Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, December 14, 1993 TAG: 9312140088
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: Jane Brody
DATELINE: LENGTH: Long
Women, including many who are nationally prominent, now discuss their own experiences with menopause openly with friends and family, co-workers and bosses and even the general public. The subject is being discussed in popular books and periodicals, in the offices of the National Institutes of Health and on the floor of Congress as well as in gatherings of women of a certain age.
A new quarterly magazine, Via, has just begun publication to guide women through menopause and beyond, and public television stations throughout the country recently presented a two-hour PBS series, "Straight Talk on Menopause."
In the series, an articulate and accessible gynecologist, Dr. Judith Reichman of Cedars-Sinai Medical Center in Los Angeles, exploded the many myths about menopause and replaced them with facts about signs and symptoms, immediate and long-term effects and the benefits and risks of various management options, including doing nothing at all.
The information Reichman presented can enlighten doctors and laypersons alike, and can help women of all ages, from teen-agers to the elderly. Given the damaging mythology of decades past, everyone can benefit from the truth, and women in particular can be liberated by it.
Menopause makes women crazy. This myth probably developed because some women do experience mood swings, not unlike premenstrual symptoms, when their hormone cycles become erratic during the four years or so as they enter and pass through the menopause. But the more serious psychological symptoms that have been associated with menopause are more likely to result from night sweats, or hot flashes, which disrupt sleep. Dr. Reichman recalls a recent study in which men were awakened every time they lapsed into the deep sleep during which dreaming takes place; after three days of being deprived of dream sleep, the men showed distinct signs of psychosis.
Menopause precipitates depression. This myth may arise from the fact that women in midlife may experience the death of parents, the breakup of a marriage or the loss of a job or may suddenly find the nest empty, all of which may lead to depression. Women are far more likely to be hospitalized for depression during their premenopausal years, when they may buckle under the combined pressures of child-rearing, job demands and financial, family and household stresses.
Menopause spells the end to a satisfying sex life. In fact, freed of worry about unwanted pregnancy and fears of interruption by children, many women find that their enjoyment of sex increases after menopause. Rather than a hormonally precipitated loss of sex drive, the decline in libido some women experience is more likely to result from the lack of an interesting or interested partner or discomfort during intercourse caused by vaginal dryness. Vaginal dryness can be treated with lubricants, estrogen therapy or both. And the libido of those who are affected by the decline in ovarian hormones can usually be revived by small doses of testosterone.
At the turn of this century, the average life expectancy for a woman in America was 50. Today it is nearly 80, meaning that women in America can expect to live a third of their lives after menopause.
During those postmenopausal decades, a woman's risk of developing two costly, life-threatening diseases - heart disease and osteoporosis - rises sharply, a fact that is forcing medical researchers to take a serious look at the health consequences of menopause and how they might be stemmed.
After the age of 50, women have a 31 percent chance of dying from heart disease in their remaining years; heart disease kills four times more women than breast cancer does. At 55, heart disease becomes the leading cause of death among women; women are more likely than men to die after a heart attack or cardiac surgery.
When the amount of estrogen declines at menopause, a woman's blood level of heart-protecting HDL-cholesterol often falls and heart-damaging LDL-cholesterol rises. At the same time, women's arteries become narrower and less elastic and blood clots form more easily.
There is also a change in the distribution of body fat, with more fat accumulating around the abdomen, as happens in men who gain weight at any age, instead of around the hips. All these changes add up to a significant increase in coronary risk.
As for osteoporosis, Reichman pointed out that one postmenopausal woman in three is developing or already has severe bone loss, a silent, preventable $10-billion-a-year problem that results in 1.3 million fractures and thousands of deaths each year.
The most rapid bone loss occurs in the first five years of menopause, and close attention to preventive measures is urged, particularly for those at highest risk: thin white women, women who smoke or drink excessively and those who have a family history of osteoporosis, as well as women who enter menopause with thin bones or whose menopause occurs early, in their 30s or early 40s, perhaps as a result of surgery or chemotherapy.
Menopause can be accompanied by a loss of muscle tone in the pelvic region, resulting in stress incontinence (urine leakage when one coughs, sneezes, laughs or exercises vigorously) and a discomforting drop of pelvic organs.
Skin thins out and becomes more lax and wrinkled when estrogen production declines, and the relative increase in testosterone (also produced in the ovaries) may result in growth of facial hair and thinning of scalp hair.
Reichman said the most important approach to menopause is to take action: assess your personal and family medical history for health problems that are related to menopause, stop health-damaging habits like smoking and abusing alcohol and overconsuming caffeine and adopt health-promoting habits like regular weight-bearing exercise and a low-fat diet rich in vegetables, fruits and grains and calcium-rich foods.
Then there is the option of hormone replacement. The pendulum, which has swung back and forth about estrogen supplements in recent decades, is now clearly on the side of taking them, at least for most women. Only 15 to 20 percent of menopausal women are now on estrogen.
Some are against what has been called "the medicalization of menopause" and question the wisdom of monkeying with nature. Others have health concerns, like a history of breast cancer, that preclude its use. Still others are afraid that menopausal hormones might increase their risk of getting cancer. Before making a decision, it pays to weigh the existing evidence.
Next week: Deciding about hormone replacement.
by CNB