Dealing with menopause

| Wednesday, October 05, 2005

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After re-evaluating risks and benefits, some women are choosing to return to hormone replacement therapy.

By Lynn Taylor Rick

Journal Staff Writer

As an oncology nurse, Ginny Shockey knows cancer all too well.

As a 53-year-old woman, she also knows the struggle of living with menopausal symptoms.

Those two facets of her life collided in 2002 when the Women's Health Initiative study found that hormone replacement therapy increases the risk of breast cancer.

The Rapid City woman, who had been taking hormone replacement therapy or HRT for about four years when the study broke, admits she was scared.

"I kind of panicked … I tried to get off the hormones. I went cold turkey," Shockey said. "Immediately, I just went into the whole cycle again, only it was worse."

Back were nightly hot flashes that left her drenched and exhausted. "It's just this overwhelming heat like your body is on fire," she said. "You'll be awake on and off all night: hot flash, fall asleep; hot flash, fall asleep."

Eventually, Shockey took a closer look at the study. She found the risk factors "less significant" than she first suspected.

She weighed those numbers against her quality of life and decided to go back on HRT. "For everyday living, I just can't put up with the symptoms of menopause."

Menopause

No woman will escape it.

While some women have few problems during menopause, others suffer from major symptoms, according to Rapid City obstetrician/gynecologist Shana Bernhard.

Bernhard spoke to a group of Black Hills women in late September, outlining their options for menopause symptom relief and answering questions about the controversy over HRT.

Bernhard explains that menopause begins as the body's level of estrogen begins to drop.

At birth, women already have all the eggs they will ever have. Each month, eggs are released. As women age, fewer and fewer eggs remain. The body's estrogen levels drop as the egg supply diminishes. When only a couple hundred eggs remain, menopause symptoms begin, Bernhard said.

Menopause is official once a woman has gone without a period for one year.

For most women, menopause will occur around the age of 50; but the range can be from 45 to 55. In some cases, women experience menopause in their 30s or as late as their 60s. Smokers tend to experience it earlier, Bernhard said.

The symptoms often begin before actual menopause. That pre-menopause period is called perimenopause. During that time, the body's hormone levels fluctuate, causing some of the same symptoms as menopause, including hot flashes, vaginal dryness, night sweats, weight gains and memory loss. During perimenopause, periods often become erratic.

Bernhard said for most women, menopause will have a beginning and an end. The HRT eases the symptoms during that time, but doesn't delay menopause.

A small minority of women will experience menopause symptoms that don't subside with age, Bernhard said.

Doctors don't know which women will suffer from severe symptoms and which will pass through menopause without problems, Bernhard said. There doesn't appear to be any hereditary connections or indicators of body shape or fitness level.

"It's hard to predict," Bernhard said. "Everybody is different."

The risks of HRT

For years, the medical doctor's answer to menopause symptoms was HRT.

Not only did the drugs relieve symptoms, but doctors believed they also prevented cardiovascular disease, Bernhard said. HRT also prevents bone loss.

With these credentials, it wasn't uncommon for a woman to be on hormone replacement from menopause into her 80s, Bernhard said.

That all changed when the Women's Health Initiative study came out, Bernhard said.

The highly-publicized 2002 study found that the cardiovascular benefits did not, in fact, exist.

Instead, HRT increased women's risk of breast cancer, stroke and blood clots. Portions of the study were suspended early due to those findings.

On the positive side, the study confirmed that HRT lowered the risk for hip and vertebral fractures and colon cancer, Bernhard said.

Bernhard remembers the day the study broke. As a resident, she watched the attending physicians field phone calls from scared patients all day long.

Many women, like Shockey, simply went off HRT.

Today, three years after the study came out, there still remains a lot of fear about HRT, but doctors have a better grasp of the risk and benefits, Bernhard said.