Skip to Navigation

Menopause (transcript)
Share This:

A NATURAL PART OF AGING CAN LEAVE MANY WOMEN CONFUSED ABOUT HOW TO BE TREATED.  A COMMON THERAPY IS ONE OF THE MOST CONTROVERSIAL MEDICAL ISSUES OF OUR TIME.  COMING UP ON SECOND OPINION, IT’S SOMETHING ALL WOMEN WILL EVENTUALLY FACE.  AND WE’RE ABOUT TO TAKE A LOOK AT THE PROBLEM, AND THE OPTIONS.

 

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING:  THE JOSIAH MACY, JR. FOUNDATION AND THE PARK FOUNDATION.

 

DR. SALGO: WELCOME TO SECOND OPINION WHERE EACH WEEK WE SOLVE A REAL MEDICAL MYSTERY.  WHEN WE CLOSE THIS CASE A HALF AN HOUR FROM NOW, YOU’LL NOT ONLY KNOW THE OUTCOME, BUT YOU’LL ALSO BE BETTER ABLE TO TAKE CHARGE OF YOUR OWN HEALTHCARE.  I’M DR. PETER SALGO AND AS ALWAYS WE HAVE ASSEMBLED A NATIONALLY RECOGNIZED HEALTHCARE TEAM, EXPERTS IN TODAY’S TOPIC.  SOME ARE DOCTORS, SOME ARE NOT, BUT THEIR EXPERIENCE WILL HELP US TACKLED TODAY’S CASE.  NO ONE ON THIS PANEL KNOWS THE CASE EXPECT OF COURSE FOR ELISSA ORLANDO, OUR RESIDENT CIVILIAN.  SHE’S HERE TO GIVE US A REALITY CHECK.  HOW ARE YOU DOING, ELISSA?

 

ORLANDO: GREAT, THANKS PETER.

 

DR. SALGO: ALL RIGHT, WHY DON’T WE GET RIGHT DOWN TO THE CASE?  AND BY THE WAY, THIS IS DR. LOU PAPA, OUR PRIMARY CARE PHYSICIAN.  I ALMOST FORGOT YOU, LOU!

 

DR. PAPA: THAT’S ALL RIGHT, IT HAPPENS. [LAUGHTER]

 

DR. SALGO: I DIDN’T MEAN TO DO THAT.

 

DR. SALGO: LET ME GIVE YOU THE CASE AND WE’LL GET RIGHT INTO IT, ALL RIGHT?  I’M GOING TO TELL YOU ABOUT GLORIA.  GLORIA IS 48 YEARS OLD, SHE’S MARRIED, SHE HAS FOUR CHILDREN, SHE IS AT A WEIGHT THAT SHE CONSIDERS HER TARGET WEIGHT.  SHE’S COMFORTABLE WITH THAT.  SHE’S JUST BEEN LET GOT FROM HER JOB AND SHE’S FEELING A BIT OVERWHELMED.  THERE ARE FAMILY TROUBLES WITH HER CHILDREN AND THERE’S SOME FRICTION WITH HER HUSBAND.  SHE GOES TO HER DOCTOR BECAUSE SHE’S BEEN VERY MOODY LATELY, SHE HASN’T HAD MUCH OF A SEX LIFE.  SHE WANTS TO TALK ABOUT THE POSSIBILITY OF GETTING ON, AS SHE SAYS HERE, ANTI-DEPRESSION DRUGS.  SHE WAS ON ONE A FEW YEARS AGO WHEN HER MOM DIED.  SHE THINKS IT REALLY HELPED HER AT THAT TIME.  HER PERIOD HAS BEEN IRREGULAR, SHE’S BEEN HAVING TROUBLE SLEEPING AND SHE’S BLAMING ALL OF THIS ON STRESS.  LOU, WHAT DO YOU THINK IS WRONG?

 

DR. PAPA: WELL, THERE ARE A COUPLE OF THINGS.  I MEAN, I DO WORRY ABOUT DEPRESSION, ESPECIALLY IF SHE HAS A HISTORY OF IT.  YOU DO HAVE RELAPSES AND SHE DOES HAVE SYMPTOMS THAT MAKE ME CONCERNED ABOUT THAT.  SHE IS ALSO HAVING SOME MENSTRUAL IRREGULARITIES AS WELL, AND SHE IS IN THE AGE GROUP WHERE SHE CAN BE GOING THROUGH MENOPAUSE AS WELL. 

 

DR. SALGO: IS THERE A WAY TO PARSE THAT OUT?  CAN YOU TELL FROM AN OFFICE VISIT?

 

DR. PAPA: IT’S HARD TO TELL, I MEAN, QUITE HONESTLY I DON’T USUALLY SEE THEM AT THAT POINT.  THAT’S USUALLY THE GYNECOLOGIST THAT SEES THEM.  BUT THERE AREN’T REALLY EFFECTIVE WAYS TO REALLY TELL IF YOU’RE GOING THROUGH MENOPAUSE, IF YOU’RE IN THE PROCESS OF GOING THROUGH MENOPAUSE.  THERE’S NO GOLD STANDARD TEST.

 

DR. SALGO: WELL IT’S USUALLY THE GYNECOLOGIST THAT, YOU KNOW, IT JUST SO HAPPENS WE’VE GOT ONE OF THOSE HERE.

 

DR. PAPA:  OH, GOOD! [LAUGHTER]

 

DR. HARTMANN: WELL, I USUALLY SEE THIS TYPE OF INDIVIDUAL AND THIS IS ACTUALLY A FAIRLY COMMON SET OF THINGS THAT ARE GOING ON.  IT’S NOT UNUSUAL FOR A 48-YEAR-OLD WOMAN TO HAVE SOME MENSTRUAL IRREGULARITIES.  AS ONE MIGHT EXPECT, WE KNOW THAT MENOPAUSE IS AFTER AN INDIVIDUAL HAS STOPPED HAVING PERIODS, BUT YOUR BODY GOES THROUGH A PERIOD OF TIME WHERE IT STARTS TO ADJUST TO THAT CHANGE, AND IT STARTS TO HAVE, USUALLY, SOME IRREGULARITIES TO THE PERIODS.

 

DR. SALGO: WELL, COULD WE JUST ASK YOU BEFORE WE EVEN GO INTO THIS ENTIRE AREA OF MENOPAUSE AND THE FINE PRINT, HOW DO YOU DEFINE MENOPAUSE IN THE FIRST PLACE?

 

DR. HARTMANN: THE ACTUAL DEFINITION OF MENOPAUSE IS SOMEONE WHO HAS NOT HAD A MENSTRUAL PERIOD FOR A YEAR. 

 

DR. SALGO: THAT’S IT.

 

DR. HARTMANN: THAT’S IT.

 

DR. SALGO: JUDY NORSIGIAN, I CAN’T TELL YOU HOW PLEASED I AM THAT YOU’RE HERE.  YOU’RE AN ICON.  YOU WROTE “OUR BODIES, OURSELVES” AND…

 

NORSIGIAN: WELL ONE OF MANY WHO DID.

