Hormone Replacement Therapy (HRT) - The HeaRT of the Matter

I was getting my hair done a couple years ago at my favorite salon, along with five other women 'of an age', when talk turned to the Change. Most of us were loudly proclaiming our favorite natural remedies and fixes. The woman in the chair adjacent to mine finally spoke up apologizing to the roomful of menopausal goddesses for having “caved”, finally starting HRT (Hormone Replacement Therapy)..

“It's just that I couldn't sleep,” she told us shamefacedly. “I couldn't sleep at all. I was so tired I couldn’t function. And nothing else worked.” We all leapt in to assure her that there was no need to feel guilty. The risk-benefit ratio seemed pretty clear to all of us. Underscored for us was that we women need to support one another through this process rather than judge anyone, including ourselves.

But I have to admit that I was feeling pretty smug and blessed that I was coping without HRT. My symptoms were manageable. What’s that thing they say goeth before a fall? Oh yeah, pride. I no longer have a surplus of that. I eventually ended up on low dose HRT myself. And honestly, I wish I’d taken it sooner.

First welcomed as a godsend, now seen as a terrifying, politically incorrect alternative for menopause symptom relief, HRT may actually be neither. In deciding whether we wish to consider HRT as a viable option, we really need to evaluate our personal risk-benefit analysis. In other words we need to list pros and cons, and then weigh those pros and cons in order of importance.

History of breast or other reproductive cancers in your family would cause you to rate your risk higher. Family history of blood clots, stroke, or heart disease also put you at higher risk. If you have or have had any of these conditions yourself, the risk may be too high and you'll want to look elsewhere for help. And if you are a smoker? HRT is not a great idea for you; your risk of heart attack, stroke and other cardiovascular disease spikes.

On the benefit side, if your hot flashes are 30+ per day, so intense that you are nauseous, or your sleep deprivation from insomnia is making you psychotic, then HRT may be a valuable help in the short term. More risk is associated for all women with long term usage of HRT, so taking it to “get over the hump” may be an option. Above all, do not feel guilty if you decide that the herbal, natural route didn't work for you and you need to avail yourself of HRT. Our own Beej-Venus tried herbs and immediately stopped using them because they “gave me a rush”.

If you should decide to consider HRT as an alternative, be sure to stay aware and re-evaluate periodically whether you might be ready to slowly decrease and ultimately discontinue your hormones. Above all, be gentle with yourself and choose what’s right for you. (Next blog entry, we’ll examine briefly both bioidentical and synthetic hormones. Material partially adapted from our upcoming book -to be released very soon. We’ll keep you posted. For the latest, visit our mothership blog at menopausegoddessblog.org)

Bioidentical Hormone Access Threatened - Act Now

Many women use bioidentical hormones from compounding pharmacies for relief of menopausal symptoms. In fact, so many women are turning to bioidenticals that a significant chunk of the menopausal health care dollar has been diverted from the drug companies.

And now we got trouble - right here in River City. The FDA has told seven compounding pharmacies they may not “make misleading claims” that bioidentical hormones are better than the synthetic ones. The impetus behind this decision? A petition from Wyeth pharmaceuticals - yes the people that brought you Prempro and Premarin, hurtin’ cowboys financially since the WHI study was halted due to dangerous side effects.

Now, technically the FDA may be correct that no double blind research validates that bioidenticals are safer (Gee wonder why that is - maybe no real money to be made, so the research was not funded.) On the main page of the FDA website describing their recent action, they also say this: “All patients who use compounded hormone therapy drugs should discuss menopausal hormone therapy options with their health care provider to determine if compounded drugs are the best option for their specific medical needs.”

Sounds like an appropriate measured response, doesn’t it? Then I dug a little further into the FDA website, and found another little part to their action:

“In addition, FDA warned a number of pharmacies that they may not compound drugs containing the estrogen substance estriol without a valid investigational new drug application. Firms that do not properly address violations identified in Warning Letters risk further enforcement, including injunctions that prevent additional violations and seizure of violative drugs.”

I can tell you from my experience as a nurse that getting an investigational drug permit is a BIG deal. You don’t just go to the wizard and ask for one. Think killing the wicked witch was a difficult task? Try obtaining and implementing an investigational drug protocol from the FDA! I’m not a conspiracy theorist, but I do believe that the FDA is bowing to pressure to limit access to bioidentical hormones and this is only the first step.

Here’s the kicker. It’s not like we can individually call up a compounding pharmacy and order our own hormone therapy willy nilly. A physician MUST prescribe it. And they have been prescribing estriol for decades. Safely. Responsibly. The FDA admits that its action was not a concern for safety. There have been no recorded instances of any adverse effects with the use of Estriol, probably because it is a natural hormone in our body.

There has been a tremendous response from physicians and women like us, filing comments with the FDA and writing our congresspeople. But we need to be vigilant and proactive here. We can’t let the government restrict our (and our physicians) access to bioidentical hormone therapy. For more information, on contacting your elected representatives, download the pdf document at our main blogsite www.menopausegoddessblog.org and/or click on the link below for HOME (Hands Off My Estrogens) Coalition,
www.homecoalition.org

Oh LIbido, Where Art Thou

Oh Libido Where Art Thou?

Some women actually experience increased libido during menopause. If this describes you, skip this part. (And know that the rest of us are so envious of you! Victoria-Venus is an exception, since she is one of you.) Decreased libido is a much more common function of menopause than the converse. It’s not that we don’t want to have sex, it’s that we just don’t think about it. At all. The hormones that stoked the fires have diminished to the point that we’re lucky if we have a pitiful little ember of lascivious desire glowing somewhere deep inside us. Our mates may worry that we no longer care for them or find them attractive. All the Venuses were clear that this was not the case; we still loved our spouses and thought they were empirically attractive. We just didn’t have any drive to act physically on that attraction.

If sex was once 50% mental (or emotional), it seems that now lovemaking is at least 98% governed by our head and heart, rather than our physical sexual organs (at least until things get rolling.) So the Venuses were in agreement that they needed to find ways to stimulate mind and emotions to remind them how much they enjoy intimate physical closeness.
Rae-Venus reads romantic books or watches chick-flicks to get “in the mood.” Then she ‘remembers’ her own passion and is able to fully engage sexually with her husband.

One of our honorary Venuses likes to make sensuality ‘dates’ with her husband to make sure that physical intimacy is shared. It seems to be working well for them in maintaining their sexual connection. Sensual lingerie, candlelit dinners, music, and dancing are all great ways to get in the mood for sexual pleasure. It’s been the experience of each Venus that once physical contact is initiated, the tiny ember of lust she carries within soon blooms into a full blown romantic fire. But you may have to mark it on your calendar, because if you wait for your hormones to signal that it is time for sexual intimacy, it may never happen.
(excerpted from our upcoming book "Venus Comes of Age: The Wit and Wisdom of Menopausal Goddesses")