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A Special Thank You 13
Foreword to Healthcare Providers 15
Introduction: Why I Wrote This Book 17
Part 1 Important Facts about Menopause
Chapter 1 Do You KnowThis about Menopause? 23
Chapter 2 A Brief History of Menopause Helps You Understand Your Options 25
Chapter 3 What Are Bioidentical Hormones? 49
Part 2 The 7 Steps to the Perfect Menopause
Chapter 4 Step one Know Your Menopause 67
Chapter 5 Step Two Determine Your Treatment Goals 85
Chapter 6 Step Three Manage Major Symptoms 105
Chapter 7 Step Four Get to Your Perfect Weight 129
Chapter 8 Step Five Reverse Aging and Manage Your Dryness, Inside and Out 153
Chapter 9 Step Six Dramatically Improve Your Sexual Desire 177
Chapter 10 Step Seven You Can Have a Better Night's Sleep 203
Part 3 More Resources to Help You Achieve the Perfect Menopause
Chapter 11 How to Choose and Work with the Perfect Medical Provider 215
Chapter 12 Put Your Plan into Action: Make These the Best Years of Your Life 226
Chapter 13 Selected Resources for Additional Information 227
About the Authors 235
The average woman will spend one-third or more of her life in menopause.
Menopause is new, but hormone therapy is not.
Before 1900, most women did not live long enough to experience menopause.
The ancients drank the urine of the young and virile men and women (hormones)-to capture the essence of their vigor and virility.
Menopausal women in the 1800s ingested the extracts of ground up animal ovarian tissue.
There has been significant progress made and new knowledge gained about menopause in just the last two years, all of which is relevant to your menopause management.
Most women-even doctors-are confused by the changing data on hormone use.
Bioidentical hormones were first isolated by chemists in 1928; they became available for general use in the 1960s.
Bioidentical hormones are available both as compounded and pharmaceutical preparations.
Hot flashes and night sweats are common symptoms, but the most common menopause complaints are fatigue and body aches.
Hot flashes and night sweats last for 4-5 years for most menopausal women; for at least 10% of women, they will last for the rest of their lives.
Weight gain, mood swings and decreased sexual desire are also common complaints at perimenopause and menopause, and there are effective ways to alleviate them.
Weight gain is the number one complaint of women in my office practice; decreased sexual desire is the second.
Beauty may be only skin deep. Did you know that decreased hormone levels dramatically reduce skin thickness, leading to skin dryness, wrinkling, and the rapid appearance of aging?
Did the famous hormone study of 2002 (WHI-Women's Health Initiative) show that estrogen causes breast cancer after all? Recent analyses of this data, and additional new studies, show that estrogen use may actually prevent breast cancer for many younger postmenopausal women in at least the first five years of use.
If you are on hormonal therapy and decide to go off, it may be risky to just abruptly stop.
Natural doesn't necessarily mean safe. There are many natural therapies, including herbal therapies, which are safe and very useful for menopause symptoms. Some are not useful, and some may even be contaminated and/or harmful. This book will help you with these issues.
ConsumerLab.com is a highly respected and reliable source to check on the purity of your herbal supplements.
There are safe and effective herbs and natural substances that can help your hot flashes, night sweats, fatigue, sleep disturbance and sexual desire.
Most medical schools and reputable OB/GYN residencies provide very little teaching and experience on menopause.
Do these facts surprise you? Read on to learn the real and current facts about menopause, and how they can affect your real options and successes for therapies.
Chapter Two A Brief History of Menopause Helps You Understand Your Options
You've just learned a few facts about menopause and treatments that may have surprised you. The fact that it is only within the last century or so that life expectancies increased enough for menopause to become a regular experience for women indicates that the field of menopause is a relatively new area of medical research. Before the 1900s, the average life expectancy for women was 47. Women often died at younger ages than men because of infections and childbearing complications. Women who did live long enough to experience menopause received little support from the medical community. The few articles that were in the medical literature about menopause received little attention. At that time, the majority of doctors were male, and most of them held the Victorian view that the change of life "unhinged the female nervous system," changing women personally and physically. The implication was that menopausal women were moody, looked older, and became undesirable at menopause.
Thankfully, years of the medical community dismissing menopausal symptoms gave way to real interest and significant research. While the scientific community's understanding of the "whys, whats and hows" of menopause is still rather new, our knowledge about the experience and how to best treat the symptoms of menopause is constantly and rapidly growing. You have not been alone. Women have been living with (and through) menopause symptoms for years, and there have been long-standing efforts to deal with the experiences you are having. This is one of the big reasons that when it comes to menopause, as Professor Einstein put it, "The answers have changed."
Knowing a brief history of the medical community's research into menopause and therapies can be very helpful to you in understanding the healthcare practitioners' perspective towards recommending treatments. Appreciating their perspective may help you to communicate with him or her more effectively, and will benefit you when it comes time to carefully select your options for treatments.
