New start on life It began about four years ago when a laugh or a sneeze would cause slight urine leakage. Other changes followed, but Candy Baker, then living in Florida, said she didn't even think of menopause.
There are ways to conquer the
fear of what menopause will bringBy Helen Altonn
haltonn@starbulletin.com"I hadn't looked into menopause. I only knew about hot flashes and I wasn't having any hot flashes, so I thought I was fine," she said.
Baker, now 51 and living in Honolulu, was in a perimenopausal stage -- the gradual period of change leading into menopause.
Perimenopause may last four or five years, with menopause occurring on an average at 50 or 51 years of age, said Dr. Neal Winn, obstetrician/gynecologist who specializes in that area.
He said menopause, a natural biological event, is an opportunity for a woman to get "a whole new start on life." Yet, "there is a lot of fear about what's going to happen." Women worry that they're getting older, deteriorating and are useless, he said, adding, "That is more myth than fact."
The last third of a woman's life allows her to develop as a person because she does not have to worry about reproduction or children, he pointed out. It's an opportunity for better marriages, "to devote yourselves to each other and not to children," he said.
Winn retired in 1998 but remains active as a menopausal consultant at the Kapiolani Women's Center and as chief medical officer for medical specialists at Kapiolani Medical Center for Women and Children.
"The obsession with boobs and bodies in this country make it difficult but it (menopause) certainly doesn't have to be bad," he said.
"It may take a little patience to fine-tune it. One single treatment doesn't work for everybody. There are a lot of alternatives."
Dr. Bruce Kessel, reproductive endocrinologist who supervises residents at the Queen's Medical Center, said menopause is "a normal physiologic process" and many women go through the transition without any problems.
Kessel is an associate professor at the University of Hawaii John A. Burns School of Medicine and has a private practice at Queen's concerned exclusively with hormones. He said some perimenopausal women have a difficult time because of significant hormone fluctuations but "there is a vast array of therapies available now."
Baker goes to a Menopause Support Group conducted by Winn every third Thursday from 5:30 to 6:30 p.m. at the Kapiolani Women's Center, 1907 S. Beretania St. (To register for the classes, call 973-3044.)
Exercise cleared up some knee and foot problems, and an incontinence class at the Kapiolani Women's Center "took care of that problem," Baker said. Hormones evened out her sleep cycles, she said. "Now I'm pretty symptom-free, really."
Baker said her hair and skin began changing texture and she wasn't sleeping well. She didn't have night sweats, a common sign of menopause, but was extremely sensitive to temperature, putting on covers and kicking them off at night. "It kept me awake a lot."
Her menstrual periods become irregular and her obstetrician/gynecologist was concerned that her progesterone was off, throwing her hormones out of balance, she said.
Three different medications were prescribed and none worked, so about a year ago her doctor put her on a low-dose birth control pill, she said. She was recently given new medication combining estrogen and progesterone.
It's good that there are many choices available to treat menopausal women, Kessel said, but it also increases confusion over the risks and benefits of some therapeutic options.
Winn also pointed to overwhelming information on the Internet. "The hard part is to understand what is useful or poorly documented information. There are a lot of scams; a lot of hype."
More menopause treatments are coming, the doctors said, with a number of things pending Food & Drug Administration approval and others entering final testing phases.
"I think we're increasingly moving toward a time when there will be a lot of individual tailoring of specific hormonal treatments to the patient's needs," Kessel said. "In the past, there was kind of a one size fits all approach to hormone replacement therapy."
Winn said physicians are a little more cautious about ordering estrogen for everybody because of recent studies raising some concerns. "It reminds us, there isn't one pill for everybody."
Family history, risk for cardiovascular disease and osteoporosis and other issues, such as lifestyle, must be considered in prescribing hormone replacements, he said. "It is a very dynamic situation, with new information, new therapies and new risk factors.
About 30 new treatments have appeared in the last few years, Winn said, as well as different ways of delivering them via pills, patches, implants and vaginal creams.
But he stressed, "Probably the first thing people should look at is lifestyle -- exercise, smoking, alcohol consumption and relationship issues. They should take care of themselves."