Managing menopause

For some menopausal women experiencing hot flashes and night sweats, the best course of action may be simply sweating it out rather than turning to menopause treatments, according to a study done by a consensus panel from the National Institutes of Health.

The NIH panel also concedes that much is still unknown about this natural phase in a woman's life. Studies show that some symptoms are a direct result of menopause; others are typical of the aging process, according to Dr. Carol M. Mangione of the University of California in Los Angeles and chairwoman of the panel.

Counselors and other medical professionals who work with both Saint Francis Medical Center and Southeast Missouri Hospital say the best thing women can do for themselves is to learn as much about menopause as possible before talking to their gynecologists about treating it.

"I always encourage women to do as much reading as they can and find out the facts so when they talk to their physician, they have a plan in mind," said Barbara McKeon, an employee counselor at Southeast Hospital.

McKeon suggests that some women may be too impatient about seeing results from their treatment and switch therapies before they've actually had a chance to work.

Too often physicians prescribe hormone replacement therapies routinely for women who may not need it, said Trinka Hileman, director of Saint Francis Medical Center's Womencare.

"Whatever the doctor says is gospel," Hileman said. "I think that's why women need to educate themselves and have a good understanding before they see their physician, and make a wise decision. They need to be informed."

Cape Girardeau gynecologist Dr. Tami Williams said she encourages her patients to learn as much as possible so that she can help them set a treatment goal.

"It makes my job so much easier when the patient is well-educated and knows what she wants out of treatment," Williams said. "She also should be willing to assert her treatment goals. A lot of women have difficulty doing that--doctors don't get offended."

Williams cautioned that despite the publicity about the risks associated with hormone replacement therapy, for some women it is the best solution.

According to the NIH, hormone replacement therapy was offered for years as routine treatment for hot flashes and night sweats. Its use tapered off after 2002 when a major study found that hormone therapy increased the risk of heart attack, stroke and breast cancer, but some women returned to hormone replacement therapy when their symptoms returned.

For some women, their quality of life is so impacted by menopausal symptoms that hormone replacement therapy is worth the risks associated with it, said Williams.

"They are real risks," she said. "There are risks of heart attack and stroke, but we are talking about very, very small numbers. Typically the risks increase after age 59 for heart attack and stroke. The breast cancer issue is still out there."

Williams said she recommends that her patients who are going through a natural menopause stay on hormone replacement therapy at the lowest possible dose for as short a time as possible. However, she cautions, "We can't make a blanket statement. One size does not fit all."

Williams said she doesn't trust some of the alternative herbal therapies because they're neither tested nor regulated, but she stops short of advising patients not to use them.

Plant estrogen and herbal remedies are growing in popularity among menopausal women. Williams said that they seem to work best for women who have mild to moderate symptoms.

McKeon and Hileman agree with Williams that herbal treatments are unreliable because their dosages are not regulated and the quality of the products is not refined. But both counselors say they know of women who are satisfied with the results of herbal remedies. They advise that women who use them should be cautious.

"People think because they are herbal they're harmless, and they are not," McKeon said. "Some are dangerous if children get hold of them."

Hileman said she always recommends women who are trying herbal remedies to let their doctors know what they are using to avoid reactions with other medications they may be taking.

McKeon added that women might consider other symptoms of aging that might be causing discomfort. Metabolism normally slows down with aging, she said, and cutting food portions and increasing exercise will help keep energy levels from dropping. She also suggests that middle-aged women consider having their thyroid checked. Often, she said, a thyroid deficiency can mimic menopause symptoms.

"It's another hormone," she said. "If we're having problems with one hormone, it makes sense some of the others will act up."

lredeffer@semissourian.com

335-6611, extension 160