OUR BODIES ARE DIFFERENT
Surely women are women? Of course women have specific similarities, but it is their differences that serve to drive home the subtitle of this book, namely, in contemporary menopause management, one size does not fit all! I will return to this subject shortly, but first it is necessary to provide the background information to menopause and its appropriate management.
Let me emphasize one point immediately. Until the late 1990’s, whenever the word menopause came up in some medical circles, it was almost universally equated with another term “Hormone Replacement Therapy (HRT), as if the one could not get along without the other. This implied you could not be fully active or healthy after menopause unless you took hormonal medication. Today, a new philosophy prevails.
Contemporary menopause management is a complex subject involving many aspects of preventing or treating both minor and major medical problems, requiring on occasion advanced diagnostic technologies, and incorporating a broad range of potential treatments, starting with the most noninvasive such as changes in lifestyle, and progressing to some new and very complicated pharmaceutical products.
WHAT IS MENOPAUSE?
Here is the official definition (North American Menopause Society, 2010): The word menopause implies permanent cessation of ovulation and menses. Spontaneous or natural menopause is said to have occurred after 12 months without a period (amenorrhea) with no pathologic cause. It reflects a near-complete but natural diminution of ovarian hormone secretion. There is no adequate biological marker for menopause.
In simple English, menopause means the last, final, and never-to-return loss of the monthly menstrual period, a natural event through which all women will eventually traverse. But if only it was that simple. To many women worldwide it is as much a state of mind as it is a state of bodily change. There are numerous descriptions, misconceptions, and even marketed untruths (yes, lying for purpose of gain) as to what the “change of life” is really all about. Few of these stories match each other, except that none ever paint a pretty picture of what to expect.
To most people, even the clinicians, menopause means more in their minds than the final menstrual period. Rather, it is a word used to collectively include the final period, as well as years before and many years after, and a host of real or perceived symptoms and potential diseases. I will not try and struggle against the headwinds, but instead will broaden my use of the word so that we can just get on with business and deal with the essential issues. Europeans tend to use climacteric (Greek: steps of a ladder) instead of menopause to refer to this time in a woman’s life.
Given the great mythology that has built up around the word menopause it is little wonder that many women approach this significant event with nothing short of dread, anxiety, and fear. In desperation, most women turn for guidance to friends or family, to women’s magazines, to the Internet, or the lay medical press (confirmed information through Gallup polls). What do they get out of this? Mostly confused – a confusion that may aggravate an already existing distorted image of life and where it is going.
• “There is nothing to it,” says one friend, but “it is the change of life and beginning of old age,” says another.
• “My sex life ended and my husband left me,” confides her next-door neighbor, while her aunt warns: “Take life easy or you will break a bone!”
• “Menopause is a galloping catastrophe,” stated one early renowned physician who hurried to add that with hormone therapy, “you will be much more pleasant to live with and will not become dull and unattractive.”
• “You must really be crazy to allow a male chauvinist gynecologist prescribe you hormones. Don’t you know they cause cancer and heart attacks?” shouts her daughter.
And so it goes on and on, with increasing confusion, more indecision, hot flashes, night sweats, and greater emotional distress, the escalating and inevitable results.
Whose fault is this distorted idea of menopause? Probably ignorance aided and abetted by social attitudes, fallacies, and misconceptions. The situation, moreover, has often been traded upon by groups as disparate as the fashion industry, parts of the medical profession including most notably the cosmetic surgeons, the pharmaceutical industry, sports good producers, ….the compounding pharmacy and bioidentical hormone movement, and operators of spa and health farms. This list is not complete!
Yet this common distorted image of menopause is not pervasive throughout our society, and certainly not in many parts of the world. Do you know that:
• Some women really do look forward to menopause?
• The average European woman has less anxiety about menopause and aging than her American sister?
• In Japan there is not even a word in the language to describe a hot flash?
• Stresses and strains are placed on many people, not just aging women, by the so-called “youth culture”?
• A change in your sex life is not inevitable?
• If you are considering taking hormones but are not certain what to do, there is a whole new body of evidence as well as carefully considered medical recommendations from leading scientific organizations that can assist you in your decision?
