- The Washington Times - Tuesday, July 17, 2001

Many menopausal baby boomers face a dilemma. If they are considering hormone replacement therapy to counter menopausal symptoms, they have to weigh the benefits of fighting osteoporosis against the risk of getting certain kinds of cancer.
Dr. Malone, an obstetrician-gynecologist in Northwest, talks with women daily about a variety of subjects, including the symptoms of menopause — disrupted sleep patterns, mood swings and hot flashes and her ugly stepsister, night sweats.
At one time when women asked their doctors, "When will this end?" the answer always was the same: "I don't know."
That's not the case today. Menopause is inevitable, but it does not have to be excruciating. With 40 million female baby boomers about to enter the menopause age range, there's no reason to cry.
"The good news is that women have options to help them manage menopause today that their grandmothers and mothers didn't have a decade ago," Dr. Malone says.
Hormone replacement therapy, or HRT, is a combination of estrogen and progestine — not that different from birth-control pills except HRT contains far less estrogen than do low-dose birth-control pills, she says. HRT can alleviate symptoms associated with menopause and a woman's falling estrogen levels. It comes in a variety of forms, such as pills, patches, vaginal creams and suppositories. HRT has long-term and short-term benefits, the physician says.
"At its best, it is used for treating menopausal symptoms, which include hot flashes, vaginal dryness, mood swings and sometimes depression that comes with menopause," says Dr. Malone, 42. She has been a partner at Foxhall OB/GYN Associates, P.C., in Northwest since 1992 and is an assistant clinical professor of obstetrics and gynecology at George Washington University.
"The long-term benefits include prevention and treatment of osteoporosis and possibly the prevention of cardiovascular disease. In this day and age, there are treatments available to women that we didn't have 10 years ago. And there are also alternatives to HRT," she says.
Dr. Malone says there is no pat answer to whether a women should use HRT. A lot depends on her symptoms and what her risk factors are for cardiovascular disease and osteoporosis. Ask questions, she advises. Get the facts.
"I urge women to go to their doctors and find out what their options are. With all the medications on the market, pharmaceutical companies are going directly to the consumers. Women come in [to their doctors' offices] with notions of what they want to take without all of the information," she says.
Along with HRT's upside, Dr. Malone says, there are risks associated with its use, especially for women who have any pre-existing history of cardiovascular disease.
"Women who have had one heart attack or evidence of pre-existing cardiovascular disease should not take HRT. This is new information that we just found out within the past two to three years," she says.
"Women also should not take HRT if they have a history of breast cancer or a history of blood clots. Those are about the only absolutes," Dr. Malone says about HRT not being an option for certain women.
She recognizes women's No. 1 fear when considering whether to take HRT: developing breast cancer. Once again, she says there is more good news to report. HRT has been around for 40 years, and doctors have a lot of data on what happens to women and how HRT affects them, she says.
"All studies show a slight increase of breast cancer in longtime users — five to 10 years. One of the strategies we have adopted for those who are symptomatic is putting them on HRT for shorter periods of time — maybe five years, and then reassess to find out whether it's good or not beyond that time," Dr. Malone says.
"There are some women who after five years say, 'I feel great. Let's not rock the boat.' That's the one thing that gets underplayed — a quality of life — and that is a legitimate reason for choosing to take HRT. One of the big issues with post-menopausal women is sexual dysfunction, a lack of libido and vaginal dryness. And for a 50-year-old woman today, that's simply unacceptable.
"Baby boomers are not content to have the same kind of menopause their mothers and grandmothers had. They're not ready to go and sit in rocking chairs," the mother of three children says.
Menopause begins at age 51, on average. But remember, Dr. Malone says, that menopause is a process that takes years to complete. It doesn't happen in a day. For example, if a woman has her last period at 51, the changes in her reproductive cycle started five years earlier, she says. The years leading up to menopause are called perimenopausal years.
"That's why women get confused when their cycles are regular and they experience mood swings. Menopause is a process; it is not a one-time event. But symptoms can occur as early as five years prior to a woman's last period and can go on for years after their last period," Dr. Malone says.
"I've had women in their 60s who still have hot flashes. There are some women still having those problems that far out. On the other hand, there are some women who go through it and never blink an eye. That's the range of how women respond to hormonal changes," she says.
HRT works well for some women, but not everybody.
Michele Anthony, a Maryland resident, grappled for a year with the question of whether or not to take HRT before trying it in 1998. She stopped last year. She says her symptoms were not severe, and in her opinion, the risks — the possibility of breast cancer or strokes —outweighed the benefits. Irregular sleep patterns prompted her to consult her doctor.
"I noticed that my sleeping patterns had changed, and I would wake up regularly at 2 a.m. in the morning, and I couldn't get back to sleep," says Ms. Anthony, 56.
"I started taking [HRT] for that reason. Then, I noticed, it seemed like I was retaining fluid. Almost as if there was this constant swooshing going on inside me. So, I called my doctor to ask if there were any complications coming off of them," she says.
