By Frances C. Whittelsey
Thursday, September 27, 2007
What was once euphemistically referred to as women's "change of life" is now a topic fit for musical marquees. But as Menopause Awareness Month comes to a close, women's advocates say therapies are still shrouded in uncertainty.
(WOMENSENEWS)--Barbara Seaman had a good laugh when she heard that September is Menopause Awareness Month.
"They really need a month?" she said, continuing to chuckle, but then turning serious. "Women have been made over-aware of the menopause. They've been made to feel they have to take all kinds of medicine: estrogens, testosterone, now sleep drugs."
Seaman, whose 1969 book, "The Doctors' Case Against the Pill," led to congressional hearings on the safety of early birth control pills, found humor in the designation of an awareness month because she has been writing about the menopause for more than three decades. Now she is working on the fifth of what she jokingly calls her "estrogen trilogy;" books that warned about the dangers of hormone treatments for menopausal symptoms long before clinical trials actually measured the risks.
Women these days no longer whisper in embarrassment about the so-called change of life. Instead, they even howl with laughter at the long-running musical with the once shameful word in its title.
But despite the current openness, confusion about medication and menopause has increased since the 2002 release of the results of a study from the federally funded Women's Health Initiative. The study found an increased risk of breast cancer, heart disease, stroke, blood clots, urinary incontinence and dementia in women taking Premarin and Prempro, combinations of estrogen and progestin that formerly had been widely recommended and prescribed for relief of hot flashes and other symptoms as well as the prevention of bone loss in postmenopausal women.
In that context, Menopause Awareness Month highlights the need for clear and accurate information and the continuing effort to steer women to new drug treatments for symptoms.
The average age of menopause in the United States, according to the U.S. Food and Drug Administration, is 51, with normal menopause occurring as early as 40 and as late as 58 or 59.
But is that really true? No one knows for sure, says Cindy Pearson, executive director of the National Women's Health Network, a nonprofit membership group in Washington, D.C., that since 1975 has worked to influence how women's health issues are perceived and addressed.
Pearson says there is no definitive information on how long women experience hot flashes, or whether factors such as body weight and exercise can influence their number or severity.
SWAN--a Study of Women's Health Across the Nation--which includes 3,302 women and is now in its 11th year will eventually answer these and many other questions, she said. The study is sponsored by the National Institute on Aging, among other federal health centers.
When the study results are available, continued Pearson, "women who go to doctors and say they are really flooding (from hot flashes) will know how long this is likely to last . . . Then they can decide if they want to take drugs or just wait it out."
According to the FDA, about 35.5 million U.S. women are in the age group approaching or into menopause.
One of the menopausal symptoms to receive new attention from the drug industry is disturbed sleep.
During the fall of 2006, the Red Hot Mamas, an advocacy and support group that is now owned by a commercial entity, conducted an online sleep survey of 485 women with funding from Sepracor, the Marlborough, Mass., maker of Lunesta, a prescription sleep medication.
Sepracor paid for both the Mamas' sleep survey and the newsletter that reported it with a "nonrestricted educational grant," according to a spokesperson for the Mamas.
The survey found that more women were experiencing sleep disturbances (18 percent) than other symptoms like hot flashes or vaginal dryness (10 percent). Overall, 42 percent of the menopausal women surveyed said they experienced sleep disturbances every night.
The Red Hot Mamas was founded in 1991 by Karen Giblin after she underwent a hysterectomy and removal of her ovaries, and thus suddenly found herself in the throes of menopause.
"I decided to start a program so women would get more information, because I didn't think that the seven to 15 minutes you get with the doctor is sufficient," she said. Her daughter saw her having hot flashes, called her a "red hot mama" and Giblin adopted the name.
Giblin is still the face of the Mamas, whose educational forums take place in hospitals around the country. But today the Mamas organization is owned by Prime Plus, which on its Web site describes the Roswell, Ga., business as "a diversified educational organization serving the health care industry." Another "area of practice" of Prime Plus is the launching of products.
Of course, sleeping like a baby, which is to say sleeping through the night, is just a fond memory for many older people of both genders. Countless jokes revolve around the need to get up during the night to go to the bathroom. But for some menopausal women, loss of sleep is anything but a joke. What should they do?
"Facts About Menopausal Hormone Therapy," a booklet published by the National Institutes of Health, suggests over-the-counter sleep aids, exercise early in the day as opposed to the evening, drinking a glass of milk or taking a hot shower before turning in.
Millions of women stopped taking hormones--which were not very effective for sleep problems--when they learned about the findings of Women's Health Initiative.
Women in the study taking estrogen alone had higher rates of blood clots in deep veins, mild cognitive impairment and urinary incontinence.
Women taking both the combination products and estrogen alone benefited from fewer hip and other fractures, but the expected benefits to the heart did not materialize.
Laura Eldridge, who is co-authoring Barbara Seaman's book-in-progress, "The No-Nonsense Guide to Menopause," notes that one of the negative consequences of the study is that doctors are now prescribing different drugs for each symptom--"bisphosphates for bones, statins for the heart, hypnotics for sleep, antidepressants for hot flashes"--and that the safety of these medications has not been studied as thoroughly as hormones. Furthermore, she said, little is known about how the various drugs interact.
Another unknown about menopause is why some women have few problems while others suffer.
In her many years of interviewing menopausal women, Seaman noted that most of the women who experienced "hellish menopauses" had been castrated; that is, their ovaries were removed. Removal of the ovaries occurs in about 75 percent of the hysterectomies performed in the United States and causes sudden and immediate menopause. Many of these procedures are unnecessary in the view of Seaman and other women's health advocates.
Author and journalist Frances Cerra Whittelsey writes about consumer and women's issues and the environment from her home in Huntington Bay, Long Island, N.Y. She has previously written about testosterone deficiency in the context of women's cancer treatment.
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National Institutes of Health booklet,
"Facts About Menopausal Hormone Therapy":
The North American Menopause Society:
"Let's Make May the Month to Tame Osteoporosis Hype":
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