Dr. Kerr: Focus on quality of life in menopause treatment

Hot weather is not kind to menopausal women. In this country alone, women spend millions of dollars on supplements and herbs with questionable benefits or safety profiles. I know one woman who swears that riding her motorcycle is the best remedy she has found for hot flashes. And 50 percent of women will feel better for two or three months just on placebos.

The symptoms of menopause can range from none to debilitating. Most women do notice some changes at this time of life. Vaginal dryness is almost universal. Hot flashes, insomnia and fatigue are common. Some women complain of joint pain and stiffness, and because there are estrogen receptors in the brain, many women will notice a cognitive loss.

The conventional wisdom is that symptoms only last a year or two, but for 10 percent to 15 percent of women that's just not true. And for some, the symptoms are severe enough that even a year or two is intolerable.

A few years ago, women going through menopause had it much easier. Doctors were encouraging hormone replacement therapy (HRT) to assuage their symptoms. Then in 2002, the Women's Health Initiative (WHI) study informed the public that they were discontinuing HRT trials because participants were developing breast cancer. Women started throwing away their hormones and all across the country menopausal women got scared, hot and cranky.

It helps to understand the design of the WHI study. First, this study did not measure quality of life, which is the only real reason to take hormones during menopause. The WHI intended to study heart disease, cancer and osteoporosis prevention, but the study was discontinued after five years when researchers decided that the risks outweighed the benefits of hormone therapy. But the average age of the participant in the WHI study was 63.6 years old, women already about 12 years past the average age of menopause. These women already had a higher risk of cancer and heart disease than women in their 50s.

After throwing out hormones, some women found that they could manage without medication. It's true: If symptoms are not severe, they can be managed with nonhormonal methods such as fans, layered clothing and the avoidance of cigarettes, alcohol, spicy foods and stress. Increasing calcium intake, taking vitamin D supplements and getting regular weight-bearing exercise can help manage the risk of bone loss after menopause.

But sometimes this just isn't enough. It's all about quality of life, and if menopause is significantly affecting your well-being, then it may be worth taking hormones to ease the transition. Taking low-dose natural hormones for less than six years may have benefits that outweigh the risks.

According to Dr. Bob Field, a longtime Santa Rosa gynecology specialist, there are some guidelines for safe management of debilitating menopause symptoms:

If you take estrogen with progesterone, take estradiol, which is a plant derivative and structurally the same as the body's natural estrogen. To protect the uterus, take prometrium, which is a plant-derived progesterone and may be safer than medroxyprogesterone, which is synthetic. The WHI study used medroxyprogesterone.

Plan to taper off hormone replacements after two or three years of use, and plan to be completely off hormones after about five or six years if possible. That's when the risk of cancer starts to increase, and symptoms can usually be controlled before then with a slow taper.

Do not take hormones to protect your heart or against colon cancer. And although hormones do protect against bone loss, there are better medications designed specifically for bone strength.

Do not consider hormone replacement therapy if you have a history of blood clots, coronary artery disease or stroke.

Naturally, life is better if you don't have to take any medication. But if menopause is significantly affecting your quality of life, set the guilt and fear aside. Short-term, low-dose hormone replacement is still a viable option. It can be safer than many over-the-counter medications and herbs that make empty claims, and it is certainly much safer than riding a motorcycle and counting on wind chill for relief.

Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.