 

DR. SALGO: WELL, YOU’RE VERY MODEST.  WHAT’S IT LIKE ON THE OTHER SIDE OF THE TABLE, THE OTHER SIDE OF THE DESK, FOR A WOMAN TO HEAR THESE WORDS?  IS IT DISTURBING? 

 

NORSIGIAN: IT CAN BE, AND IN FACT A LOT OF WOMEN ARE FEARFUL OF MENOPAUSE IN A WAY THAT IS REALLY TOO BAD BECAUSE IF YOU GO BACK TO EARLY STUDIES WHERE THEY DIDN’T GO TO THE POPULATION OF WOMEN WHO WENT TO THE GYNECOLOGIST’S OFFICE BECAUSE THEY WERE HAVING REAL PROBLEMS WITH HOT FLASHES, BUT YOU JUST DID A POPULATION-BASED STUDY, YOU’D FIND THE VAST MAJORITY OF WOMEN WERE NOT HAVING HORRENDOUS PROBLEMS WITH MENOPAUSE.  SO WE DON’T REALLY NEED TO BE AS FEARFUL AS SOMETIMES WE ARE ABOUT MENOPAUSE.  MOST OF US GO THROUGH WITH A LOT OF HOT FLASHES, HOT SWEATS, WE HAVE SOME DISTURBANCES, BUT WE DON’T HAVE THE SORT OF DIRE PICTURE THAT’S OFTEN PAINTED, YOU KNOW, YOU SHRIVEL UP AND GROW OLD. 

 

DR. SALGO: ELISSA, DOES THIS BOTHER YOU THAT WE HAVEN’T NAILED THE DIAGNOSIS DOWN?

 

ORLANDO:  I’M WONDERING…I HAVE A QUESTION.  WE HAVEN’T NAILED THE DIAGNOSIS, WE DON’T REALLY KNOW WHAT’S GOING ON WITH HER.  SO IF I WALKED IN TO YOUR OFFICE AND YOU TOLD ME THAT WAS ONE OF THE THINGS TO THINK ABOUT, THAT MIGHT BE THE ONLY THING THAT I WOULD THINK ABOUT.  THE OTHER THING I’D ASK JUDY, YOU JUST MENTIONED THAT, YOU KNOW WHAT WE TALKED ABOUT THE SYMPTOMS, COULD ONE CAUSE THE OTHER?  SHE THINKS IT’S STRESS BUT MIGHT IT BE MENOPAUSE AND WE MIGHT THINK IT’S MENOPAUSE BUT MIGHT IT BE STRESS? 

 

DR. HYMAN: THE ANSWER IS YES.

 

NORSIGIAN: YES, AND SOMEONE WHO’S JUST LOST HER JOB, I’M SURE SHE’S FEELING…AND SHE’S NOT GETTING ALONG ALL THAT WELL WITH HER HUSBAND AND SEX IS AN ISSUE.  THESE ARE ALL THINGS IN AND OF THEMSELVES THAT COULD RAISE, YOU KNOW, HACKLES FOR A LOT OF US.

 

SLAGO: HOW DO WE NAIL THIS DOWN?  IS THERE A LAB TEST OR SOMETHING WE CAN GET IN THE DOCTOR’S OFFICE?

 

ORLANDO: CAN YOU CHECK MY LEVELS OF SOMETHING AND FIND OUT YES, YOU’RE IN MENOPAUSE RIGHT NOW CLINICALLY?

 

DR. HYMAN: YOU CAN.  YOU CAN BUT THEY’RE MEANINGLESS BECAUSE MONDAY IT COULD UP, ON TUESDAY IT COULD BE DOWN. 

 

ORLANDO: THAT’S IT?

 

DR. HYMAN: WHATEVER BLOOD TEST YOU MIGHT GET TO LOOK AT MENOPAUSE LIKE SOMETHING CALLED FSH OR LH, WHICH WILL GIVE YOU AN IDEA OF WHETHER OR NOT YOUR BODY THINKS YOUR HORMONES ARE OUT OF BALANCE.  BUT THEY CHANGE FROM MOMENT TO MOMENT.  SO IT’S REALLY THE FLUCTUATING LEVELS OF HORMONES THAT CAN CAUSE ALL THESE SYMPTOMS AND STRESS CAN PRECIPITATE A LOT OF THESE IMBALANCES.  AND THAT’S WHAT’S HAPPENING TO GLORIA. 

 

DR. SALGO: I JUST WANT TO TAKE ONE SMALL MOMENT OVER HERE BECAUSE I WANT TO SUM UP WHERE WE ARE AT THE MOMENT.  I THINK IT’S FAIR TO SAY AND YOU WOULD ALL AGREE, THAT MENOPAUSE IS A NATURAL, BIOLOGIC PROCESS THAT BEGINS WHEN A WOMAN’S BODY STARTS MAKING LESS ESTROGEN AND LESS PROGESTERONE AS A RESULT OF CHANGES IN OVARIAN FUNCTION.  IS THAT ALL FAIR? 

 

DR. HYMAN: I WOULD DISAGREE WITH THAT.

 

DR. SALGO: I GUESS THAT’S NOT FAIR.  TELL ME WHY NOT. [LAUGHTER]

 

DR. HYMAN: BECAUSE I THINK, YOU KNOW, IF WE TAKE THE ASSUMPTION THAT MENOPAUSE IS ESTROGEN DEFICIENCY AND THAT CAUSES THE SYMPTOMS, THEN EVERY GIRL IN KINDERGARTEN SHOULD BE HAVING HOT FLASHES AND YOU AND LOU AND I SHOULD BE HOT FLASHING RIGHT NOW BECAUSE ALL OF OUR ESTROGEN LEVELS ARE LOWER THAN ALL MENOPAUSAL WOMEN.  SO THAT REALLY THE PROBLEM IS THE FLUCTUATING LEVELS OF HORMONES THAT BOUNCE AROUND AND THE THINGS THAT CAUSE MORE OF THOSE LEVELS TO BOUNCE FURTHER IS WHAT CAUSES THE SYMPTOMS. 

 

DR. SALGO: SHE’S GOT ALL OF THESE SYMPTOMS AND I CAN TELL YOU THAT SHE HAS PERHAPS SLEEP DISTURBANCES.  CERTAINLY SHE’S HAD EMOTIONAL CHANGES.  SHE’S GOT DECREASED SEX DRIVE.  BUT ARE ALL OF THESE EXPLICABLE SIMPLY ON THE BASIS OF DECREASED OR FLUCTUATING ESTROGEN?  OR IS ESTROGEN SIMPLY ONE MORE MANIFESTATION OF MENOPAUSE?  WHAT’S THE CHICKEN AND WHAT’S THE EGG OVER HERE?

