Sixty years ago, women entering the menopause years might just as well have put on skates for their trip downhill.
People assumed menopausal women were bound to lose their power of judgment and ability to think clearly - not to mention their sex appeal. Indecisiveness, moodiness and depression were thought synonymous with menopause. Victims, psychologists said, would virtually go crazy or develop serious health problems. And many did.Despite advances in medical technology, the myths persist.
But hot vaginal douches and some strange-looking exercises involving a board and a chair, once prescribed by physicians, are out.
What's in is estrogen-replacement therapy, described by a local specialist as the greatest medical advancement in the past 60 years to treat the symptoms of menopause.
"Estrogen-replacement therapy has not only been shown to be safe, but also lifesaving," said Dr. Mary K. Beard, a local obstetrician/gynecolo-gist and co-author of the successful book, "Menopause and the Years Ahead."
"Whereas the relief of uncomfortable menopausal symptoms such as hot flashes and vaginal dryness was the prime reason for taking estrogen, research has demonstrated that it must be taken by nearly every post-menopausal woman to avoid the development of crippling, deforming and life-threatening osteoporosis and also to prevent cardiovascular tragedies."
No longer, Beard said, must women "tough it out" or view the discomforts of menopause as a natural phenomenon to be taken in stride. Physicians today can both prevent and treat the unpleasant symptoms that affect 85 percent to 90 percent of menopausal women.
Beard, on staff at both LDS and Holy Cross Hospitals, said most or all of the autonomic or involuntary symptoms can be relieved with estrogen. Physical and metabolic changes may be slowed by estrogen-replacement therapy.
"But these symptoms will continue to a certain extent. Because many of these changes are due to aging, they cannot be totally blamed upon menopause."
For example, Beard said thinning and wrinkling of the skin will continue but possibly at a slower rate on estrogen-replacement therapy. "Some evidence suggests estrogen has a beneficial effect upon collagen, the connective tissue under the skin. We believe estrogen slows the loss of collagen from the skin and may slow the wrinkling process in the skin."
Beard said unless other causes are present, the psychogenic symptoms related to menopause are also relieved by estrogen-replacement therapy.
But is it for every woman?
In the 1960s and 1970s, the threat of breast and uterine cancer cast a shadow over the use of hormones. Extensive research, however, has now exonerated female sex hormones as a cause of breast cancer. It has also vindicated estrogen when combined with progesterone as a cause of cancer of the uterus.
However, Beard said women who have breast cancers are not good candidates for estrogen replacement therapy. Estrogens do not cause cancer, but may cause it to grow faster.
In the past, women suffering gall bladder and/or liver diseases or blood clots weren't deemed appropriate for the therapy either. That's changed with the use of transdermal estrogen patches, which avoid the first pass through the liver. Estrogens are also available in tablets, vaginal creams and injections.
"If the tissue is not estrogen-dependent, there is no concern," Beard said. "As far as we know, there is no relationship to the development of other forms of cancer and use of estrogen."
Menopause, Beard said, is inevitable - if a woman lives long enough. It occurs between ages of 48 and 52, but symptoms can occur much earlier.
Today only 10-15 percent of women are on estrogen-replacement therapy; the rest are doing nothing to prevent and treat the symptoms and complications of the condition.
Yet in 1986, there were 1.3 million to 1.7 million women nationally who sustained fractures thought to be directly related to osteoporosis, Beard says. Hip fractures are most serious, with 30,000 to 50,000 women dying each year as a direct complication. Another third become physically and socially inactive by being confined at home or in a nursing home.
"This is evidence that menopause is really a social problem as well as a tremendous health problem," she said. "It's a costly one for the elderly - and society."
***** Symptoms of menopause
-Autonomic (involuntary symptoms), including hot flushes and flashes, heart palpitations, increased perspiration, sleep disturbances.
-Physical and metabolic, including changes in the menstrual cycle, breast size, skin thinning and wrinkling, vaginal dryness and bladder dysfunction, loss of bone mass (osteoporosis).
-Psychogenic, including apathy, depression, fatigue, forgetfulness, headaches, irritability, mood changes.