Anjali Tate, M.D.,  Gynecology, Obstetrics , San Jose, Silicon Valley, California

Menopause

 

 

 

 

So, what's a girl to do?

So, what's a girl to do? Menopause, those years when a woman's ovarian function and hormone levels drop, is a difficult and confusing time. Historically, women have been told to start on hormone replacement therapy to relieve her menopausal symptoms and protect her from osteoporosis and heart disease. But recent studies have demonstrated that there is an increased risk of breast cancer, heart attacks and strokes associated with hormone replacement therapy. Now what? Do we need to live with the hot flashes, night sweats, mood changes, vaginal dryness among other symptoms? And how do we protect ourselves from developing osteoporosis and heart disease?

As with most every other decision we make, we need to look at the information and then decide based upon our own symptoms, lifestyle and risk factors, the appropriate course of action.

In July 2002, the public was stunned and surprised that the National Institute for Health (NIH) discontinued one trial arm of the Women's Health Initiative (WHI); one arm of the trial is continuing and is scheduled to end in 2005. The WHI had enrolled more than 20,000 women between 1993 and 1998 at more than 40 sites. The discontinued trial arm consisted of women taking 0.625 mg of conjugated estrogen with 2.5 mg of medroxyprogesterone acetate or placebo. The continuing arm of the study consists of women who have undergone a hysterectomy and are taking only 0.625 mg conjugated estrogen.

Why was a part of the WHI study discontinued? It was determined by a review board that there was a 26% increase in breast cancer rates, a 29% increase in the heart attack rates and a 30% increase in stroke rates in women taking both conjugated estrogen and medroxyprogesterone. So what does this really mean? There were 8506 women with an average age of 65 taking both hormones, 2.5% of them had these health events. For every 10,000 women taking estrogen plus progestin, we would expect eight more women with breast cancer, seven more heart attacks and eight more strokes. We would also see six fewer colorectal cancers and five fewer hip fractures.

This study did not, however, evaluate the impact of hormones on a woman's quality of life. By quality of life, I am referring to menopausal symptoms that interfere with a woman's day to day life and relationships. Hot flashes and night sweats interfere with both the quantity and quality of sleep a woman is getting. Depression, anger, anxiety and other mood changes can manifest themselves any time a woman goes through hormonal changes such as puberty, pregnancy, menstruation and most of all, menopause. Vaginal dryness, decrease libido and difficulty reaching orgasm will impact a woman's sexual life. And then there is the intangible "sense of well being" that women experience with hormones.

Depending on her menopausal symptoms, family history, lifestyle and risk factors, a woman may choose to:

  • Continue on hormones, often opting for a "bioidentical"
     
  • Use supplements such as black cohosh, dong quoi and/or soy estrogens to relieve  her of the menopausal symptoms
     
  •  Make lifestyle changes such as diet, exercise, yoga and meditation

In truth, there is no right answer. Each woman needs to take the time to understand her needs and work with her physician to develop a suitable regimen to guide her through the menopausal years so that she can live a long happy and healthy life.

A Guide to Managing Menopause

Click here for a questionnaire that can be used as a reference by you and your physician to develop a personalized menopause management plan (25 K PDF file. You will need an Adobe® Acrobat reader to view and print out the intake form. If you do not have a reader, you can obtain a free copy through this link.) 

 

To explore options, I invite you to call for an appointment

Dr. Anjali Tate

 

 

 

 

4/15/04

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Anjali Tate, M.D.
2577 Samaritan Drive, Suite 810, San Jose, CA 95124, 408.358.1888; Fax-408.356.0877. Email Dr. Tate

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