What Part of Menopause Don’t You Understand??

CHAPTER SUMMARIES

• Quick Reference Sheet:

A two-sided, tear-out sheet that answers some of your most pressing hormone questions. It also contains a list of the human sex hormones and what they do, plus examples of sources for hormone home test kits. The back contains tables showing all the brand-name hormone replacement therapy (HRT) products on the market at the time the book was compiled. One table lists only those products that are completely bio- identical (exactly the same as human hormones). The second table lists products that contain bio- deviant hormones ( not the same as human hormones), including products that are combinations of bio-identical and bio-deviant hormones.

• INTRODUCTION: Dealing with Information Overload

Highlights the author's motivation for undertaking this project, and tells readers what to expect and how to make the most of the book. Readers can use it as a reference to quickly find a specific topic only as a need arises, or explore it completely from beginning to end. It is designed to work well either way.

This chapter covers important cautions and recommendations and encourages readers to actively assist their doctors in the quest for solutions. It also asks for reader feedback to improve future editions of the book.

• CHAPTER 1: A Brief History of Women's Medicine

A fascinating look at the painfully slow evolution of medical knowledge about hormones and the phases of a woman's life. Though not directly relevant to issues facing women in menopause, this discussion explains some of the reasons why so little is known, even with today's medical advancements, about the roles of the various sex hormones. It includes a timeline of key HRT milestones, which illustrates how our understanding of the risks and benefits of treatment has been severly limited over the past 50 years by focusing research on only two products.

• CHAPTER 2: How Your Reproductive System Works

Describes the female reproductive organs and the hormones that are produced or influenced by them. Provides insights into the roles of our natural hormones and how they work together in our bodies during our reproductive years. It discusses how things can go wrong, even during our youth, and the signs of hormone imbalances we may have missed. This chapter explains these complex biochemical processes in everyday language and with simple graphics everyone can understand. It provides the critical foundation needed to understand what happens when hormone levels plummet at menopause.

• CHAPTER 3: What Happens at Menopause

Lists over 80 signs of low or imbalanced hormones, including the classic symptoms (hot flashes and night sweats), plus many others that women may complain of during the perimenopausal transition and on into post-menopausal years. It illustrates how the menopausal experience can vary dramatically from one woman to the next.

This chapter offers numerous means (other than observing the classic symptoms) that we can use to find out if we are in menopause. Although the traditional definition of menopause is "having no natural periods for 12 months in a row," we can have low and imbalanced hormone levels while continuing to have periods.

Homone testing is covered here, including the various types of tests (whether ordered by a doctor or done at home using a test kit), the hormones and levels that are most indicative of menopausal status, how/where to obtain home test kits, and which hormones to test and why.

It also addresses questions about recognizing menopause in women who are on contraceptive hormones, and when it's safe to stop taking contraceptives.

• CHAPTER 4: Symptoms and Diseases

We seek treatment at menopause for two main reasons: either we have bothersome symptoms, or we want to prevent diseases. Usually it's both.

Chapter 4 begins by explaining the three types of hormonal conditions that can affect us: hormone deficiency, hormone imbalance and abrupt hormone withdrawal. Each condition can trigger a set of symptoms and make us more vulnerable to disease. It's important to understand each and know what's really happening in our bodies before we try any treatment. We may assume, for example, that our symptoms are the result of low estrogen. But if we actually have low estrogen and even lower progesterone, taking estrogen by itself will only increase the symptoms caused by the imbalance.

The balance of this chapter discusses the major classes of diseases and symptoms associated with menopause. Solutions are touched upon here, and many are covered in detail in later chapters. Tables provide at-a-glance summaries of the most common symptoms and their solutions, and lists of diseases along with their risk factors.

• CHAPTER 5: Statistics, Studies and Scares

Before delving into specific solutions, we take time here to talk about the information that drives our doctors to approach our menopausal issues in certain ways and that influences our perceptions and decisions regarding their approaches.

