My favorite part of being an elected school board member of my local school district is commencement day! Being able to shake the hands of the graduates as those bright-eyed, fresh-faced, newly minted grads cross the stage to receive their diploma is clearly the best part of the duty. This ceremony marks their official entrance into the adult world.
As I sat at graduation and listened to the speeches about the importance of this life transition, being a physician and menopause specialist, I couldn’t help but think about the transition in life that occurs for all women (who live long enough). That is the transition from the “reproductive, menstrual phase” of life to the postmenopausal “period free” phase of life. This transition is medically, personally and hormonally an important phase of a woman’s life. Just as a high school graduate will never again be a high school student, a postmenopausal woman will never again ovulate. I have often said to my patients that menopause marks their entrance into their ‘second adulthood.’
Getting the Right Treatment for Menopause Symptoms
While menopause is a natural phase of life, it doesn’t mean it is worry free or without the need for reflection, assessment and sometimes medical intervention. Just as graduates pause to reflect on their high school careers as they begin the first phase of adulthood, which may include college, entering the workforce, and/or serving our country in the military, it is important for women and their physicians to reflect on menopause. Physicians should assess whether the woman is potentially estrogen deficient, which can have the following consequences:
• quality of life
• bone health
• skin and hair
• metabolic state
• genitourinary status
The Truth About the Risks of Hormone Therapy
That brings me to the absurdity of the U.S. Preventive Services Task Force recent statement that the risk of menopausal hormone therapy outweighs the benefits. That is true if you are only talking about women with NO symptoms and NO indications for menopausal hormone therapy. Duhh! Just like we don’t go around giving all women thyroid hormone preventively because 1 in 8 eventually will be low in thyroid; physicians only prescribe thyroid hormone to persons who are low in thyroid hormone. So if a postmenopausal woman has enough hormones, has no symptoms, then there is no reason to preventively give her potent hormones. However, if she has symptoms because she is low in female hormones then the benefits of menopausal hormone therapy clearly outweigh the risks for mostly all women. Some women need:
- Systemic menopausal hormone therapy
- Local vaginal estrogen
- Simply to improve their lifestyle
So as you face your menopausal matriculation, be positive, optimistic, and do not be needlessly scared by headlines about the risks of hormone therapy.
Be Strong, Be Healthy, and Be in Charge!
—Dr. Holly L. Thacker
Speaking of Women’s Health is a national women’s health education program by Cleveland Clinic.