Primitive and Early Beginnings
There are folklore stories about the kings and queens of ancient tribes who drank the urine of their young and vigorous subjects, believing it would help them stay, and feel, youthful and energetic in every way. While these ancient peoples may not have known that urine contained hormones, these are the earliest reports of hormonal therapies.
The first scientific articles in the literature about menopause treatments were seen during the 1700s. Medical practitioners suggested bloodletting as well as ingesting crushed animal parts, such as "crushed powdered penis of ass" (donkey), in an attempt to alleviate hot flashes and moodiness, symptoms ascribed to menopause even then. At that time, practitioners thought that these treatments worked. In the 1800s and early 1900s, scientific articles described "ovarian therapy" for hot flashes and moodiness. This therapy consisted of ingesting ground-up ovarian tissue from animals. Clearly, not much had changed for menopausal women in over a century!
The First Hormone Era (1900-1960)
By the early 1900s, considerable interest was building to understand the role of hormones during the menopause transition. A medical article published in 1903 linked the reduced level of hormones in menopausal women with symptoms such as hot flashes, however treatment options hadn't advanced much yet. "Ovarian therapy" with extracts of ground-up cow, sheep, or pig ovarian tissue was still the recommended remedy. Partially purified fluids that had been extracted from animal ovarian tissue even became commercially available treatments for menopausal symptoms.
By the late 1920s, women's life expectancies had increased enough that the menopause transition was becoming a common occurrence. Doctors began to recognize that menopause was a syndrome with a set of symptoms, and that it was directly related to a decline in estrogen production by the body. Then, in 1928, the German chemist, Butenandt, extracted the human ovarian hormone estrone from the urine of pregnant women. This was the first discovery of a "bioidentical" hormone, and Butenandt won the 1939 Nobel Prize for his discovery.
While many chemists were making good use of Butenandt's discovery, the process of extracting hormones from the urine of pregnant women simply was not a practical means to develop therapies for the increasingly large number of women who wanted to treat their menopausal symptoms. Demand for treatments was strong enough that chemists soon turned their attention to a more readily available source of hormones-animal urine. Pregnant animals, like pregnant women, excrete high levels of estrogens in their urine, however harvesting urine from pregnant animals did not pose the same practical concerns that harvesting urine from human subjects did.
Throughout the 1930s an increased intensity regarding the medical professional's concern to treat menopausal symptoms began to make its way into the medical literature. For the first time, the concept of "menopause management" was introduced, and articles recommending the use of hormones to achieve this were published.
In 1942, the first "modern" commercial hormone preparation for menopause therapy, Premarin[R], was introduced into the market. Named for its source of estrogens, pregnant mares' urine extraction, Premarin was a major breakthrough in 1942, a major advance in medicine, and a major and significant benefit to the field of menopause management. Premarin would eventually become the most widely prescribed drug in the United States. It is still available as a menopause therapy today, and its active ingredients are still extracted from the urine of the pregnant mare.
What the 1960s Meant for Menopause: The Modern Era of Menopause Therapies
By the 1950s, more women were living much longer, and were now experiencing both menopause and many postmenopausal years. In 1960, Dr. Robert Wilson, a famous gynecologist, published the best-selling book Feminine Forever that promoted the concept of Estrogen Replacement Therapy-ERT. "The menopause woman is not normal," Dr. Wilson argued. "She suffers from a deficiency disease and needs treatment." This assessment summed up the prevailing thoughts of both patients and physicians regarding the menopause phenomenon. At the same time, however, a small but vocal minority was of the opinion that nothing should be done to treat menopausal symptoms. This school of thought professed that menopause was normal and that women should simply endure the symptoms. Many years later, both schools of thought were criticized for their all-or-nothing approaches. However, these opposing positions on the treatment of menopause set the tone for the ongoing debate over if, and how, menopausal symptoms are treated. This basic debate is echoed even today when any new information on menopause becomes available. You probably can name your friends and family members that are vehemently "pro" or "con" regarding the treatment of menopausal symptoms. Regardless of the intellectual debate, most women and their doctors were desperate for menopause therapies, and Premarin continued to be successfully used.
In the late 1960s, precise measurements of bone density became available and doctors discovered that significant bone loss began at menopause. Now doctors began to suggest taking estrogen as a way to protect against osteoporosis. Sales of Premarin soared.
A New Emphasis on Research
Intense research on hormones in the 1950s and 1960s allowed scientists to isolate a compound, diosgenin, which was discovered in and obtained from the yam plant. Diosgenin turned out to be a natural hormone "precursor," or building block. In the laboratory, diosgenin could be converted in to many hormones very simply, including the human-bioidentical estrogens estradiol, estrone, and estriol. Because diosgenin could be obtained from plants, this hormone precursor could be more readily available in large quantities, and with fewer practical concerns, than hormones extracted from pregnant animals. Diosgenin, it turned out, is also easily converted into other hormones in the lab such as testosterone, progesterone, DHEA, and cortisol. Large quantities of diosgenin were also found in cactus and soy plants as well. (Figure 2-2) These discoveries constituted a major advance in hormone science, and paved the way for the introduction of new, commercially-produced therapies for menopause.