Many of us misunderstand the risks we face. In some cases, we think we're less vulnerable to a condition (such as heart disease) that is actually is huge threat to our health and lives. And in other cases, we have been so frightened by reports of study results that we see enormous risks where they are actually very small. This chapter provides a more realistic picture of disease and death risks, using statistics available from reliable sources presented graphically to put them into clearer perspective.

Its Studies section includes snapshot summaries of all the major hormone studies and their most notable conclusions.

It then goes into considerable detail about the Women's Health Initiative (WHI) Prempro study that frightened hundreds of thousands of women into quitting HRT in 2002. It reveals little-known facts about flaws in the study's conclusions, and exposes as absolutely false the claim that the study proved that Prempro increases the risk of breast cancer. It also illustrates the actual risk data in everyday terms we can all understand.

Because no printed book can keep up with new information coming out of the medical and scientific communities, the Studies section includes tools to help us evaluate the facts in any new reports that may surface in the future. These tools tell us what to look for in even the most complicated-sounding medical reports and teach us how to quickly spot facts that are meaningful to us or dismiss the report as irrelevant.

Similarly, the Scares section helps us understand why the media often frighten us with exaggerated or incorrect interpretations of medical news. It shows us how to avoid the panic these stories often trigger and helps us gather key information so that we can find and evaluate the actual reports using the tools provided in the Studies section.

And finally, it suggests there may be a conspiracy to eliminate hormone replacement therapy (HRT) as a valid treatment for menopausal women. Perhaps a fanciful idea, or maybe it's all true. It leaves each of us to decide for ourselves.

• CHAPTER 6: Do-it-yourself Solutions

A summary of the types of menopausal solutions we can implement on our own, including behavioral and lifestyle changes, food and nutritional solutions, vitamin and mineral solutions, herbal supplements, and alternative therapies (such as acupuncture and acupressure). Each of the major solutions is discussed in depth. And tables offer snapshots of the various solutions along with their pros and cons.

Little-known secrets of certain food solutions are revealed here, offering healthful, non-prescription methods to help balance hormones, minimize symptoms and prevent diseases.

• CHAPTER 7: The Great HRT Debate

Chapter 7 is dedicated to busting the many myths, misconceptions and absurd notions about hormone replacement therapy (HRT). While it may be the funniest part of the book, it also expresses the frustration many of us feel as our concerns are discounted and our decisions are ridiculed. This chapter prepares us for the discussions of HRT and other prescription solutions in Chapter 8.

• CHAPTER 8: HRT and Other Prescription Solutions

Perhaps the most anticipated part of the book for some of us, this covers all the forms of hormone replacement therapy (HRT) available today, along with the non-hormonal drugs that may be used in conjunction with, or as alternatives to, HRT for menopausal symptoms and diseases.

In its HRT section it defines common terms that often lead to confusion. And it discusses the differences between bio-identical hormones and bio-deviant ones, plus the pros and cons of each.

For those interested in bio-identical HRT, it provides insights to help us chose between custom-compounded hormones and prepackaged, brand-name hormones. And if compounding is warranted, it helps us find a pharmacy (either local or online) and helps our doctors understand and prescribe custom hormones.

The next section deals with anti-hormones (SERMS) and non-hormonal prescription solutions . It lists the pros and cons of various drugs used with or instead of HRT. And it describes the primary roles of the anti-estrogenic selective estrogen receptor modulators (SERMS) to treat or prevent certain cancers, creating menopausal side effects rather than resolving them.

And finally, the decision to use prescription solutions is broken down into into individual factors for our consideration. Hormone delivery media (pill, patch, cream, shot, etc.) are addressed here in both a snapshot table of pros and cons and in detailed discussions. Choices regarding type of drug (hormonal vs. non-hormonal, bio-identical vs. bio-deviant), menstruation, frequency/convenience of dosing, adjustment flexibility, cost and other factors are discussed.

And since we have generic alternatives to many prescription solutions, both with or without hormones, this chapter offers a bit of insight into the differences between brand and generic drugs to help with our decisions.