 

NORSIGIAN: IT ISN’T NECESSARILY THAT YOU’RE GETTING LESS ESTROGEN CIRCULATING, IT’S THE FLUCTUATION. AND THE VASSAL MOTOR SYMPTOMS, YOU KNOW, THAT WOMEN HAVE ARE CLASSIC DURING MENOPAUSE.  SOMETIMES AROUND THE TIME OF MENOPAUSE YOU HAVE ERRATIC AND PROBLEMATIC BLEEDING AND IT MIGHT BE UTERINE CANCER.  YOU HAVE TO RULE THAT OUT.  IT MIGHT BE SOMETHING THAT’S REAL.

 

DR. SALGO: SHE SIMPLY SAYS HER PERIODS ARE IRREGULAR.  AND I WANT TO COME BACK TO THIS QUESTION, IS ESTROGEN THE CAUSE OR IS ESTROGEN THE EFFECT?

 

ORLANDO: WELL I’M HAVING…

 

DR. HYMAN: IS ESTROGEN DEFICIENCY THE CAUSE, OR IS ESTROGEN EXCESS THE CAUSE? 

 

ORLANDO: I DON’T EVEN UNDERSTAND HOW ESTROGEN PLAYS INTO ALL THIS.  BUT I DO HEAR THE WORD ESTROGEN ALL THE TIME WHEN I HEAR ABOUT MENOPAUSE AND THE ONLY OTHER SYMPTOM I EVER HEAR IS HOT FLASHES.  SO THOSE THREE WORDS GO TOGETHER FOR ME: MENOPAUSE, ESTROGEN, HOT FLASHES. 

 

DR. HYMAN: NORMALLY YOUR CYCLES ARE RHYTHMIC…

 

ORLANDO:  RIGHT.

 

DR. HYMAN: …AND THE HORMONES ARE SECRETED EVENLY THROUGHOUT THE MONTH IN A CERTAIN PATTERN AND WHEN THAT PATTERN CHANGES, EVERYTHING GOES AWRY AND YOU EXPERIENCE SYMPTOMS. 

 

DR. SALGO: NOW, DR. HSIA, YOU WERE ONE OF THE PRINCIPLE INVESTIGATORS IN WHAT HAS BECOME A WORLD-FAMOUS STUDY, THE WOMEN’S HEALTH INITIATIVE.  ONE OF THE THINGS YOU WERE LOOKING AT WAS ESTROGEN IN WOMEN.  WAS THAT THE ASSUMPTION, THAT IT WAS ESTROGEN AS THE PRIMARY CAUSE OF ALL THESE SYMPTOMS?

 

DR. HSIA: WELL, I THINK THAT THE WHOLE GROUP HAS RAISED AN IMPORTANT ISSUE THAT YOU DON’T WANT TO JUST BE ATTRIBUTING SYMPTOMS THAT WOMEN HAVE WHILE IN THEIR LATE 40’S AND 50’S TO MENOPAUSE WHEN IT MIGHT BE DUE TO OTHER CAUSES, AND JUST THEREFORE DISMISS THE OPPORTUNITY TO DIAGNOSE CONDITIONS THAT HAVE OTHER SPECIFIC TREATMENTS LIKE UTERINE CANCER, DEPRESSION OR WHATEVER.  SO I THINK IT IS VERY IMPORTANT TO CONSIDER OTHER DIAGNOSES, PARTICULARLY ONES FOR WHICH THERE ARE SPECIFIC TREATMENTS BEFORE GOING ON AND THEN DECIDING THAT THE SYMPTOMS ARE DUE TO MENOPAUSE.

 

DR. SALGO: LET ME TELL YOU WHAT HAPPENED TO GLORIA.  HER DOCTOR DECIDED THAT SHE WAS HAVING MENOPAUSE AND SHE’S SHOCKED. SHE WAS ONLY 48.  SHOULD SHE HAVE BEEN SHOCKED AND IS THAT A NORMAL REACTION? 

 

NORSIGIAN: NOT AT ALL, BUT I MEAN MENOPAUSE CAN START IN HER EARLY 40’S AND THAT ACTUALLY, THE RANGE BETWEEN 40 AND 60 IS REALLY IN THE RANGE OF WHAT IS, YOU KNOW, REASONABLE.  IT’S NOT NECESSARILY DISEASE.

 

DR. SALGO: OK.

 

NORSIGIAN: I STARTED ACTUALLY WHEN I WAS 47.  I STARTED HAVING, YOU KNOW, SLIGHTLY IRREGULAR PERIODS, I STARTED HAVING A HOT FLASH OR TWO.  AND THEY INCREASED OVER TIME. 

 

ORLANDO: THAT DIDN’T UPSET YOU?

 

NORSIGIAN: NO.  ACTUALLY I HAD ANOTHER THING THAT HAPPENED TO ME, WHICH IS MY HUSBAND DIED THE YEAR BEFORE, SO I FIGURED IT COULD BE A COMPLICATED, YOU KNOW, CONSTELLATION OF THINGS GOING ON.   BUT WHAT WAS REALLY IMPORTANT TO ME AT THAT POINT WAS TO THINK ABOUT WAS WHAT CAN I DO TO MAKE THINGS LIKE HOT FLASHES LESS SEVERE?  WHAT CAN I DO TO MAKE MY LIFE MORE COMFORTABLE?  AND THAT’S WHERE I FOCUSED MY ENERGY WAS ON MAKING IT A LITTLE EASIER TO GO THROUGH THIS ALL.

 

DR. SALGO: WELL LET ME TELL YOU WHAT’S IN THE CHART.  HER DOCTOR HAS WRITTEN IN THE CHART, “PATIENT REASSURED THIS IS MENOPAUSE.  NOTHING TO WORRY ABOUT,” AND SENT HOME.

 

DR. PAPA: DOES SHE FEEL ANY BETTER?  I MEAN, I’M CONFUSED HERE.  SHE MAY HAVE MENOPAUSE, AND THERE MAY BE SOMETHING ELSE GOING ON.

 

DR. HYMAN: PART OF THE PROBLEM IS IT’S A STIGMA.

 

ORLANDO: IT IS.

 

DR. HYMAN: YOU KNOW, MENOPAUSE IS CONSIDERED A DISEASE.  IT’S CONSIDERED UNATTRACTIVE TO HAVE.

NORSIGIAN: IT’S A SIGN OF AGE.  

ORLANDO: WELL, YEAH!

DR. HYMAN: WE DON’T HONOR AGING.

 

DR. SALGO: DOESN’T THIS MEAN MY LIFE IS OVER, THAT YOU KNOW, I CAN SEE THAT THE ROAD AHEAD IS SHORTER THAN THE ROAD BEHIND?  ALL OF THESE THINGS.  YOU KNOW?

 

DR. HYMAN: FOR A LOT OF WOMEN, LIFE BEGINS AFTER MENOPAUSE!

