Menopause Is Not A Disease -- Dr. Susan Love Takes Practical Approach To Explaining The Change
Seattle Times Staff Reporter
Talking to Dr. Susan Love about menopause is like sitting down over a cup of tea with your best friend - assuming your friend has written a 362-page comprehensive book on the change.
"Dr. Susan Love's Hormone Book," (Random House, $25) sounds like a pseudonym for an advice column. However, it is anything but. In her book, Love (her real name) dissects the facts and beliefs about menopause in a common-sense way without sacrificing depth or complexity while also poking fun at myths, symptoms and stereotypes.
She tosses in feminist quips such as, "If estrogen deficiency is a disease, are all men sick?" The lighthearted jab is meant to push the point that women in menopause are not ill, and low estrogen isn't any more a symptom of disease than it is for prepubescent girls. Rather, menopause is the hormonal reflection of puberty - and life before puberty and after menopause can be liberating states of being.
In her research, Love, a breast surgeon, discovered that one-third to one-half of women have no symptoms as they pass into menopause, which usually occurs between the ages of 48 and 53. Of those who have hot flashes, mood swings, irregular or heavy menstrual bleeding or other symptoms experienced during the three to six years before menopause (called perimenopause), a small percentage will need hormones to relieve the symptoms.
The book includes refreshingly intimate detail about how hormones work in our bodies and how alternative therapies such as herbs, diet and exercise can relieve symptoms and prevent related conditions of aging such as heart disease, osteoporosis and reproductive cancers.
Love says physicians tend to prescribe hormones to women approaching menopause as a preventive measure unless there is a compelling reason not to, such as a family history of breast cancer. Love calls this view the "medicalization of menopause," similar to when childbirth was taken over by drugs and surgical instruments before the upsurge of hospital birthing rooms and midwives returned natural and combinations of options to women.
Among the women who choose hormones to relieve menopausal symptoms, few need to take them for the rest of their lives because the symptoms are a result not of low estrogen, but rather of fluctuating hormones, Love said. For most women, once estrogen levels out, the symptoms dissipate. She says women have mixed feelings about taking hormones: Only 30 percent fill prescriptions they've received for hormone-replacement therapy.
"Maybe the problem isn't estrogen deficiency after menopause - maybe it's too much estrogen before," Love writes. "Maybe the only way woman can become docile enough to couple and reproduce is if they are under the influence of domesticating hormones. . . . I know you're laughing - or at least smiling. Who knows what's true? But doesn't this view make you feel a whole lot better about menopause?"
Love admits hers is not the prevailing view among gynecologists, but it is gaining interest, especially among women approaching or in menopause. She has spent the past three weeks promoting her book, and she has sparred with a critical colleague or two. As she points out in the book, between one-sixth and one-fourth of all post-menopausal women have prescriptions for Premarin, the leading estrogen supplement.
"A gynecologist called in to a Washington, D.C., radio show and said, `I don't think you should be saying estrogen deficiency is not a disease,' " Love said. "He just went down the list of myths and restated them. The time has come as baby boomers are headed into menopause that we reclaim it from the medical profession, which has appropriated it as a disease. I don't actually care if women are taking hormones. I care a lot that they know the information; that they realize this is an experiment. We need to be really honest about the data."
Exercise, diet not profitable
For example, take estrogen and exercise. Premarin is the nation's most frequently dispensed brand-name drug for a reason, Love says: The manufacturer, Wyeth-Ayerst Laboratories, can make money relieving menopausal symptoms.
"Exercise and diet - all these boring lifestyle things that will work just as well for prevention - are not profitable," she adds.
Premarin is made from the urine of pregnant horses. The animal-rights group People for the Ethical Treatment of Animals runs an ad campaign deploring the conditions under which the mares are kept, but sales remain brisk. In the book she remains neutral but describes how the horses are kept (in a tiny stall and given minimal water to concentrate the urine).
When the World Society for the Protection of Animals was invited to inspect 32 Premarin farms in the Canadian province of Manitoba (where most of the 480 are situated), the society found the horses were deprived of exercise, sleeping space and often neglected when ill.
Both exercise and estrogen supplements have been shown to relieve menopausal symptoms as well as decrease bone loss for the 15 out of 100 white women and six out of 100 black women who are estimated to suffer fractured hips because of osteoporosis. They both decrease the risk of heart disease. Estrogen has the side effect of increasing the risk of breast and endometrial cancer, while diet and exercise reduce the risk of cancer in general.
Love's book is chock-full of research, which she prefaces with a detailed explanation of each study's degree of reliability based on how it was conducted. The best study is yet to come. When the Women's Health Initiative is completed in 2008, it will be the first randomized controlled study of postmenopausal women and hormones. The doc expects it will bear her out. Until then, she says, listen to your body.
"What I'm trying to do is interpret the data we do have and fit it to women's experiences," Love said.
The dried-up ovary is a myth. Instead, Love says, ovaries undergo a "career change: they go from dropping eggs to continuing to produce hormones. They don't fail, and we don't fail either." After menopause, ovaries dispense estrogen and androgen instead of estrogen and progesterine. And here's the fact that Love stresses the strongest: Menopause as life-enhancing rather than life-depriving is more representative of the range of women's experiences.
Research and other interests
After 20 years as a breast-cancer surgeon, Love left her clinical practice last summer to pursue research and other interests. She remains an adjunct associate professor of clinical surgery at the University of California at Los Angeles and directs the Santa Barbara Breast Cancer Research Institute. Love and co-author Karen Lindsey previously wrote "Dr. Susan Love's Breast Book." As she researched this second book, Love realized her shift away from her practice was a direct response to her time of life. So is her next project, studying for a master's of business administration at UCLA so she can "fix managed care."
Menopause, she says, brings a renewed sense of living. "Typically, there is the sense that I've been taking care of everybody for so long that I need to stop and take care of myself. Sometimes I think the crabbiness is so that people will leave you alone so you can get things done."
Anthropologist Margaret Mead spoke of "postmenopausal zest."
Love lists names of women who have made waves in the world: Indira Gandhi, Eleanor Roosevelt, Golda Meir, Margaret Thatcher - all past menopause.
"They are the ones who have the time and energy to fix the world."
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