Menopause Part 3: Rx for relief

Heavy bleeding and night sweats were taking a toll on Barb Osmundson. She was waking every 30 minutes and was exhausted. But after two years of looking for a doctor who was knowledgeable and sympathetic about menopause, Osmundson, now 56, of Albert Lea, stopped looking.

Her longtime general practitioner was kind but had no expertise in menopause. He suggested a low-dose version of Premarin, an estrogen drug made from the urine of pregnant mares. But Osmundson's mother died at 50 of breast cancer and she feared the hormone would dramatically increase her cancer risk.

As her periods became alarmingly heavy, Osmundson turned to a young female gynecologist, whom she found brusque and unsympathetic. When the birth control pills she prescribed failed to regulate Osmundson's periods, the doctor said, "I'm sorry, but there's nothing I can do for you until you haven't menstruated for a year."

Osmundson wanted a doctor who would look beyond the prescription pad and consider a natural course of treatment that might include diet, creams, herbs and lifestyle changes. When a friend referred her to such a provider in Blue Earth, Minn., who took time with her patients, Osmundson found that her insurance wouldn't cover the visits.

Today, as her debilitating hot flashes continue, Osmundson believes that menopausal women deserve more.

"I would wish that doctors would sit down and just let you talk -- give you the sympathetic ear. Not say, 'It's menopause. Get over it.' "

At the Mayo Clinic's new Women's Health Clinic in Rochester, director Dr. Lynne Shuster and her colleagues do just that. They allot 45 minutes to an hour for each initial visit, exploring women's symptoms and making sure they feel heard.

In additional to hormone therapy and a battery of medical support services, Shuster's clinic, which opened in July, offers a variety of nontraditional approaches to menopause -- including herbal remedies, relaxation techniques, nutritional advice and FDA-approved bioidentical estrogen and progesterone products.

"Women get conflicting advice about hormone therapy as one of the main decision points about menopause," Shuster said. That's one frustration. "Another is that so many things in their bodies change with menopause that have nothing to do with hot flashes that they feel their physicians think it's all in their heads."

Expertise may be lacking

With about 40 million American women entering or already in menopause, clinics specializing in it have become a growth market.

"It concerns me because I see the poor results," said Sandy Greenquist, a certified midwife and menopause clinician who, after specializing in menopause for 15 years, founded the Menopause Center at United Hospital in St. Paul three years ago.

"All of a sudden, places are saying, 'We're going to have a menopause clinic, too.' But the people staffing them do not have years of experience," she said.

It's not unusual for a woman to tell Greenquist that she's spent $1,500 to $2,000 on visits, lab tests and hormones at one of these clinics.

"I am appalled by some of the prescriptions I see people being given, and the lack of guidance," she said. "I have a patient who was told, 'You'll have to play around with how much cream to use and how often and see what makes you feel best.' That's absurd! That's not giving a woman a prescription. It's turning her loose and saying, 'Here, figure it out.' "

How is a woman to choose?

Finding a provider who takes time with patients is key, said Dr. June LaValleur, associate professor of obstetrics at the University of Minnesota and a pioneer in menopause medicine.

LaValleur spends 30 minutes on initial visits and encourages patients to bring a list of questions with them. After reviewing their medical history, she asks patients to describe what they are experiencing.

"Then the floodgates open," she said, as women describe hot flashes, memory lapses, lost sleep and mood swings -- symptoms that for some last as long as seven years. Half have low libido. Some endure hot flashes into their 80s.

Friends are often a woman's best source of information on providers.

A teacher from a large school district told Greenquist, "I work with a whole bunch of women who are about the same age and I'm the guinea pig." Soon other teachers, librarians and coaches were flocking to Greenquist on the teacher's advice.

Of the 50 to 70 menopausal patients whom LaValleur sees each week, half ask for balanced or bioidentical hormones. When she asks what that means to them, they say they want hormones like their bodies made when they were ovulating.

On a bar graph, LaValleur sketches the wildly diverging peaks and valleys that four reproductive hormones -- progesterone, estrogen, follicle-stimulating hormone and luteinizing hormone -- take during the month and from woman to woman.

"I can't re-create that cycle. No one can," she said. "Women are told by some that bioidentical hormones are safer. But there is absolutely no evidence that they're any different. The reality is that all hormones, whether they're bioidentical or not, are manufactured."

Traditional hormone therapy, which is safe for many women, remains the single most common way to treat hot flashes, vaginal dryness and diminished sex drive. Many doctors now recommend the lowest possible dose for the shortest time possible.

For women who cannot or don't want to use hormone therapy, studies have shown that the antidepressants Effexor, Prozac and Zoloft can reduce hot flashes by up to 80 percent, LaValleur said.

Treating the 'whole woman'

Women also need to assess how much responsibility they're willing to take for their health. Smoking cessation, regular exercise, decreased caffeine and alcohol consumption, meditation and relaxation techniques, herbal teas, avoiding spicy foods and layering clothing all help.

When looking for a doctor, look for providers who treat the "whole woman," assessing bone density, breast and colon cancer risk, heart health, sexual and emotional health -- not those who just hand out prescriptions for hot flashes, Shuster said.

"Drugs are only part of the answer -- a very small part," she said.

If you are interested in alternative treatments, ask if the clinic provides nontraditional solutions that may include bioidentical hormones, herbal and dietary treatment, vitamins and progesterone creams.

Osmundson decided that finding a solution was up to her, so she has been attending seminars on menopause and experimenting with soy, progesterone cream and black cohosh. So far, none of it has worked.

"My family physician is very open to whatever I come up with. He just can't help with the menopausal part," she said, chuckling. "Once his wife starts lying in bed next to him, sweating, he'll want to do something about it."

Kay Miller • 612-673-4393

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