 

DR. SALGO: WELL I’LL YOU WHAT HAPPENS.  GLORIA GOES HOME.  AND WHILE SHE’S AT HOME OVER THE ENSUING WEEKS AND MONTHS, GUESS WHAT?  SHE GETS MORE SYMPTOMS.  NOW WHAT’S BOTHERING HER THE MOST ARE THE HOT FLASHES.  OR HOT FLUSHES DEPENDING ON HOW YOU PREFER TO DESCRIBE THEM.

 

DR. HYMAN: OR POWER SURGES.

 

DR. SALGO: I’VE NEVER HEARD POWER SURGES.

 

DR. PAPA: POWER SURGES.  I’VE NEVER HEARD THAT ONE BEFORE! 

 

DR. SALGO: SOMEONE CALLS IT POWER SURGES?  SO SHE TALKS TO HER GIRLFRIENDS, SHE TELLS HER FRIENDS, MOST OF THEM WOMEN, THAT SHE’S IN MENOPAUSE AND HER FRIENDS SAY THAT THEY’RE TAKING HERBAL SUPPLEMENTS, SOME OF THEM.  ANOTHER ONE IS ON HORMONE REPLACEMENT THERAPY.  SO GLORIA GOES TO THE DOCTOR TO ASK ABOUT THE OPTIONS.  AND SHE SAYS, “DOC, WHAT ARE MY OPTIONS?”  AND YOU WOULD SAY TO HER WHAT?

 

DR. HARTMANN: WELL, ONCE AGAIN YOU NEED TO TAKE A BETTER HISTORY TO FIND OUT WHAT IS THE MOST TROUBLING CONCERN AT THIS POINT. 

 

DR. SALGO: WHEN ASKED THAT QUESTION, HER DOCTOR’S NOTES REVEAL WHAT’S REALLY TROUBLING HER ARE THESE HOT FLASHES.  WOULD YOU GIVE HER HT, HORMONE THERAPY, FOR SYMPTOMATIC RELIEF OF THESE SYMPTOMS?

 

DR. HARTMANN: DEPENDING ON HOW UNCOMFORTABLE SHE IS…

 

DR. SALGO: VERY UNCOMFORTABLE.

 

DR. HARTMANN: DEPENDING ON IF SHE’S TRIED OTHER METHODS.

 

DR. SALGO: SHE HAS NOT.  SHE’S IN YOUR OFFICE.  SHE’S HEARD HER FRIENDS HAVE GOTTEN IT.  THIS IS WHAT SHE’S ASKING FOR.

 

DR. HSIA: I THINK THAT YOU KNOW, IT’S NOT JUST A MATTER OF GIVING SOMEBODY A PILL, THAT YOU HAVE TO HAVE A DISCUSSION WITH THEM ABOUT WHAT THE RISKS AND BENEFITS ARE ASSOCIATED WITH IT.      

 

DR. HYMAN: I ALWAYS START OUT BY TELLING HER THERE ARE CHOICES.  THAT NUMBER ONE, YOU DON’T HAVE TO SUFFER.  NO ONE SHOULD HAVE TO SUFFER, NO WOMAN SHOULD HAVE TO SUFFER ANY SYMPTOMS OF MENOPAUSE BECAUSE THERE ARE GOOD TREATMENTS WHETHER THEY ARE LIFESTYLE CHANGES, ALTERNATIVE TREATMENTS, OR HORMONE THERAPY IF NEEDED, WHICH SHOULD BE IN THE LOWEST DOSE FOR THE SHORTEST AMOUNT OF TIME IN THE RIGHT APPLICATION TO MEET THOSE SYMPTOM NEEDS.

 

DR. SALGO: WELL IT JUST TURNS OUT WE’VE GOT THE WORLD EXPERT ON HORMONE REPLACEMENT.

 

DR. HSIA: THAT’S FLATTERING OF YOU TO SAY THAT.

 

DR. SALGO: BUT TO PUT THIS IN PERSPECTIVE, YOU WERE—GO AHEAD.

 

DR. HSIA: WHEN THE WOMEN’S HEALTH INITIATIVE WAS STOPPED EARLY BECAUSE OF EXCESS RISK OF 40% INCREASE RISK OF STROKE, A 26% INCREASE RISK OF HEART ATTACK, A 24% INCREASE RISK OF BREAST CANCER, AND DOUBLE THE RATE OF DEMENTIA ASSOCIATED WITH TAKING HORMONES, ALL THE INVESTIGATORS WHO WERE TAKING HORMONES AT THAT TIME STOPPED THEIR PILLS IMMEDIATELY.  AND THERE WAS A LOT OF DISCUSSION ON THE CONFERENCE CALLS ABOUT THEIR SYMPTOMS AND WHAT THEY WERE DOING ABOUT THEM, AND THE DRESSING IN LAYERS CAME UP, THE GEL PACKS THAT YOU KEEP IN THE REFRIGERATOR THAT YOU SLAP ON YOUR NECK AT NIGHT, THE THERMOS OF ICE WATER BY THE BEDSIDE, SOMEBODY ACTUALLY BOUGHT A LITTLE REFRIGERATOR AND PUT IT IN THEIR BEDROOM SO THERE COULD KEEP COLD STUFF IN THERE, SO THERE ARE A LOT OF THINGS THAT YOU CAN DO.

 

DR. SALGO: SO, ONCE AGAIN, THIS IS THE STUDY YOU’RE TALKING ABOUT, THE WOMEN’S HEALTH INITIATIVE, OF WHICH YOU WERE ONE OF THE PRINCIPLE MOVERS AND SHAKERS, THIS GOT A LOT OF PRESS.

 

ORLANDO: I MEAN, I KNOW HORMONE REPLACEMENT THERAPY, HORMONE THERAPY IS THE THERAPY THAT CAUSES BREAST CANCER.  THAT’S WHAT WE HEAR ABOUT IT.

 

DR. HSIA: THERE ARE TWO DIFFERENT STUDIES.  ONE IS THE STUDY ON WOMEN WITH A UTERUS, WHERE THERE WERE 16,608 HEROIC WOMEN WHO EITHER TOOK COMBINATION ESTROGEN WITH PROGESTERONE OR IDENTICAL-APPEARING PILLS THAT HAD NO ACTIVITY, AND THEY DID NOT KNOW WHAT THEY WERE GETTING.  THEY WERE FOLLOWED FOR ABOUT 5 YEARS AND THE STUDY WAS STOPPED EARLY BECAUSE OF RISKS.  THEY HAD AN EXCESS RISK OF HEART ATTACK, STROKE, BREAST CANCER AND DOUBLE THE RATE OF DEMENTIA.  THE BENEFITS THAT WERE ASSOCIATED WITH TREATMENT WERE THAT THEY HAD LESS FRACTURE, SO IT WAS GOOD FOR BONE, AND THEY ACTUALLY HAD LESS COLON CANCER, WHICH WAS SOMEWHAT UNEXPECTED.  THE STUDY DOES NOT SAY YOU SHOULD OR YOU SHOULD NOT TAKE HORMONES.  WHAT IT SAYS IS THESE ARE THE RISKS AND THE BENEFITS, INDIVIDUALIZED DECISIONS SHOULD BE MADE BETWEEN HEALTH CARE PROVIDERS AND THEIR PATIENTS.

