Have a question about women’s health or menopause? Dr. Patricia Yarberry Allen may have the answer. Click here to send in your question to be posted on WVFC.


Question
: I am one of those women who is not managing her menopausal symptoms well. I am 47 and have a very complicated life. I work 60 hours a week in a very high profile and high pressure environment.

No one seems to talk about the women I have seen in my industry (finance) who crash and burn at their peak in mid-life from the stressors of work, family and the added burden of menopausal symptoms. It is a dirty little secret that causes women in their early 40s without symptoms to distance themselves and pretend that this will never happen to them. I know. I was one of them.

I want to start hormone therapy but my gynecologist “doesn’t believe in hormone therapy.” I am really suffering here and have to get help.

For the record, I am very healthy. There is no cancer in my family; no
one has had an early heart attack or stroke; and, to the best of my
knowledge, I have no known risk factors for blood clots.

I used the birth control pill for years and loved the predictability of my period. The control of menstrual pain and bleeding were great side benefits.

Now I have unmanageable hot flashes. I am sweating in meetings and of course there are night sweats and no sleep. So by the next day I am exhausted and feel as though I am thinking in a fog. I have to get these symptoms under control or I will not be able to manage my work or life. What do you suggest? – Beth

Dr Pat: You have so nicely described the confluence of life demands that many women face in their 40’s and 50’s: expectations of continued perfection in the workplace with younger colleagues just waiting for you to trip and fall; increasing familial stressors with aging parents and growing children who often seem to need more from us rather than less as they are becoming quasi-independent; and relationships with partners that often end if one does not have the foresight and energy to devote time to intimacy.

Then there is that gaping hole in a woman’s life called self-care that just gets bigger when she doesn’t attend to it.

Hormone therapy is certainly an option for you based on your description of your personal and family history and the symptoms that are making your life unmanageable.The North American Menopause Society and the American College of Obstetrics and Gynecology both suggest that a woman begin hormone therapy with the lowest dose possible of estrogen and progesterone (since you have a uterus, you must take a progestin to prevent the increase in endometrial cancer from estrogen used alone).

Plan to take it for a short period of time, usually about two years, before slowly withdrawing from this medical treatment and reassessing your symptoms at that time.

You need to find a gynecologist who specializes in caring for women in this life stage and who does not have preconceived notions about hormone therapy — not a doctor who has decided that all hormone therapy for all patients is a bad choice. Doctors don’t like to take risks in general, but hormone therapy is, in general, a good thing for patients who are suffering to the extent that you are.

We must all do a risk benefit analysis in health decisions constantly. What is the risk/benefit of having a mammogram? What is the risk/benefit of treating a mild but persistent increase in blood pressure? What is the risk/benefit of enjoying too much rich food every night?

In your case the risk/benefit of hormone therapy is clear to you. Hormone therapy may give you the control you need with improved sleep, energy and cognitive functioning. I also urge you to use this time in your life to reassess priorities. You must find time for exercise, meditation and some fun.

Call a family conference after you have regained your equilibrium. Let everyone know that you must have their support so that you can be your best for yourself, your work, your partner, your family and friends. Come up with a family plan that gives you time for this much needed self-care.

Be optimistic. You may have seen women in top management positions falter in mid-life, but the truth is, most women do find a way to get their groove back professionally and personally. Expect the worst and it will certainly knock on your door. Expect to be lucky, and you are already on the right journey.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to askdrpat@womensvoicesforchange.org.

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  • Karen O'Kane February 21, 2008 at 9:58 pm

    It is truly possible to have a demanding job, a busy life (keeping up with family, friends and social obligations) and continue functioning well during menopause. I must admit that I have had my moments and it has not always been a walk on Easy Street.
    I work closely with many management and executive level females who either are currently going through or have gone through menopause. Most of us have done this without hormone replacement therapy and experienced all of the symptoms you mentioned — night sweats, sleeplessness, hot flashes, mental fogginess etc. We continue to function well and handle very responsible jobs that involve decision making, budget responsibilities, strategic planning etc.
    I was also in good health and practiced good health habits going into menopause, but found that I had to do even more to compensate for some of the symptoms I was experiencing. It is time to take stock and maybe make a few adjustments.
    This is why as Dr. Pat suggested, you really need to practice self care. Take time out for you. Find others who are going through this and talk to them about it and have a few laughs about it! I am certainly not suggesting that menopausal symptoms are a laughing matter, but my co-workers and I have had a few humorous moments. Once at a Board of Directors meeting which was male dominated; three of us menopausal females experienced hot flashes at the same time. We caught each others eye, knew what was happening and experienced a serious case of the giggles.
    Keep up good eating habits, make some time for exercise and do something enjoyable every day. Also keep some ice water handy during meetings — it will help cool you off. Most importantly find a doctor who you are comfortable with and who can help you make the right choices and guide you through this journey.

