Beyond hot flashes

Dr. MillerMenopause is a case of mistaken identity. Almost everyone equates menopause with hot flashes. Particularly common is the notion that a woman may believe menopause is not relevant to her because she has not yet started having hot flashes, or on the other end, a woman may believe that menopause is not relevant to her because her hot flashes have already stopped. The problem comes from narrowly defining menopause solely by the presence or absence of hot flashes. Hot flashes do not define menopause and Womenopause: Stop Pausing and Start Living is not a book just for women who currently have hot flashes.

Menopause is a single moment in a woman’s life, the pausing of menstruation; in other words, her final menstrual period. Midlife women, ages forty to forever, have health and wellness concerns that go far beyond menstrual periods and hot flashes. Ovarian function and ovarian dysfunction play a pivotal role for all women, especially during perimenopause and postmenopause. Erratic estrogen production (perimenopause) and cessation of ovarian estrogen production (postmenopause) are the most important biological transitions that women face. Since aging and menopause are inextricably bound, so is aging and estrogen. There is simply no way around it.

Hot flashes that frequently occur during estrogen withdrawal (perimenopause and early postmenopause) are the proverbial tip-of-the-iceberg. Obviously, the mountain of ice that is seen above water can be a terrible problem, but the ice below the surface poses a much greater risk; just ask the travelers on the Titanic. Hot flashes are the ice seen above the water. Serious chronic diseases and life-threatening conditions, the ice unseen below the water, get a foothold during midlife and are in virtual lock step with estrogen deficiency. Women do not die from hot flashes; and it is common for “non-flashers” to treat hot flashes with derision. However, hot flashes signal an important physical change that portends cardiac disease (heart attacks), vascular disease (strokes), dementia (loss of ability to think or remember), metabolic disorders (diabetes, hyperlipidemia, and the metabolic syndrome), depression (development of bad mood), osteoporosis (thin bones susceptible to fractures of the hip, wrist, and spine), vaginal dryness (with resultant vaginal itching, pain, and displeasure with sex), and skin aging and wrinkling. These conditions kill women and can make their lives miserable.

Unfortunately, “hot flashes” is used as a shorthand phrase for lack of estrogen. It is so much more important than that. Womenopause, perhaps, can be substituted for a more correct way of understanding “menopause” and may come to represent the important biologic changes that midlife women experience. Estrogen deficiency of postmenopause seems to serve no useful biologic purpose, quite the contrary. For the majority of women, estrogen deficiency hastens cardiac disease, dementia, weight gain, osteoporosis, and depression. The question today, based upon the most current medical and scientific research, should be, “Which few woman should not receive postmenopausal hormone therapy?” The vast majority of postmenopausal women would be healthier and live longer with menopausal hormone therapy.

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