 

DR. HYMAN: BUT THE RECOMMENDATIONS ARE TO NOT TAKE IT TO PREVENT HEART DISEASE, TO NOT TAKE IT TO PREVENT…

 

DR. HSIA: IT CLEARLY IS OF NO BENEFIT FOR PREVENTING HEART DISEASE. 

 

DR. HYMAN: BEFORE IT WAS RECOMMENDED TO PROTECT YOU.

 

DR. HSIA: RIGHT.  IT CLEARLY IS OF NO BENEFIT FOR PREVENTING HEART DISEASE.

 

DR. HYMAN: THAT’S A HUGE CHANGE.

 

NORSIGIAN: BUT ACTUALLY YOU’RE GETTING TO ONE OF THE REASONS WHY WOMEN TEND TO BE VERY UPSET RIGHT NOW WITH THIS WHOLE SPHERE, BECAUSE MANY WOMEN BEGAN TO TAKE ESTROGEN SIMPLY FOR PREVENTING HEART DISEASE (ABSOLUTELY) AND NOW THEY HAVE A TRUST PROBLEM.  AND THERE WERE GYNECOLOGISTS AND THERE WERE PRIMARY CARE PRACTITIONERS WHO SAID, “WE DON’T HAVE THE FINAL DATA IN.  LET’S WAIT FOR THE RESULTS.”  AND THEY WERE HOLDING OFF ON GIVING THESE DRUGS FOR HEART DISEASE.

 

DR. PAPA: IN PRIMARY CARE, IT’S USUALLY IF I GOT A PHONE CALL, I KNOW THE GYNECOLOGIST GOT TEN.  BUT IT BLEW ME OUT OF THE WATER ALSO BECAUSE THE CONSENSUS WAS THAT ESTROGEN WAS NO GOOD.  AND THERE WAS A LOT OF OBSERVATIONAL-BASED STUDIES KIND OF STEPPING BACK AND LOOKING AT NOT DOING IT IN A REAL SCIENTIFIC WAY THAT SAID, “LOOKS LIKE IT’S GOOD.”  SO THIS REALLY ALTERED NOT JUST THE PATIENTS’ PERCEPTION BUT DOCS HAD PROBLEMS WITH IT AS WELL.  SO THEY’RE AFRAID TO EVEN GO NEAR ESTROGENS.

 

ORLANDO: WHY PUT IT IN YOUR BODY TO BEGIN WITH?  CAN’T YOU JUST TOUGH IT THROUGH THESE SYMPTOMS?  I KNOW MY MOTHER DID.

 

NORSIGIAN: BUT IT’S NOT ALWAYS THAT EASY.  THERE ARE WOMEN WHO…AND THEY GO THROUGH A FEW WEEKS, A FEW MONTHS, YOU KNOW, I HAD SOME HOT FLASHES.  I DIDN’T, YOU KNOW, DRENCH MY SHEETS AT NIGHT LIKE MY MOTHER DID.  THAT’S ACTUALLY…THAT WAS IN MY MIND.  OH GOD, AM I GOING TO WAKE UP AND HAVE TO CHANGE THE BED?  IT WASN’T SO BAD.  BUT OTHER WOMEN THEY CAN’T WORK. YES, THEY TAKE OFF THEIR CLOTHES.  THEY BRING FANS TO WORK.  THEY OPEN THE WINDOWS.  THEY JOKE ABOUT.  BUT THEY CAN’T FOCUS BECAUSE THEY’RE ACTUALLY HAVING SUCH A HEAT WAVE INTERNALLY THAT THEIR WORK IS DISRUPTED.  THEY NEED SOMETHING STRONGER.  THEY’RE NOT GOING TO TOUGH IT OUT BECAUSE SOME OF THESE WOMEN GO MONTHS AND MONTHS WITHOUT A CHANGE.

 

DR. HYMAN: IT’S LIKE YOU SAID.  THERE’S MOOD PROBLEMS, THERE’S COGNITIVE PROBLEMS, THEY CAN’T THINK AND REMEMBER AND THESE ARE…

 

NORSIGIAN: IT’S NOT THE MAJORITY, BUT IT’S SOME WOMEN. 

 

DR. SALGO: LET ME BACK THIS UP FOR A MOMENT BECAUSE GLORIA’S STILL SITTING IN HER DOCTOR’S OFFICE LOOKING FOR HELP, AND IF YOU DON’T WANT TO GIVE HER ESTROGEN PER SE, SHE’S GOING TO ASK YOU, SHE DID ASK, ABOUT SYNTHETIC ESTROGENS, OTHER OPTIONS.  SYNTHETIC ESTROGENS, NATURAL ESTROGENS, PHYTOESTROGENS.  WHAT THE HECK IS SHE ASKING ABOUT? 

 

DR. HARTMANN: WELL, THERE ARE CERTAIN TYPES OF ESTROGENS LIKE SOY PRODUCTS THAT YOU CAN USE AND SOMETIMES WILL HELP HOT FLUSHES.  AND THE STUDIES THAT ACTUALLY HAVE BEEN DONE, THEY ARE NOT OVERWHELMINGLY SUPPORTIVE OF SOY BEING THE ANSWER REGARDING TREATING HOT FLUSHES.

 

DR. SALGO: SO THE JURY’S STILL OUT? 

 

DR. HARTMANN: JURY’S STILL OUT. 

 

NORSIGIAN: WE DO HAVE SOME DATA THAT ABOUT SIX MONTHS OF USE IS SAFE WITH THINGS THAT WORK FOR SOME WOMEN, NOT FOR OTHERS, YOU KNOW, BLACK COHOSH…

 

DR. SALGO: I WANT TO GET TO THAT.

 

NORSIGIAN: …AND THOSE KINDS OF THINGS.  NO, BUT EVEN SOME OF THE NUTRACEUTICAL PRODUCTS THAT ARE OUT THERE.  BUT IT’S NOT CLEAR THAT THEY REALLY…THAT THEY’RE GOING TO WORK FOR MOST PEOPLE. 

 

DR. SALGO: WELL NEXT YEAR ISN’T HELPING OUR FRIEND RIGHT NOW.  MARK HYMAN, THIS IS YOUR—WHY DON’T YOU ENLIGHTEN US ON SOME OF THESE THINGS?

 

DR. HYMAN: AND I’M JUST CHOMPING AT THE BIT HERE BECAUSE I THINK WE’RE MISSING THE POINT, WHICH IS THAT THERE ARE CAUSES FOR HOT FLASHES, THERE ARE CAUSES FOR HORMONAL IMBALANCE AND NOBODY IS TALKING ABOUT.  LIKE SMOKING, LIKE ALCOHOL, LIKE CAFFEINE, LIKE STRESS, LIKE HIGH-SUGAR DIET, LIKE A HIGH-JUNK FOOD DIET.

