Wednesday, September 9, 2009

Menopause...... the mystery of it all

Menopause, and it's sister perimenopause, has always been a secret process that sneaks up on women without any warning and throws many into a world of complete dissarray. I too found the whole process quite disturbing and a complete surprise as I was barely in my 40's!

I had a partial hysterectomy (only uterus removed) when I was only 37 and very shortly after I started developing some trouble staying awake all day, I couldn't loose the weight from my last child who was already 4 years old and I felt so sluggish. I then found out my thyroid was not functioning properly (very common problem). Once this was straightened out I started feeling so much better. I felt like the light was finally turned on and I was back on track. Then about 2 years later I gained weight, my cholesterol went wacko, I started having these horrendous headaches which were diagnosed as migraines. With this new found problem I felt like I was falling apart! Turn 40 and everything quits working.

About a year later I felt angry all the time, I gained 10 pounds in about 4-5 months, and my hot flashes got so bad I had some labs done to see if I was in menopause or not (since I didn't have a uterus I hadn't had a period in years so I had NO idea if I was having irregular periods or not). It was inconclusive at one point so I went back to my PCP and had my thyroid checked again and sure enough it was off kilter. So, we upped my medication and I felt a little better. Not long after this I started having a lot of trouble sleeping at night, I woke up constantly - sometimes sweating and sometimes just woke up! I was mad all the time, my temper flared for no reason at all and I had no idea what was going on. I had heart palpatations and I felt depressed. I was recently married and I didn't want to scare off my sweetheart. Since I couldn't figure out what was going on I tried a new medical provider and she tried me on several anti-depressants, sleeping pills, and Xanax as needed and sent me to have a sleep study done. I am not fond of taking so much medication as I rather fix the problem and not mask it. Well, the sleep study showed I was not have any apnea and my sleep was disrupted some but overall the study showed no problems. Ok, once again, I felt like I was going crazy. I quit taking the sleep medication and I only took the xanax if I was feeling completely ugly - I wanted to keep my husband and I felt this was more for him than me!

I also started developing horrible pains and some swelling in my hip, finger joints, wrists, and wherever it decided to flare up. I felt like a cripple. I started seeing an endocrinologist and he started me on some medication that helped a lot. Then my liver started having problems with the medication and I had to take a short break. The pain came right back! Well, this MD took a sudden leave of absence and I had to find another one... ughh! I found a great endocrinologist and he worked me up again to try and figure out what was going on. Nothing came up positive, but one MRI showed something that looked like a type of spondylosis type arthritis ( we ruled out lupus, Lyme disease and other autoimmune problems)....... hmmm - What else could go wrong? We have tried several medications, all of which require labs every 6 weeks to be sure my liver function is still good as these medications are cleared through the liver and can cause problems if not watched closely. I tried to tell my endocrinologist about all my other problems and he too was puzzled and unfortunately they weren't in his field of practice.... so more labs to be sure there wasn't some hidden reason and those were all fine. At least I wasn't dying, but I wanted to understand what was happening. Being a Nurse Practitioner I was always trying to self diagnose - not a good idea.

I tried to keep working out, but didn't do anything on a regular basis and couldn't revive my motivation.

Well, my hot flashes got worse and worse - I would sweat profusely while seeing my patients and my face would get all flushed - this was not acceptable to me! I finally had enough of all this and went to my PCP and asked, no, told her I wanted on estrogen and I wanted it now or I would not be a functioning humban being! She made a deal with me, I get a mamogram ( I do this every year anyway) and she would prescribe me estrogen. After just one week on the estrogen I felt like a whole different person! I slept almost all night long, my hot flashes were very tolerable, if I had one it was so faint I barely knew it was there. I quit having palpitations, I wasn't angry all the time and I wasn't depressed either! I went back to my endocrinologist and told him how miraculously my life turned around once I started on my estrogen and he laughed and said "So, it was all hormonal" - and told me he didn't want to say that before because it probably wouldn't of gone over very well and he was right! Funny thing is my pains all went away and I wanted to stop the medication given to me by the Endocrinologist, but he convinced me not to stop right now. I am still taking what he has me on and my thyroid medication and my estrogen (premarin) and lots of supplements - that's it! I work out at least 6 - 7 days a week and eat healthy as I can with only minimal cheating and I feel better than ever and I am 47 years old.

*I also started taking Evening Primrose Oil twice a day about 6 months ago and I firmly believe this also helps my hot flashes and night sweats. I should be taking it 3 times a day but for me twice a day fits my schedule. This is an herbal product available over the counter and for me it works very well. It took a few months before I realized any benefits, and ever since if I miss a few doses I start to have increased hot flashes and I quickly remember to take it! As with any herbal medication everyone must let their PCP knows they are taking it because there can be some serious interactions between herbal and OTC/prescriptions medications. Just because it is herbal doesn't mean it won't have any serious interactions. Always research and discuss any OTC products with your medical provider.

Estrogen is not a cure-all drug for every woman out there having menopausal symptoms, but each woman who is thinking about taking it needs to have a good understanding of the risk versus benefits of the drug. With proper research and a good discussion with their PCP they can make a wise choice of treatment for their symptoms.

As wonderful as I think estrogen is for me, there are always reasons a woman should not take it. These include: a personal or family history of breast or uterine cancer, heart disease, blood clots
or strokes. I am sure many of you are familiar with the Women's Health Initiative - a very large study on women and the effects of hormones. Here is one site with some great information about the study - http://www.whi.org/findings/ They abruptly stopped the study on women taking estrogen alone due to the possible increase in strokes in the women in the estrogen only group. That scared a lot of people and providers, the study showed more women had strokes and blood clots in the estrogen group compared to those taking a placebo. The study showed in one year out of 10,000 women there were 12 more strokes in the estrogen only group than the placebo group. The number of women who had blood clots was smaller but still more than the placebo group. On the benefit side of the study for the particpants taking only estrogen - their level of coronary artery calcium was much lower than the women on placebo - "When taken for an average of 7.4 years, estrogen-alone is not likely to increase heart disease risk in recently menopausal women who are considering hormone therapy for menopausal symptoms." (WHI.org June 2007). It also found the placebo group had fewer hip fractures and breast cancer (which needs more investigation). WHI study reports - "We consider CEE to have no important (neutral) effect on heart attacks, colorectal cancer, and death because the differences were very small." *CEE is conjugated equine estrogen.

In my case I do not have any of the health risks mentioned above, and my immediate family does not either so I feel I have more of a benefit with the estrogen than without. I will of course continue to monitor myself for breast cancer and will get an annual physical to be sure I am not having any complications from the estrogen. I do not plan to take it forever, but will try to wean myself off from time to time by testing my symptoms as I cut back from a daily dose to every other day and so forth. I am having a much healther and happier life right now so estrogen will continue to be close by no matter where I may go!