Thursday, March 15, 2007
Dear Crabby:
I took HRT (hormone replacement therapy) for about a year but stopped it because of the cancer scare. I am now on an over-the-counter supplement with black cohosh to control the hot flashes. But my worst problem is that I feel like I am having waves of depression. I have never felt like this before, and I don’t like it. What can you recommend? What is your opinion of prescription vs. OTC products? Thanks for your input.
Kathy
Dear Kathy:
Sometimes menopause IS like a beach — scorchingly hot; giant waves of depression; moods, like the sea and sky, everchanging; and a dry sandy/scratchy feeling in your — never mind, you get the picture. There are some lucky women who sail right through it (“Why, I don’t think I’ve had a period in a year or two … imagine that!”), but some women find themselves rudderless, scraping bottom or hitting the rocks of despair (to continue with the nautical metaphor. And I don’t even own a boat. Go figure!).
This is when my patients and I have the sit-down talk, because menopause treatment today is all about individuality. As a health-care provider, I have to help a woman assess her risks of things like breast cancer, heart disease, stroke and osteoporosis, and weigh them against the quality of her life at present due to her menopausal symptoms. Then, together, we can decide what treatments, if any, are needed.
I do include natural supplements, like black cohosh, in the list of possible treatments for women, and we go over everything from lifestyle modification (diet, exercise, blah-blah-blah, you know the drill) to prescription medications. We also discuss the tests and preventive health maintenance tasks that are a good idea at midlife. We usually commiserate a little about the slings and arrows of menopause during this visit, and there are usual a couple of hot flashes — mine and hers. The point is, it’s not an easy decision, unlike the early days of HRT, when the (usually male) MD handed you a lifetime prescription for Premarin and said something like,
“Here. This will save your marriage.”
Nice. Reeeeal nice.
So, Kathy, the real answer to your question is, it depends. But it sounds to me like you might be having a real issue with your mood, a common menopausal symptom. And that can be fixed, even without HRT. If it’s a mild problem, self-care and stress management can help. So can eating well and exercise. If it’s serious, with interference of your daily functioning — like getting out of bed and getting showered and dressed, or really serious, like “I’m feeling like maybe life isn’t worth living,” you need to get help, right away, in the form of medication and therapy. So see your health-care provider. Let her know you might need a little extra time. She’ll appreciate it and be better able to help you.
And take heart. Eventually you will steer your boat through the rough waters of menopause and it will be smooth sailing from then on. And, since I’m sticking with a nautical theme, perhaps all you hot-flashing readers should rent "The Pirates of the Caribbean: The Curse of the Black Pearl." Johnny Depp is soooo therapeutic.
Comments
tess1960 (anonymous) says...
This is just what I was needing to read right about now. My husband turned 50 at the end of 2006 and his aging has brought my certain eventual menpoause to the forefront of my mind. I think I might even be in pre-menopause as I have had a few hotflashes and cold sweats already over the past year. And the desire has all but left me (you know what I mean). I can't imagine how I will ever get through menopause. Reading others ways of coping and the meds and OTC's available is helpful indeed.Thanks for the question and answer.
March 15, 2007 at 9:49 a.m. ( permalink | suggest removal )
cariedaway (anonymous) says...
I know it's very controversial, but I think a good thing to read at this point is Suzanne Somers' book "Ageless". She interviews a number of doctors about various types of HRT. You may or may not agree with her views, but I think it's important to at least investigate some of the "alternative" thought on HRT, if you are considering it at all.
March 15, 2007 at 1:19 p.m. ( permalink | suggest removal )
amazonratz (anonymous) says...
I know that Somers talks a lot about "bioidentical hormones"--plant based hormone creams that you need a prescription for. I do want to address this in a future Crabby column. For now, what I can say is that at times I do prescribe them, and I treat them as though they have the same risks and benefits as traditional prescribed HRT. There have not been enough large-scale studies to convince me that they don't hold the same consequences. The key is good communication with your health care provider, and if you do choose HRT, using the lowest dose for the shortest time possible. Thanks a lot for reading, and feel free to email your questions to be addressed in future columns! Crabby
March 15, 2007 at 3:09 p.m. ( permalink | suggest removal )
cbetz (anonymous) says...
I'd like to add a little information from my experience using both HRT and bioidentical hormones. HRT is pretty much "one size fits all" while bioidentical hormones are mixed in a compounding pharmacy according to one's own bodily hormone levels as indicated by individual testing. They are supposed to be "identical" to the hormones my own body produces, unlike HRT, which primarily come from abused mares' urine.
I have a number of friends using bioidentical hormones. None of us are on the same doses and all are doing very well on them. I sleep at night, no hot flashes, and I haven't felt the urge to kill anyone in since using them.
Do your own research. Suzanne Sommer's book is a good place to start. Cynthia
March 15, 2007 at 7:38 p.m. ( permalink | suggest removal )
sewandsew55 (anonymous) says...
Dear Karen, What can I do about my libido? I used to be a hot mama and now I'm more like a cold fish. :o( I tried to discuss this with my doctor and he handed me a free sample of Viagra, which I never took any of because it scared me. There must be something that would bring back that old desire in me. I am getting kinda desperate thinking my hubby will look elsewhere if he doesn't get any from me. He made the comment,"I can see why some husbands leave their wives during menopause." He reassures me that he never would leave me or have an affair, but I am concerned. I live in between Lawrence and Topeka,KS and I hope that you can help me with this issue! Thanks!
March 18, 2007 at 10:01 a.m. ( permalink | suggest removal )
amazonratz (anonymous) says...
Dear sewandsew:
There's one more new column coming up, and I am working on more...I think I will tackle your problem in the next one I write. I will try to review the options in some depth. In the meantime, let your husband know how insecure such a comment would make any woman feel! This is a common issue for women at midlife, so you are not alone. PS: Viagra hasn't really shown to be very effective on women...Crabby/Karen
March 18, 2007 at 6:40 p.m. ( permalink | suggest removal )
lcdefior (anonymous) says...
This issue is so where I am right now. Just went this week to be tested for menopause even though I know I'm in the throes of it. Had the worst hot flash/anxiety attack/heart palpitations ever when meeting with our new CFO for the first time. OMG - started removing my clothes as he began looking alarmed. Had to excuse myself - out of body experience - the hair follicles on my arms stood at attention, I was sweating in places I didn't know could sweat like between my toes. My neck and face were bright red. The worse thing about it was that I had no control over my body. During my appt Dr had hot flash so at least I felt better to know that she had no more control than I do. She offered HRT which I rejected - she offered anti-anxiety drugs which I also rejected. She suggested OTC soy or black cohash or flax seed. I'm trying the soy, more exercise and better diet. We'll see...
March 22, 2007 at 10:16 p.m. ( permalink | suggest removal )
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