 

DR. HSIA: SEDENTARY LIFESTYLE.

 

DR. HYMAN: AND LACK OF EXERCISE.  YOU KNOW, ALL THOSE THINGS ARE PRECIPITANTS OF WORSE SYMPTOMS.  SO IF YOU DEAL WITH THOSE, THEY’LL GET BETTER.  AND IF THAT DOESN’T WORK, THEN THERE ARE ALTERNATIVES. 

 

DR. SALGO: LET ME RUN SOME OF THESE BY YOU IF I MAY.  SHE ASKS ABOUT ST. JOHN’S WORT, BLACK COHOSH, CHASTEBERRY, EVENING PRIMROSE, DON QUAI AND VALERIAN ROOT.  THIS IS YOUR AREA…

 

DR. HYMAN: YES, YES, SOME OF THEM HAVE BEEN STUDIED AND FOUND NOT TO BE EFFECTIVE, ACTUALLY. 

 

DR. SALGO: DO YOU LIKE ANY OF THEM?

 

DR. HYMAN: DO I LIKE ANY OF THEM?  PERSONALLY I HAVEN’T HAD MY HOT FLASHES REDUCED BY THEM.  [LAUGHTER]

 

DR. SALGO: AS A PHYSICIAN DO YOU…?

 

DR. HYMAN: I DO USE COMBINATIONS OF HORMONES TO TREAT SYMPTOMS THAT ARE EFFECTIVE.  AND I WOULD SAY NINE TIMES OUT OF TEN TIMES I DON’T EVER NEED TO USE ESTROGEN OR PROGESTERONE TO TREAT SYMPTOMS AND GET EFFECTIVE BENEFIT.  AND I CAN USE DIET, LIFESTYLE, EXERCISE, STRESS REDUCTION TECHNIQUES AND HERBS AND VITAMINS AND MINERALS, MAGNESIUM, B6, AND A NUMBER OF OTHER THINGS, VITAMIN E, THAT ALL HAVE BENEFIT.  THEY’RE NOT MIRACLE CURES.  THEY DON’T WORK FOR EVERYBODY.  BUT THEY…

 

DR. HSIA: IT DOES SOUND LIKE A LOT MORE WORK AND TROUBLE THAN THE PILL.

 

DR. HYMAN: IT IS!  ABSOLUTELY.

 

DR. SALGO: I WANT TO SUM UP A LITTLE BIT OF WHAT WE’VE BEEN DISCUSSING. THERE ARE SEVERAL THINGS THAT YOU CAN DO TO ALLEVIATE THE PHYSICAL, THE EMOTIONAL AND THE BIOLOGICAL SYMPTOMS OF MENOPAUSE AND THESE INCLUDE HORMONE THERAPY.  IF ESTROGEN IS NOT AN OPTION FOR YOU, THERE ARE OTHER OPTIONS INCLUDING HERBAL SUPPLEMENTS, FOR EXAMPLE, A WHOLE LIST OF WHICH HAVE REALLY BEEN LOOKED AT.  NOT ALL OF THEM I WOULD THINK EVEN FOR YOU HAVE BEEN LOOKED AS SATISFACTORILY. 

 

NORSIGIAN: THAT’S WHAT OUR FEDERAL GOVERNMENT IS DOING RIGHT NOW, TRYING TO LOOK AT SOME OF THEM IN A MUCH MORE BALANCED WAY.

 

ORLANDO: HOW DO YOU GET THOSE?  CAN YOU JUST GO AND BUY THEM IN A HEALTH STORE?

 

DR. HYMAN: YOU CAN BUY THEM IN A HEALTH FOOD STORE.  BUT I WOULD SUGGEST WORKING WITH A PRACTITIONER WHO KNOW HOW TO TREAT PEOPLE WITH THOSE PRODUCTS.

 

DR. SALGO: WELL, WOULD YOU LIKE TO KNOW WHAT GLORIA DECIDES TO DO?

 

NORSIGIAN: OH SURE.

 

DR. SALGO: DO YOU WANT TO GUESS WHAT GLORIA DECIDES TO DO?

 

DR. HSIA: SHE WANTS HORMONE REPLACEMENT.

 

DR. SALGO: SHE WANTS ESTROGEN. 

 

DR. HSIA: RIGHT. 

 

DR. SALGO: SO, SHE DECIDES TO…

 

DR. HARTMANN: AND I THINK WE KEEP DANCING AROUND THIS ISSUE.  I ABSOLUTELY AGREE WITH EVERYONE THAT EVERYTHING THAT YOU CAN DO IN A GENERAL HEALTH, NATURAL KIND OF WAY TO ALTER YOUR LIFESTYLE, TO STOP SMOKING, TO WATCH ALCOHOL INTAKE.  IF YOU CAN GET AWAY WITH THOSE CHANGES, WHICH ARE ABSOLUTELY POSITIVE NOT ONLY FOR THESE SYMPTOMS BUT FOR THE REST OF YOUR HEALTH, AND DECREASE YOUR HOT FLUSHES AND OTHER THINGS THAT MIGHT BE DISTURBING YOU, THAT’S ABSOLUTELY THE BEST WAY TO GO.  HOWEVER, THERE ARE SOME WOMEN WHERE YOU COME TO A POINT THAT THEY TRULY HAVE GIVEN A TRY TO ALL OF THESE THINGS AND THEY ARE STILL MISERABLE.  AND IF YOU’RE GOING TO PICK ONE THING THAT RELIABLY WILL HIT SOME OF THESE SYMPTOMS, MAINLY THE HOT FLUSHES, IT’S ESTROGEN. SO SOME PEOPLE NEED IT.

 

DR. SALGO: WELL GLORIA’S DOCTOR WROTE A VERY CAREFUL NOTE IN WHICH SHE SAYS IN LANGUAGE WHICH IS FAMILIAR TO MANY CLINICIANS, “HAVE HAD DETAILED DISCUSSION WITH PATIENT BOTH PRO AND CON ABOUT THE RISKS AND BENEFITS,” I’M SURE SHE’S GOT A LAWYER SOMEWHERE WHO TOLD HER HOW TO WORD THIS, “ABOUT ESTROGENS, AND PATIENT WANTS TO TAKE ESTROGENS AND TOGETHER WE HAVE DECIDED TO TRY THIS.”  SO SHE GOES ON ESTROGENS.  WHAT DOES THIS OBLIGATE HER TO NOW?  HOW DOES HER LIFE CHANGE NOW THAT SHE’S TAKING ESTROGEN?

 

DR. HARTMANN: SHE WILL FEEL SO MUCH BETTER.

 

DR. SALGO: OKAY.

 

ORLANDO: DOES SHE HAVE TO BE FOLLOWED UP THOUGH?  I MEAN I WOULD THINK YOU’D HAVE TO LOOK AT HER RISK ALL THE TIME NOW DEPENDING ON HOW LONG SHE’S ON IT. 