    Reply
  • Karen O'Kane February 21, 2008 at 9:58 pm

    It is truly possible to have a demanding job, a busy life (keeping up with family, friends and social obligations) and continue functioning well during menopause. I must admit that I have had my moments and it has not always been a walk on Easy Street.
    I work closely with many management and executive level females who either are currently going through or have gone through menopause. Most of us have done this without hormone replacement therapy and experienced all of the symptoms you mentioned — night sweats, sleeplessness, hot flashes, mental fogginess etc. We continue to function well and handle very responsible jobs that involve decision making, budget responsibilities, strategic planning etc.
    I was also in good health and practiced good health habits going into menopause, but found that I had to do even more to compensate for some of the symptoms I was experiencing. It is time to take stock and maybe make a few adjustments.
    This is why as Dr. Pat suggested, you really need to practice self care. Take time out for you. Find others who are going through this and talk to them about it and have a few laughs about it! I am certainly not suggesting that menopausal symptoms are a laughing matter, but my co-workers and I have had a few humorous moments. Once at a Board of Directors meeting which was male dominated; three of us menopausal females experienced hot flashes at the same time. We caught each others eye, knew what was happening and experienced a serious case of the giggles.
    Keep up good eating habits, make some time for exercise and do something enjoyable every day. Also keep some ice water handy during meetings — it will help cool you off. Most importantly find a doctor who you are comfortable with and who can help you make the right choices and guide you through this journey.

    Reply
  • Karen O'Kane February 21, 2008 at 9:58 pm

    It is truly possible to have a demanding job, a busy life (keeping up with family, friends and social obligations) and continue functioning well during menopause. I must admit that I have had my moments and it has not always been a walk on Easy Street.
    I work closely with many management and executive level females who either are currently going through or have gone through menopause. Most of us have done this without hormone replacement therapy and experienced all of the symptoms you mentioned — night sweats, sleeplessness, hot flashes, mental fogginess etc. We continue to function well and handle very responsible jobs that involve decision making, budget responsibilities, strategic planning etc.
    I was also in good health and practiced good health habits going into menopause, but found that I had to do even more to compensate for some of the symptoms I was experiencing. It is time to take stock and maybe make a few adjustments.
    This is why as Dr. Pat suggested, you really need to practice self care. Take time out for you. Find others who are going through this and talk to them about it and have a few laughs about it! I am certainly not suggesting that menopausal symptoms are a laughing matter, but my co-workers and I have had a few humorous moments. Once at a Board of Directors meeting which was male dominated; three of us menopausal females experienced hot flashes at the same time. We caught each others eye, knew what was happening and experienced a serious case of the giggles.
    Keep up good eating habits, make some time for exercise and do something enjoyable every day. Also keep some ice water handy during meetings — it will help cool you off. Most importantly find a doctor who you are comfortable with and who can help you make the right choices and guide you through this journey.

    Reply
  • donnaimbarrato February 20, 2008 at 4:46 pm

    Dr. Pat’s advice is sound and true. I can relate my own experience regarding managing menopause and making decisions about serious treatment. At 45 I was diagnosed with stage 1, estrogen positive breast cancer. I have two young children, so I chose aggressive treatment and decided on a bi-lateral mastectomy with reconstruction.
    After 4 treatments of chemo, my period stopped and I entered chemo-induced menopause at age 46. My oncologist suggested I take tamoxifen for 5 years to reduce the risk of reocurrance even more. Once on tamoxifen my menopausal symptoms became worse.
    However; I was still able to manage the hot flashes, the overall dryness of every mucus membrane in my body. I was just not going to let it bother me. I had too much to do and couldn’t let this effect my quality of life. At age 49 I chose to have my ovaries removed, post-menopause, due to the growth of a benign cyst. This would also lower my risk of reocurrance. I started a different cancer drug called Aromasin. Then I began to have menopausal symptoms that were just too much to handle.
    I had managed my menopausal symptoms well up to that point, with exercise, effective diet, and yoga. But my body’s reaction to the Aromasin and the additional symptoms of menopause, surgically induced, were painful. I had vulvar pain and vaginal dryness so bad I couldn’t walk. After consulting with my new gynecologist, who specializes in woman’s menopausal health, and a new oncologist I finally got the help I needed. They took me off Aromasin. My gynecologist asked me to stop intercourse which I could not have anyway because it was too painful and had me take high dose Vitamin D. This treatment allowed all the tissue to heal over time.
    Afterwards, I had two thorough consults again with both my oncologist and gynecologist who agreed to allow me to use low-dose vaginal estrogen. Even though they were clear that we have very little info about it’s safety and absorption into the bloodstream. I did understand that if some of this estrogen is absorbed into the bloodstream it could have an impact on any estrogen positive pre-cancerous cells. But my ovaries were producing more estrogen than the dose of estrogen cream I would be using. Of course I would never have taken hormone pills or patches as they are too risky.
    After all of this over a period of months, I feel that I am making an educated choice. I am feeling much better and more like myself. I am so grateful that I have a team of doctors that totally listened to me and took my symptoms seriously, even when they weren’t so acute. They cared about my quality of life.
    Menopause is real and can be brutal. I think it’s important to let your family know what you are going through. Especially if you have a daughter. the symptoms can catch you off-guard and really effect you day to day. I am so lucky that my doctors took me seriously and cared about my quality of life.

    Reply