The discovery of diosgenin and the ability to easily convert it into a variety of hormones led to a new, cutting-edge use for hormones: the birth control pill. Virtually all birth control formulations marketed today are made with a combination of synthetic estrogens and progestins produced in the lab from the hormone precursor diosgenin.
The introduction of the birth control pill in 1960 was a huge success and greatly expanded women's birth control options. A whole new sexual revolution began with the introduction of the birth control pill, and with it, a whole new era of social thinking and interactions began. Not surprisingly, the focus placed on women's health and sexuality in her reproductive years led to more interest and focus on the understanding of her menopausal years.
Some Side Effects of Estrogen are Exposed
The latter half of the 20th century saw the most intense research and development in the area of hormones and menopause in human history. With so many women now taking hormones for their menopausal symptoms, it became easier to notice various menopause- and estrogen-related trends. Intense research showed many effects of estrogen therapies, both positive and negative. One of the most profound discoveries that has become a cornerstone of menopause therapy was that much lower doses of hormones, both in menopausal therapies and birth control pills, could be as therapeutically effective as the higher doses while decreasing the side effects. Lower-dose estrogen products quickly became the therapies of choice.
In the 1960s, menopausal women had their first "estrogen scare" when researchers reported that estrogen therapy alone (estrogen without other hormones) in women who had not had a hysterectomy may lead to an increased risk of uterine cancer. To protect the lining of the uterus, physicians added progestins to the estrogen therapy, resolving this issue for women who had not had a hysterectomy. This new treatment regimen, called combined therapy, was administered using two major treatment protocols: a combined continuous or a cyclic protocol. Combined continuous treatment, where progestin is taken every day along with the estrogen, became the most popular treatment regimen for menopausal women. In the cyclic progestin regimen, the progestin is only dosed for several days of every month or every three months. The use of progestin cyclically, instead of daily, was recommended for women who experienced unpleasant side effects from continuous progestin. Today, bioidentical porgesterone or one of the several synthetic progestins are used for this.
Other Diseases and Quality of Life Issues are Linked to Decreased Estrogen
Numerous women's health studies began to link estrogen deprivation at menopause to a variety of disease states. Research seemed to show that estrogen deprivation was responsible for increased risks of developing cardiovascular disease, osteoporosis, cognitive deficiencies such as memory deficits, the inability to focus, and even Alzheimer's disease. Urogenital symptoms such as bladder dysfunction, vaginal dryness and thinness, and painful intercourse were also recognized as related to the estrogen deficiency syndrome. In addition to hot flashes and night sweats, women in menopause were also widely suffering from difficulty with sleep. Sexual difficulties, including decreased libido, or sexual desire, and difficulties with orgasms, were also regarded as symptoms of estrogen deficiency at menopause.
"Take Estrogen Even If You Don't Have Symptoms"
By the late 1970s through mid-2002, estrogen therapies were the hallmark of most menopause management treatment plans, and many women were put on estrogen or combination therapies either to treat significant symptoms or to prevent many of the diseases thought to be affected by estrogen loss. Even aging itself was deemed a good reason to take hormones. Many physicians in this era felt it would be malpractice not to advise patients to consider hormone therapy. Hormone therapies were extremely popular products, and the hormone preparations Premarin[R] and Prempro[R] (a combination of the estrogen-containing product Premarin and the synthetic progestin Provera[R]) continued to be very popular with patients and healthcare providers alike. New and alternative delivery systems containing plant-derived hormones were developed to give women more therapeutic choices and to try and further reduce the incidence of side effects. Women now can choose to take their estrogen via pills, injections, transdermal patches, skin creams and gels, or as vaginal creams, gels, rings, and suppositories. During these years, only a minority of patients requested hormonal alternatives to therapy, such as herbal remedies or other medicines, and few practitioners learned much about these alternatives. This minority, however, would soon be joined by thousands of women seeking a different way to alleviate their symptoms.
Excerpted from The Perfect Menopause by Henry M. Hess Tiffany Farrell Copyright © 2008 by Henry M. Hess, M.D., Ph.D.. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Posted July 30, 2011
I am blessed to have Dr. Hess as my gynecologist for the last 15 years and he has seen me through peri menopause and now menopause. Not only does he have the answers I need, but he has real compassion for what we women experience during this stage of our lives. He is a highly sought after authority on the subject of menopause. This book was exactly what I needed at a time when I wasn't sure how to handle the changes I was experiencing, offering options for treatment of the symptoms of menopause. I still use it as a reference manual on the subject.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.