as I explain it to my patients: “Think of it like exercise. If you work out vigorously and regularly from a young age, you can prevent heart disease. But take an overweight, out of shape 65 year old and have him/her run full out and you could trigger an MI.” (It’s a crude analogy, but it works.)
The Times article does a good job framing both the hope and the hype around the window hypothesis, and the dilemma it appears to pose for women entering menopause today, which is this: If you wait for data that proves the window hypothesis is right, by the time the results are in, you’re outside the window and it’s too late to start HRT. If you start HRT now and the hypothesis is proven wrong, then you’ve been taking medication with potential risks for years without any benefit. Or as author Cynthia Gorney so succinctly put it:
“If I make the wrong decision about this, I am so screwed.”
The pharmaceutical industry, particularly Wyeth, the maker of Premarin, is, not surprisingly, working hard to get the word out about the window hypothesis. Indeed, several of the researchers working on the hypothesis who are quoted in Gorney’s article have ties to Wyeth. At the risk of further hyping a hypothesis that may prove to be unfounded, I encourage you to read the Times article, and then take the time to peruse the intelligent discussion in the comments section. If anything it is testimony to just how well-informed the American public has become about HRT.
I myself have been hearing about the hypothesis for years now, but have yet to see definitive data to prove it. Fortunately, there are studies in progress that may settle the question within the next few years. But even if the window hypothesis proves to be correct, it will not mitigate the risks of breast cancer that accompany long term estrogen use in the menopause. That risk remains, in my opinion, the biggest concern for my patients when it comes to HRT, and it is surprisingly downplayed in the Times article.
The biggest problem I have with the article is that Gorney’s experience with both menopause and HRT is anything but typical. Most women get through the transition without major mood issues, although crankiness and irritability are common, especially in women who are not sleeping because of night sweats. When true depression hits, as it did for Gorney, antidepressants are needed, with or without HRT (Gorney takes both). I have seen the occasional woman who declares “I am back!” after starting HRT, and one particularly memorable patient whose depression was cured, but this is the exception, not the rule. Most perimenopausal women who take HRT are just relieved to be able to sleep through the night or get through a meeting without hot flashes.
But most importantly, what does Gorney’s individual experience with HRT and mood have to do with the window hypothesis? She is not taking HRT to prevent Alzheimer’s or heart disease, she is using it to augment the effects of her antidepressants. The whole window discussion thing is distracting from the real question at hand for her, which is sinply this: How long should she take HRT? That depends, not on whether the window hypothesis is true, but on how she feels when she tries to stop taking HRT.
If I were Gorney’s doctor, I’d be focusing her off the window hypothesis and onto why she is taking HRT in the first place — for emotional well-being. Now that it’s been a few years on the stuff, I’d say, let’s lower your dose and see how you do. If you do well, then stay on that dose for 6 months to a year, then go off and see if you still need it. Based on Gorney’s experience with occasional missed patches, I’ll predict she’ll still need HRT, but will be able to get away with a lower dose. But if she feels just as well off HRT, then I would advise her to stay off. Do everything else she can do to prevent heart disease – diet, exercise, low salt, get enough sleep (you know the drill.)
As for using estrogen to prevent Alzheimers, well, that’s a big leap of faith that I for one am not yet ready to take. Which does not mean that I don’t have an occasional patient (usually a scientist) taking HRT because she hopes it will prevent Alzheimers. Such women, in my experience, are much less worried about breast cancer than about cognitive decline, in an attitude similar to that of Julia Berry, one of the women profiled in the Times article, who had this to say:
“I could have my breasts removed. I like them. But they’re not my life.”
Recent data suggests that Berry may not need to make this Sophie’s choice between her brain and her breasts. The mental confusion so many women experience in perimenopause may in fact resolve itself once we come out the other side, irrespective of hormone use. This suggests that it is the widely swinging hormones of perimenopause that pose the most trouble for women, but that once things settle down, so do we.
Now that’s a window hypothesis you won’t hear Big Pharma talking about.
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