 

DR. HARTMANN: TYPICALLY IF THE MAIN SYMPTOMS HAVE BEEN HOT FLUSHES, THEN THEY REALLY WILL FEEL BETTER WHEN THEY GO ON ESTROGEN.  AND IF IT’S BEEN WAKING THEM UP AT NIGHT FROM SLEEP ISSUES, THEY WILL SLEEP MUCH BETTER.  AND AS YOU MENTIONED BEFORE, ONCE YOU SLEEP BETTER, MOOD IS BETTER.  AND SO OFTENTIMES WOMEN REALLY WILL HAVE A VERY POSITIVE RESPONSE. GIVEN WHAT WE KNOW NOW, AND I THINK IT’S DIFFERENT THAN WHAT WE HAVE DONE IN THE PAST, WE USE THE LOWEST DOSE, AND THE SHORTEST PERIOD OF TIME ISSUE.  PEOPLE ASK, “WELL, HOW LONG IS THAT?”  IT DEPENDS ON THE WOMAN’S AGE.  SO IF SHE IS ON THE YOUNGER SIDE THEN THE CHANCES OF HER NEEDING IT FOR A LITTLE BIT LONGER PERIOD OF TIME MIGHT BE A LITTLE BIT HIGHER. 

 

DR. HSIA: SO WOULD YOU TRY TO TAPER AFTER 6 MONTHS OR A YEAR?  IS THAT WHAT YOU DO? 

 

DR. HARTMANN: I PROBABLY, DEPENDING ON HOW SIGNIFICANT THE SYMPTOMS ARE, I’D PROBABLY GIVE IT AT LEAST A YEAR. CERTAINLY I WOULD SEE HER IN ABOUT THREE OR FOUR MONTHS TO SEE IF THESE THINGS ARE HELPING.   BUT I WOULD HAVE HER CALL ME IN BETWEEN.  IF ESTROGEN IS GOING TO WORK AT THE DOSAGE THAT YOU PICK, IT USUALLY WORKS WITHIN THE FIRST ONE TO TWO MONTHS. 

 

DR. HSIA: AS FAR AS THE DURATION IS CONCERNED, ON THE ONE HAND IN THE WOMEN’S HEALTH INITIATIVE, THE RISK OF BREAST CANCER INCREASED THE LONGER YOUR EXPOSURE WAS.  WHEREAS ON THE OTHER HAND, AS FAR AS HEART ATTACK AND CORONARY DEATH WAS CONCERNED, THE GREATEST RISK WAS IN THE FIRST YEAR, SO THEN IN THE FIRST YEAR ON TREATMENT THERE WAS AN 81% INCREASE RISK WITH THE HORMONE WOMEN COMPARED WITH THE PLACEBO GROUP.  SO IT’S…I MEAN, I’M IN FULL AGREEMENT WITH THE FDA STATEMENT THAT PEOPLE SHOULD BE TREATED WITH THE LOWEST DOES FOR THE SHORTEST TIME, BUT THAT IS NOT AN ASSURANCE OF SAFETY. 

 

ORLANDO: YOU SHOULD STAY ON IT, CONTINUOUSLY?

 

DR. PAPA: BECAUSE WE THOUGHT IT WAS GOOD FOR YOU.  WE THOUGHT IT WOULD REDUCE YOUR RISK FOR HEART ATTACKS, WE THOUGHT IT WOULD REDUCE YOUR RISK FOR DYING FROM HEART ATTACK.

 

DR. HSIA: THAT IS A BIG CHANGE.

 

DR. HARTMANN: WE KNOW THAT IT HELPS HOT FLUSHES.  THE OTHER THING THAT IT DOES DO IS HELP PROTECT BONE LOSS. AND THE THIRD THING THAT ESTROGEN DOES DO IS PROVIDE FOR VAGINAL HEALTH.  AND WOMEN WILL OFTEN EXPRESS, OR START TO EXPERIENCE VAGINAL DRYNESS AROUND THIS PERIOD OF TIME.  AND SO THE OTHER THING THAT WE NEED TO TALK TO OUR PATIENTS ABOUT, BECAUSE THIS CAN AFFECT SEXUAL ACTIVITY, IS EVEN IF THEY’RE NOT TAKING SYSTEMIC ORAL ESTROGEN OR PATCH ESTROGEN, WE OFTEN WILL PRESCRIBE GELS OR CREAMS LOCALLY OR VAGINALLY TO TRY TO MAINTAIN GOOD TISSUE, YOUR GENITAL TISSUE.

 

DR. SALGO: LET’S PAUSE FOR JUST A MINUTE HERE BECAUSE I WANT TO MAKE THE POINT, AND I’VE BEEN TAKING IN WHAT YOU’VE BEEN TELLING ME.  IT’S TOUGH FOR ME AS A GUY TO GIVE ADVICE TO WOMEN GOING THROUGH THIS.  I WILL NEVER GO THROUGH THIS.  BUT IF I HEAR YOU CORRECTLY, WHAT YOU’RE SAYING IS THAT LIFE IS NOT OVER WITH THE ONSET OF MENOPAUSE.  IT’S A NATURAL EVENT.  IT CAN BE A GOOD TIME OF LIFE IF YOU TAKE CARE OF YOURSELF AND IT DOESN’T HAVE TO BE A TERRIBLE TIME OF LIFE.  HOW’D I DO ON THAT?  DID I GET THAT RIGHT?

 

DR. HYMAN: ABSOLUTELY.

 

ORLANDO: WELL YOU DON’T HAVE TO WORRY ABOUT YOUR PERIOD ANY MORE.  I MEAN THAT’S GOT TO BE AN UPSIDE, RIGHT?

 

NORSIGIAN: ACTUALLY SOME WOMEN SAY THAT EVEN THOUGH THERE’S, YOU KNOW, THEY REPORT LOSS OF LIBIDO, NOT AS MUCH SEX DRIVE, OTHER WOMEN FEEL A KIND OF RELEASE AND THEY REPORT A BETTER SEX LIFE.  AND THERE IS A “USE IT OR LOSE IT” PHENOMENON HERE.  AND YOU DON’T HAVE TO USE ESTROGEN TO KEEP, YOU KNOW, YOUR VAGINAL TISSUES LUBRICATED.  THERE ARE OTHER PRODUCTS ON THE MARKET THAT ARE QUITE EFFECTIVE.  AND IT’S A TIME OF EXPLORATION FOR A LOT OF WOMEN AND THEY ACTUALLY FIND THAT THEIR SEX LIVES GET BETTER. 

 

DR. HYMAN: THERE ARE A LOT OF LITTLE TRICKS YOU CAN USE TO HELP INCREASE LIBIDO AND SEXUAL RESPONSE AND THINGS THAT I FOUND IN MY PRACTICE WORK REALLY WELL.

 

DR. SALGO: GIVE US AN EXAMPLE.