• Before making decisions about your menopausal potential treatments, you really need to know the facts about them?
I will try in these pages to provide answers to these questions and many more. Written expressly for the concerned woman, it would be a wise idea for men to read it too. They need a lot of insight into menopause, as well as some understanding of the women with whom they associate. Men should know that male menopause is in some ways as real an entity as the female counterpart, and many principles and lessons presented in this book could well apply to them.
My intention is to make facts understandable. Although I write in consumer language the facts are scientific. If you feel inspired to read in greater depth, the suggested list of references and information sources at the end of the book will show you the way.
Medical research is accelerating at a furious pace. Any medically oriented book could be criticized for being out of date even before it is published. Such criticism is only true about the leading edge of research. An understanding of the basic facts is necessary before new aspects of research can be appreciated. This book should provide you with these basic building blocks. Thereafter, you can more appropriately evaluate and recognize whether each new piece of information is a genuinely real advance.
Let me quote from a statement that appears repeatedly in the position statements for various menopausal treatments presented by the Scientific Panels of The North American Menopause Society:
Evidence-based medicine implies that recommendations be limited to the women for whom the studies are relevant. Although this goal is ideal in principle, it is impossible in practice, given that there will never be adequate randomized, controlled trials covering all populations, eventualities, drugs, and drug regimens. The practice of medicine is ultimately based on the interpretation at any one time of the entire body of evidence currently available.
A CHANGE FOR THE BETTER
The Panel accepted the fact that no trial data can be used to extrapolate clinical management recommendations for the entire female population and that no single trial should be used to make public health recommendations. randomized, controlled trials covering all populations, eventualities, drugs, and drug regimens. The practice of medicine is ultimately based on the interpretation at any one time of the entire body of evidence currently available. The Panel accepted the fact that no trial data can be used to extrapolate clinical management recommendations for the entire female population and that no single trial should be used to make public health recommendations.
That is what I will be doing in these pages – coming to conclusions and making recommendations for medical practice “based on the interpretation at any one time of the entire body of evidence currently available.” Menopause is much more than hormones. Other aspects, such as the way you live your life, sexual activity, and the attitudes of society, will also be considered. The positive concept that I will present to you as a new lifestyle after menopause is based on straightforward principles that really work.
Very little in life that is genuinely worthwhile comes easily. This book is no more than a guide or practical handbook, much the equivalent of a computer or new car instruction manual that needs to be understood. The difference is that the appliance described is you. After reading it, you will be better able to judge your own needs after menopause, hormonal and other, and “change of life” can truly be made to mean, “change for the better.” (Oct., 2011) Discuss this excerpt on the menopause bulletin board.
(Printed with Permission 10/11)
Wulf H. Utian is considered to be one of the world’s most significant authorities on menopause and women’s health, Dr. Utian is the Executive Director Emeritus and Honorary Founding President of The North American Menopause Society (NAMS); the Arthur H. Bill Professor Emeritus of Reproductive Biology, Case Western Reserve School of Medicine; Consultant in Gynecology and Women’s Health, The Cleveland Clinic; Visiting Professor, University of Cape Town, South Africa, and Chairman of the Advisory Board of Rapid Medical Research. Previously, he was Director of Obstetrics and Gynecology at Mt. Sinai Medical Center of Cleveland, and then at University Hospitals of Cleveland and Chairman of Reproductive Biology at Case Western Reserve University. He received his medical degree from the University of the Witwatersrand, Johannesburg, South Africa, and his PhD from the University of Cape Town, South Africa. In 2007 he earned the DSc (Med) degree from the University of Cape Town, it’s highest degree and awarded only 11 times in over 100 years. He is Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology. He is also one of the three original Founders in 1976 of the International Menopause Society, of which he is Honorary Past President. He is the recipient of multiple research grants and has studied the metabolic and psychosocial aspects of hormones and menopause for over 40 years. During his career, Dr. Utian has written over 200 papers related to women’s health, and has authored several books, including eight on menopause, with CHANGE YOUR MENOPAUSE just published in September 2011.