Menopause and PMDD: Update and new approaches

By Mary Ann Mayo, M.A., M.F.T., a licensed marriage and family Therapist, and a prolific author and speaker. She has authored 12 books that address the mental and physical health of women her most recent Twilight Travels With Mother and Good For You. She is a widely sought-after speaker for the national media on womens health issues.
Joseph L. Mayo, M.D., F.A.C.O.G., an obstetrician and gynecologist, has been a practitioner of womens health for more than 28 years. In 1992, Dr. Mayo co-founded with his wife, A Woman’s Place Medical Center, a clinic specializing in the health of mid-life women and issues of menopause. As an expert on women\’s health, Dr. Mayo has been quoted or written for such periodicals as Shape, More, Natural Health, Energy Times, and The International Journal of Integrative Medicine.

December 2010

Menopausal women can add whiplash to the laundry list of medical issues they face at midlife. The medical profession has done an about-face in their recommendations for hormone replacement therapy (HRT).

For women of a certain age, doctors have rapidly gone from insisting on hormone replacement as prevention from life threatening consequences, to dire warnings that if they don’t get off HRT they are doomed. This reversal leaves patients understandably reeling and is at least a symbolic pain-in-the neck. But is the evidence so straightforward? Is it true that most women should be off their hormone replacement or never start it? It certainly looks that way. In contrast to years of conflicting data, the definitive answer is largely in” hormone replacement causes more problems than it fixes. While some may continue to ˜nit-pick at the evidence, the Womens Health Initiative (WHI)  results of July 2002 essentially changed the way physicians practiced”or, at least, it should have. That it may not is a tribute to the power of the message of the pharmaceutical companys physician education department and the reality that physicians, caught off guard, simply do not have options to offer.

The ˜WHI results continue to be analyzed, but what we know now, and only previously suspected, is that breast cancer, cardiac events, strokes, venous thromboembolism, dementia and mild cognitive impairment increase with HRT, while on the positive side, there is some reduction in hip/vertebral fractures and colon cancer. The question must be asked: Is there ever justification for treating a natural passage of a womans life, one that is not a disease, with interventions that cause disease? These findings have motivated a few in the medical community to at least peek through that here-to-fore locked door behind which lies alternative medicine. Enthusiasm for interventions with a side effect profile that may include headache, rash, and gastro-intestinal upset instead of cancer and heart disease still rates a caveat for each recommendation.

Typically it goes something like, While this works in Japan…is the leading intervention in Germany¦has been used by women for 2,000 years¦we don’t have double-blind-placebo controlled studies published in American Medical Journals’so take at your own risk. Additionally, there has been some acknowledgment of the power of lifestyle (including food and exercise) to impact the menopausal woman’s life. How certain foods influence production of estrogen metabolites and re-absorption is the subject of the newest research.  Most efforts, however, continue to focus on tinkering with new combinations of pharmaceuticals and narrowing the list of who can safely take them. So what should you recommend to your peri/post menopausal clients? Here are five that represent the best integration of the research with clinical practice:

Bottom line, hormone replacement therapy should be reserved for younger women who have been unable to control hot flashes any other way and who do not have family or personal histories of breast cancer or heart disease.

It should be taken, according to the American Association of Obstetricians and Gynecologists (ACOG), for the shortest amount of time and in the lowest dose that is effective.

A trial of weaning off hormones is suggested every six months.

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Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.