"I didn't have any severe symptoms — unbearable hot flashes and mood swings. I wasn't one of those people who had crying jags and bouts of depression," Ms. Anthony says.
Pain in her hands, specifically her fingers, also was a concern that she discussed with her doctor. Ms. Anthony says osteoporosis does not run in her family. She started drinking a soy protein drink, and the ache went away, she says.
Her doctor originally prescribed Premarin for her, but that led to bloating, and she says her heart raced. Then she tried another form of hormone replacement therapy, which exacerbated a pre-existing health issue because of the estrogen.
"My fibroids started to grow. One was the size of a 3-month-old fetus, and that's my main reason for discontinuing the therapy," she says. I no longer have pain in my fingers. Although, I still wake up some nights, and if I do, I'll just watch TV. I've decided that was OK," Ms. Anthony says. Once she stopped HRT, the fibroids started to shrink.
Dr. Malone says helpful information to have when women meet with their doctors to discuss HRT as a possibility includes the family medical history, a cholesterol profile and the results of a bone-density test. The bone-density test tells doctors what kind of shape their patients' bones are in and whether HRT could be a plus for preventing osteoporosis later.
"How you come into menopause is a reflection of what you did for the past 45 years. This is one of the things I try to get my young people to do — start taking calcium now at 20, so when you get to menopause you have strong bones," Dr. Malone says.
Women who use HRT must get annual mammograms and perform monthly breast examinations. Most important, Dr. Malone says, they must report any unscheduled bleeding to their doctors because that's an early warning signal of endometrial cancer (cancer of the lining of the uterus).
No pun intended, but menopause is a hot issue. Studies and research are ongoing.
Dr. Malone recently attended an international conference on menopause held in the District. "People from all over the world presented research on menopause and menopause-related issues. This is a big deal. And it's all driven by the Women's Health Initiative at the National Institutes of Health. Finally, there's a separate health initiative that deals with nothing but women's health issues. This [subject] is also driven by the fact there are so many aging baby boomers," she says.
There are alternatives to HRT, which a woman can explore with her physician. There are women who prefer phytoestrogens, or estrogen from plants, to pharmaceuticals for managing menopause. Just ask Andrea D. Sullivan, a naturopathic practitioner in Northwest. Ms. Sullivan's clients range from infants to folks well into their 80s, she says.
Naturopathic medicine treats the whole person, not just the condition, she explains, adding that menopause is a perfectly natural progression for women. Sadly, she says, society places a stigma on "the change of life."
"Adolescence isn't a disease, although some parents may disagree," Ms. Sullivan says, smiling. "Our grandparents went through menopause before hormone replacement therapy. The point is, there can be discomfort, but it should not be viewed as being bad or a disease.
"It requires some lifestyle changes, and that's when naturopathic medicine comes in. Clearly, regular exercise can help a lot. Some women haven't exercised since their teens or late 30s, and that's not good. Fifty percent of African Americans are obese, and that is a ridiculous figure due to lack of exercise. In the course of one week, spending three to four hours exercising can make a difference — not only with hot flashes — but also weight," Ms. Sullivan says.
Regular exercise promotes better bone health when a woman is going through menopause. Green, leafy vegetables provide calcium in a form the body can use, she adds.
"African-American women should be concerned about cardiovascular health. That's where we have problems, whereas Caucasian women have problems with osteoporosis," she says.
Ms. Sullivan suggests that women in favor of a naturopathic method should quit smoking and drinking alcohol. Smoking increases cardiovascular problems and aggravates menopausal symptoms. Alcohol depletes calcium from bones, so women might want to decrease or eliminate their alcohol consumption.
"Other necessary changes when you talk about menopause include food and dietary habits. Foods that are high in fat (specifically meats) that have chemicals, antibiotics and tranquilizers in them — those foods add to the problems," she says.
"There are foods called phytoestrogens like celery, parsley, cabbage, broccoli, soybeans, whole grains (including spelt, kamut and quinoa) alfalfa and herbs like fennel. These are the foods that we focus on with everyone, but certainly those going through menopause," Ms. Sullivan says. "The reason being, the chemicals in the foods will bind to estrogen receptor sites. Clearly, they aren't as active as true estrogen, but they can act in the same manner."
Ms. Sullivan penned a book, "A Path to Healing: A Guide to Wellness for Body, Mind and Soul," in 1998, which was published by Doubleday. She says more women recognize that using artificial hormones can cause serious unintended effects — such as cervical and breast cancer.
"Many women do not choose to go that route if they have breast or cervical cancer in their families, and some women just don't want to take Premarin because it is made from horse urine. In all fairness, not to say some things in naturopathic medicine may not seem odd to some, Premarin is the estrogen drug most commonly prescribed, and it is made from the urine of pregnant mares. Some people respond to it very well, and others do not," she says.

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