By Anne Rochon Ford
Friday, April 26, 2002
A new study reopens the debate whether women should rely on hormone-replacement therapy to protect their health and alleviate the side effects of menopause. Many are turning to a long-time educator for answers.
TORONTO (WOMENSENEWS)--A small newsletter published here may offer some answers and solace to women in menopause and beyond--needed more than ever as recent news reports revealed a landmark study will challenge the health benefits of hormone-replacement therapy.
News accounts about the "International Position Paper on Women's Health and Menopause: A Comprehensive Approach" that will be released officially in June by the National Heart, Lung, and Blood Institute in the United States have stunned many. Based on a review of existing studies and conducted by scientists in five countries, the report calls into question some of the claims of the benefits of the popular therapy relating to the prevention of heart disease, Alzheimer's disease, severe depression, urinary incontinence and broken bones caused by osteoporosis in postmenopausal women.
The findings of the landmark report come as no surprise to Janine O'Leary Cobb, founder of A Friend Indeed, a newsletter about menopause and midlife that caters to women who wish to be more savvy consumers as concerns grow about hormone therapy.
For nearly 20 years, the bi-monthly newsletter has advocated a cautious approach to what Cobb says is a sometimes-overzealous promotion of hormone-replacement therapy. Cobb is not opposed to the drug regimen, but she believes that women need to be fully informed about what they put into their bodies and need to know there are alternative approaches.
The North American Menopause Society notes that no hard data exist on the number of women in the United States and Canada who are reaching menopause or who are post-menopausal. It estimates that roughly 1.3 million women in the United States reached menopause naturally in the year 2000. An additional 481,000 are estimated to have gone through surgical menopause (when the ovaries are removed) in that same year, for a total of more than 1.8 million women. Comparable numbers of women reached menopause in Canada.
The menopause society further estimates that approximately 20 percent of women who reach menopause naturally use hormone-replacement therapy, at least temporarily. The figure is higher for women who have been through surgical menopause, since symptoms tend to be more dramatic following surgery.
Cobb was a college professor and mother of five children in Montreal when she found herself approaching menopause in the early 1980s. Disturbed by signs and symptoms that were unfamiliar to her, Cobb did what she had always done in matters of health: She looked for help.
But she was taken aback when she discovered how little written information was readily accessible to the public and that much of what was available claimed that concerns such as fatigue and emotional disturbances were simply "all in her head." It also angered her that, in contrast, plenty of material about pregnancy and menstruation was available.
"About all there was available to women back then was just good common sense," Cobb says. "There was advice to be found about 'coddling yourself,' watching what you ate, and spending more time with your female friends. People were still embarrassed about it in those days. Women whispered about it . . . you certainly didn't talk about it if there was a man around.
"It seemed to be the last bastion of things women could talk about, because it's so entangled with aging and we just don't want to talk about getting older," she says.
Cobb decided to take the problem into her own hands. A trained sociologist, she did her own research and produced a newsletter that introduced women to the topic of menopause. She mailed this introductory issue out to 40 friends and acquaintances.
Scores of letters poured in. The demand was clear. A Friend Indeed was born.
Referred to by one writer as "the grandmother of menopause newsletters," A Friend Indeed is now approaching its two-decade anniversary. In that time, Cobb and her newsletter have helped thousands of women throughout North America and beyond who need thoughtful, practical advice as they approach this life transition. It boasts a circulation of 3,000 subscribers--about one-third in the United States and two-thirds in Canada--and an additional 2,000 are circulated at conferences and to health practitioners' offices.
Toronto's Dr. Verna Hunt freely hands out copies of the newsletter to her patients that might benefit from it. "It provides a forum for women in their middle years to be heard as well as to learn in a way that is relevant to their lives, in a way they can understand," says Hunt.
Each issue contains a mix of information and news about menopause and midlife, such as changing sexuality and the importance of strong immune systems, but distinguishes itself by the letters readers write.
Women write firsthand about what they've experienced during menopause, remedies for side effects that have worked for them--such as progesterone cream and flaxseed oil to alleviate symptoms such as hot flashes--and the sense of comfort they get from being able to share the information. The wealth of experience that has been exchanged over the newsletter's existence is, in and of itself, a resource beyond qualification, Cobb says.
Long-time reader Barbara Mains of Toronto notes: "Janine has been cautioning women for years about the well-known and lesser-known concerns associated with hormone-replacement therapy. That isn't to say she is categorically against it and recognizes that some women benefit greatly over short periods of use. But she doesn't buy into the popular notion that almost all menopausal women should be on it for the rest of their lives."
A Friend Indeed's most popular issues have tended to be those covering hormone-replacement therapy and alternative solutions for menopausal symptoms--options such as increasing exercise, dietary changes and vitamin and herb supplements. But the newsletter has been ahead of its time in having covered some topics before they become household words. The subject of fibromyalgia, a syndrome causing fatigue and extensive pain, for example, was discussed in depth in a 1991 issue.
Physical health issues are not its only subject matter. Another popular volume dealt with the joys of being a grandmother; another at how to communicate effectively with one's doctor. The newsletter does not shy away from political hot potatoes either. Recently it explored Canada's problems in safely regulating prescription drugs.
With the vast array of information now available on menopause, A Friend Indeed finds itself competing in a radically different environment from that which it faced at its inception. The Internet is, of course, its main contender.
Other alternative sources of information on menopause include books, videos and tapes by Dr. Christiane Northrup, a practising obstetrician-gynecologist based in Maine. A popular speaker throughout the United States and Canada, Northrup's latest book, "The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change," not only provides alternatives to the physical symptoms of menopause, but offers help for a balanced, spiritual approach to aging and women's health.
The Washington-based National Women's Health Network, a non-profit organization that lobbies for health-promoting policies and information, recently released its publication, "The Truth About Hormone Replacement Therapy: How to Break Free From the Medical Myths of Menopause." The book, available through the network's Web site, offers a balanced perspective on the risks and benefits of hormone-replacement therapy and alternative treatments such as herbs and so-called natural hormones.
After devoting 15 years to her "baby," Cobb passed the torch to a new generation of editors in 1998, the same year she was diagnosed with breast cancer.
Though friends had been urging her to "get out of menopause and write more about old age," Cobb has chosen to spend that kind of energy helping out with a breast cancer advocacy group in Montreal.
Anne Rochon Ford is a freelance writer in Toronto specializing in women's health issues.
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