 

DR. HYMAN: WELL THERE ARE TWO THINGS.  ONE IS ACTUALLY LOCAL TESTOSTERONE DROPS THAT GO RIGHT ON THE CLITORIS, TWO DROPS EVERY NIGHT.  IT WORKS WONDERS BECAUSE I GET CALLS FOR REFILLS ALL THE TIME.  [LAUGHTER]  AND THERE ARE OTHER CREAMS THAT ARE MORE NATURAL, CONTAINING ARGININE, WHICH IS A VASODILATOR, OPENS UP THE BLOOD VESSELS, CONTAINS SOME HERBS, VARIOUS COMPOUNDS THAT ACTUALLY HELP INCREASE CIRCULATION AND INCREASE RESPONSE.  AND I KNOW THAT WORKS BECAUSE MY WIFE SAYS SHE LIKES IT. [LAUGHTER]

 

DR. SALGO: I’M NOT GOING TO GO ANY FURTHER ON THIS.  WE’VE HAD JUST ABOUT ENOUGH AND NOT TOO MUCH INFORMATION. [LAUGHTER]

 

NORSIGIAN: EXCEPT THAT TESTOSTERONE HASN’T BEEN ADEQUATELY STUDIED.

 

DR. SALGO: OH, YOU DON’T LIKE THAT TESTOSTERONE?

 

DR. HARTMANN:  NO, NO, NOT AT ALL.  I MEAN, YES, WE USE TESTOSTERONE, I USE IT IN CERTAIN SITUATIONS, BUT THIS IS NOT FDA APPROVED FOR THAT USE AT ALL.  REMEMBER THAT TESTOSTERONE IS METABOLIZED TO ESTROGEN FROM A BIOCHEMICAL KIND OF WAY, AND WE HAVE NO IDEA THE SAFETY OR THE TRUE EFFICACY OF, YOU KNOW, WHAT YOU’RE DESCRIBING.  I MEAN, YOU MAY SAY ANYTHING PLACED IN THAT AREA EVERY NIGHT IS GOING TO DRAW SOME ATTENTION TO IT AND THAT’S GOING TO INCREASE YOUR DESIRE TO HAVE SEX.

 

DR. SALGO: IN THE LITTLE TIME WE HAVE LEFT, LET ME TELL YOU WHAT HAPPENS WITH GLORIA.  GLORIA IS FEELING BETTER, SHE’S ON THE ESTROGENS.  SHE GOES HOME AND SHE TELLS HER MOTHER-IN-LAW, YOU KNOW, THE MOTHER OF THE MAN OF WHOM SHE WAS HAVING SOME PROBLEMS, ABOUT THE THERAPY THAT SHE’S ON AND HER MOTHER-IN-LAW REACTS BY SAYING, “WHAT’S THE BIG DEAL? I GOT THROUGH IT JUST FINE!” SAYS HER MOTHER-IN-LAW, “WHY DO YOU NEED DRUGS?”  IS THERE A GENERATIONAL GAP HERE?  I MEAN, IS SHE JUST WEAK?  ARE OLDER WOMEN GOING TO LOOK ASKANCE AT YOUNGER WOMEN WHO ARE TAKING THIS ROUTE? 

 

DR. HARTMANN: EVERY WOMAN’S DIFFERENT.  SO THE MOTHER-IN-LAW COULD’VE BEEN ONE OF THOSE INDIVIDUALS THAT BREEZED THROUGH MENOPAUSE, HAD VERY LITTLE SYMPTOMS, FELT FINE AND THIS DIDN’T HAVE AN IMPACT ON HER LIFE. 

 

DR. PAPA: OR SHE WAS THE ONE WHO HAD A TERRIBLE TIME WHO’S KIND OF TICKED OFF THAT SHE’S GETTING SOMETHING THAT WORKED AND SHE DIDN’T HAVE THE OPPORTUNITY FOR SOMETHING LIKE THAT. 

DR. HARTMANN: AND COULDN’T TALK ABOUT IT.  ABSOLUTELY!

 

DR. PAPA: BUT IT’S A GOOD EXAMPLE OF EVEN THROUGH THERE’S ALL THESE DIFFERENCES, IT REALLY BOILS DOWN TO WHAT GOES ON IN THAT ROOM WITH THE DOCTOR WITH THAT INDIVIDUAL PATIENT.  IT HAS TO BE INDIVIDUALIZED.  AND EVERY PATIENT’S GOING TO EXPERIENCE IT DIFFERENTLY WHERE IF I AS A PATIENT ABOUT MENOPAUSE AND THEY GO, “PFFT”, YOU KNOW, “IT WAS A BREEZE.”  AND THE NEXT ONE GOING TO HAVE A HORRENDOUS TIME WITH IT.  AND IT’S BEING ABLE TO MEASURE OUT THE RISKS.

 

DR. SALGO: YOU KNOW, WE’VE COVERED A LOT OF GROUND TODAY.  LET ME GO OVER SOME OF THE TOPICS THAT WE WERE SUMMARIZING WHAT WE COVERED HERE.  MENOPAUSE IS A NATURAL BIOLOGICAL PROCESS THAT DOES BEGIN WHEN YOUR BODY STARTS MAKING LESS ESTROGEN, LESS PROGESTERONE, AS A RESULT OF CHANGES IN OVARIAN FUNCTION.  AND WE ARE NOT SAYING THAT ESTROGEN IS THE ONLY CAUSE OF ALL OF THIS, IT MAY BE AN EFFECT OF WHAT’S GOING ON.  THERE ARE THINGS THAT YOU CAN DO TO ALLEVIATE THE PHYSICAL, THE EMOTIONAL, THE BIOLOGICAL SYMPTOMS OF MENOPAUSE.  AND THESE DO INCLUDE HORMONE REPLACEMENT.  IF ESTROGEN IS NOT AN OPTION FOR YOU, THERE OTHER ALTERNATIVES, INCLUDING HERBAL SUPPLEMENTS THAT WE DISCUSSED.  AND LIFE IS CERTAINLY NOT OVER WITH THE ONSET OF MENOPAUSE.  IT IS AN NATURAL EVENT AND CAN BE A GOOD TIME OF LIFE IF YOU TAKE CARE OF YOURSELF.  YOU KNOW, YOU’VE JUST BEEN TERRIFIC.  WE COULD GO ON FOREVER AND SUSPECT THAT WHEN THE LIGHTS ARE DOWN, WE WILL.  BUT THAT IS ALL THE TIME THAT WE HAVE FOR NOW.  OUR FINAL MESSAGE IS QUITE SIMPLY THIS: TAKING CHARGE OF YOU HEALTH MEANS BEING INFORMED AND HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR.  I’M DR. PETER SALGO AND I’LL SEE YOU NEXT TIME FOR ANOTHER SECOND OPINION.  

 

SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE.  THE ADDRESS IS PBS.ORG.

 

MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION.  THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING:  THE JOSIAH MACY, JR. FOUNDATION AND THE PARK FOUNDATION.