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The Honolulu Advertiser
Posted on: Sunday, May 18, 2008

Menopause: The Next Generation

By Mary Kaye Ritz
Advertiser Staff Writer

Hawaii news photo - The Honolulu Advertiser
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Kathy Jaycox knows hot flashes.

"I have this one vivid memory of being on an airplane and thinking that the top of my head was going to blow off," said Jaycox, now 59. "It was frustrating. I can't step outside for a breath of fresh air. I can't really adjust the temperature. I remember sitting there thinking, 'What am I going to do, I am SO hot! There's going to be this rivulet running down the aisle and there won't be a person anymore.' "

The University of Hawai'i administrator can laugh about it — now that a safe number of years have passed and she's back in solid form on solid ground.

"Obviously I survived," she deadpanned.

It's not as if today's women are discovering the "change of life," as it was called when Edith Bunker first fanned herself on national TV in what became a groundbreaking moment, but as Dr. Bruce Kessel, author of "Mind Over Menopause" puts it, this generation is putting its own stamp on menopause.

"The baby boomer generation is basically taking control of midlife health, including perimenopause and menopause," said Kessel, also an associate professor in the department of obstetrics, gynecology and women's health at John A. Burns School of Medicine and past president of the North American Menopause Society.

"Keep in mind, these are the same women who in their 20s and 30s took control of labor and delivery. They're actively taking charge of their midlife health."

It's happening in a number of ways, he said: Women are actively educating themselves and bringing a more positive attitude to this time of life.

The North American Meno-pause Society conducted a poll with Gallup that found women were reporting feeling their happiest and most fulfilled between the ages of 50 and 65.

"I don't think this was true in the generation before," he said, "and I don't think women were as actively talking about menopause. ... Currently, they're so into prevention, diet, exercise, mind-body techniques. (We've seen) a dramatic increase in bio-identical hormones, herbs and supplements, and the like. I think it is different than (it was for) their mothers."

LET'S GET PHYSICAL

One thing hasn't changed from one generation to the next, and that's the physical side to menopause. The No. 1 symptom women experience? Well, of course that would be having menses stop. But up to 80 percent of U.S. women also report vasomotor symptoms — hot flashes and night sweats, said Kessel, though Asian women report fewer symptoms than Caucasians.

One thing boomer women aren't doing that their older sisters might have done is using hormone replacement therapy. When the Women's Health Initiative findings were published, the practice changed.

"In the old days," — and in the area of women's health, even as recently as 2002 can be considered "the old days" — "we kind of suggested everyone considered hormone therapy," said Kessel. "The current policy is, we should not use it as prevention of a chronic condition."

That means hormone therapy may still be on the table for women with moderate to severe hot flashes and night sweats, but women are counseled about the possibility of an increased risk of heart disease and breast cancer.

Before the Women's Health Initiative, a little more than a third of women were using hormones. Up to 60 percent of those discontinued their hormones in the ensuing years.

COPING MECHANISMS

So more women are toughing out the hot flashes, as well as the other physical changes that sometimes come with menopause: vaginal dryness, mood swings, acceleration of bone loss and now, currently being studied, increases in depression.

Some women report changes in their hair texture; others have said they feel skin sensations much like having ants crawling up your arm. There's even headaches, loss of libido and hair loss for some.

If it's extreme, many still consult their doctors, but others are learning that the health store and drugstore offer some relief.

Jaycox was among those women who were on hormone therapy but went off in the aftermath of the Women's Health Initiative findings.

"Luckily for me, I was getting it when I most needed it," she recalled.

How are women coping, sans hormone therapy?

Ask Michelle Lesperance of Kahalu'u, 53, and it's all about finding environmental ways to make it bearable.

"The highlight is when I walk into the chiller at Watanabe Floral," said Lesperance, who works at Kaiser Permanente. "It's so wonderful! ... I have a newfound appreciation for air conditioning."

And boomer women are bonding over their experiences, adds Jaycox. "There are a lot of women around the same age working at UH," she said. "When the women are together, someone will say, 'It's so hot in here!'

Her colleagues will respond, "'No, it isn't, but welcome to the club,'" Jaycox said.

OTHER REMEDIES

With hormone replacement off the table, Kessel said more over-the-counter remedies are being tried, though "unfortunately, clinical trials on many of these herbs are disappointments."

That means the scientific world is not yet ready to embrace soy, cohosh and red clover for night sweats and hot flashes.

"True scientific studies on herbs and supplements have not shown that they are highly effective," he said.

What does work? Biofeedback, sometimes.

"Small studies have shown that about a 50 percent reduction in hot flashes (are the outcome of) mind-body techniques, such as yoga and abdominally led breathing exercise," Kessel said.

His book, "Mind Over Meno-pause," submits that the mind-body connection is underused by healthcare providers.

"The National Institute for Health, which funds medical research for this country, has recently decided that they do need to address this area," he said. "So they will be funding a multicenter, $22 million grant specifically designed to come up with treatments for hot flashes. They did specifically ask for some of these studies to not to be pharmacologic."

• • •

First of two parts

Today: How boomer women are putting their own stamp on the menopausal experience
Tomorrow: Menopause comes out — in pop culture and friendly bonding

DEALING WITH IT

Dr. Bruce Kessel offers these tips from his book "Mind Over Menopause":

• Meditate at least once a day, and take mini-meditation breaks as often as possible.

• Exercise regularly.

• Do something nice for yourself as often as possible (aim for at least once a day).

• Monitor what you eat.

• Be mindful of each moment; learn to live in the here and now.

• Monitor automatic negative thoughts; learn to recognize anxiety and its effects. Consider journaling to release them.

• Practice effective communication.

• Recognize humor daily.

THE NATURAL WAY

The latest controversy over hormone therapy has to do with use of bio-identical hormones. Some FDA-approved bio-identical hormones are available at local drugstores; others are designed for a specific patient, made by a "compounding pharmacist" (O'ahu has at least two).

But not everyone is as convinced. "The major (medical) societies have come out with statements that there's no evidence that compound bio-identical hormone is any better or safer than a traditional FDA-approved hormone," said Dr. Bruce Kessel.

Flaxseed and soy supplements are being studied for aiding symptoms. And natural remedies abound, including these suggestions from Laurie Steelsmith, who writes for the Prescriptions column of The Advertiser:

• Free and Easy Wanderer, an herb for hot flashes, stress and anger.

• Sepia for hot flashes and irritability.

• A Chinese remedy called Dabuyin for hot flashes.

"The highlight is when I walk into the chiller at Watanabe Floral. It's so wonderful! ... I have a newfound appreciation for air conditioning."
Michelle Lesperance
Kahalu'u, 53



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