• CHAPTER 9: Evaluation and Testing

While Chapter 3 introduced the subject of hormone testing, Chapter 9 goes into greater detail about the types of tests we should have done, how we should get them, and when we should do them.

The first section covers laboratory testing . It addresses the differences between blood tests and saliva tests in terms of the ability of each to detect "free" (bio-available) levels of hormones versus the total amount. It discusses the effects of hormone binding (which prevents hormones from being used by the body's tissues) and of hormone conversion (which turns one hormone into a different hormone in the body). And it provides even more information about home test kits, hormone testing in general and what the results really mean.

The section covers all other types of tests we should have done periodically to monitor our health.

• CHAPTER 10: Charting Your Own Course

Breaks down the process of defining a solution plan into manageable chunks. Contains worksheets with instructions that help us: identify the most pressing issues; identify the solution options that are most compatible with our lifestyles, beliefs and needs; draft and implement a plan in partnership with our doctors; and revise the plan over time.

This chapter also asks us to do our part to honor the accomplishments and wisdom of those entering this stage of life and suggest ways to reverse the negative perception of menopausal women in our culture.

• CHAPTER 11: To Our Young Women

Because we look back on our youth now with 20-20 hindsight, this chapter offers our insights to younger generations of women who can benefit from our collections of things we wish we had done 10 or 20 years ago to make this transition easier.

Know what your hormone levels are when you're operating at peak performance: get baseline hormone tests done in your late 20s to mid 30s. Build optimal bone mass while you're young. Maintain a healthy diet to prevent diseases. Watch for signs of hormone imbalances (such as extreme PMS) and treat them with hormone supplementation before they do any lasting damage. Minimize stress to avoid burning out your backup hormone supplies of the adrenal glands.

This chapter also touches on the hormones used in contraceptives and explains why bio-identical hormones typically are not effective. It discusses emergency contraception and the hormones of pregnancy.

• CHAPTER 12: Andropause - Male Menopause

Chapter 12 speaks to women whose men have experienced the symptoms of hormone deficiency, particularly a lack of sexual interest and a general loss of energy and drive. It is more common that we might think. Although men’s hormones don’t drop off as dramatically as women’s, men do experience a gradual decline that can eventually result in hormone deficiency. Unfortunately, as men age, their bodies may also convert more and more of their declining supplies of testosterone into estrogen, creating hormone imbalances.

This chapter explores the nature of the male menopause, its associated symptoms and diseases, its various names, and the biases that would seem to make the male variety of hormone deficiency more “legitimate” than the female variety. It discusses hormone testing, as well as HRT and over-the-counter solutions for men, and offers resources for more comprehensive information.

• CHAPTER 13: One Wacky Case Study (to help you feel normal)

The aptly-numbered Chapter 13 is a chronicle of the author’s adventures (and misadventures) in HormoneLand beginning just before puberty and continuing through menopause. The saga covers a variety of hormone-related experiences in her past that provide insights and gauges for measuring the subjective and objective effects of hormone replacement therapy (HRT) today.

Though few women will encounter the curious variety of menopausal symptoms she has experienced, most will appreciate the observation that every woman’s menopause is unique.

Her experiences, while in some ways out of the mainstream, illustrate how the influences of hormones have shaped one person’s life and how restoring her hormones to optimal levels has become a driving force in her life. This chapter details the solutions she has applied and the results and complications of those choices.

The moral of the story is that even women with complicated hormonal issues can find a happy ending.

• APPENDIX A: Book Reviews and Websites

A selection of recommended books and Websites for further research. Each listing contains a mini-review describing the strengths and weaknesses of each item along with a rating score.

• APPENDIX B: Worksheets

Contains full-size, master versions of the worksheets referenced in Chapter 10 and elsewhere. Readers are encouraged to copy these and fill them out to document their experiences, find their own best solutions and track the results.

• APPENDIX C: Glossary

Definitions of key terms used in the book.