Menopausal Hormone Therapy
National Conference Center, NIH, Bethesda, MD.
October 23-24, 2002
M. Pomerance, MSW, LICSW
Psychotherapist, Menopause Educator
2000 P St. NW. Suite 720
Washington, D.C. 20036
raging debate about the health risks and benefits of hormone therapy
comes out of the medical model in which menopause is treated as
a disease. In the more holistic Complementary and Alternative Medicine
(CAM) model, menopause is seen as a natural condition. Under the
holistic model medications and lifestyle changes are given equal
weight in treating menopausal symptoms. I believe treating women
holistically relieves the pressure on the physician to solve all
problems of menopausal mid-life women, and offers women the services
of health practitioners with expertise in mental health, nutrition,
and physical therapy.
MEDICAL MODEL OF MENOPAUSE
the medical model, the medical aspects of menopause become the dominating
focus for diagnosing and treating, what is, in fact, one of the
many mid-life events that a woman is experiencing. Treatment under
the medical model centers on medication. Replacing diminishing hormones
has become an appealing solution, not just for hot flashes and vaginal
dryness, but also as a broader, more vague panacea for decreased
libido, dry and wrinkled skin, and an overall decrease in joie de
vivre. Hormone treatment has also rapidly expanded to include more
long-term conditions of aging, primarily heart disease and osteoporosis.
Consequently, healthy women, many of whom have had no adverse menopausal
symptoms, were urged to take hormone therapy.
fact, for most women, The Menopause , the end of their reproductive
cycle, is not a negative event. Studies have shown that if women
have overall life satisfaction, menopause is not experienced as
stressful. If mid-life women are in crisis, it may be because of
the end of child rearing which may have been the most image-defining
activity of the past fifteen years.
themselves in financial straits without a high enough paying
burnt out in their chosen career but thinking they are too old
to start another.
the horizon on their life span for the first time and feeling
yearnings about how much time is left to do all the things dreamed
about when younger.
emptiness in her long-term relationship now that child reading
has receded as the primary focus of the couple.
and/or anxiety around these and other issues bring many women into
therapy or counseling, usually by themselves, sometimes with their
partners. In these cases, the woman and her partner can deal with
menopause issues in the context of the emotional and physical health
of the couple. For example, decreased libido may have more to do
with deteriorating communications than with waning hormone levels.
to the medical model, amid conflicting medical opinion, women are
once again faced with a very personal choice, similar to the one
made about birth control when they were fertile. Then, it was weighing
the risks and benefits of birth control pills, IUDs, foams, creams,
diaphragms, rhythm , and tubal ligations. If a woman s partner was
not involved with her and her doctor in weighing the risks and benefits
of birth control he is not likely to be involved in her hormone
medical model puts increasing pressure on physicians to ensure as
risk-free a hormone choice as possible and to be available to assuage
their patients anxiety about the outcomes of their choices. In a
fifteen-to-thirty minute office visit, a physician can barely do
an adequate physical exam much less address the anxieties of hormone
treatment which are embedded in her other mid-life issues. For example,
neither the doctor nor patient might feel comfortable with frank
discussions about sexual issues. Nor is there time or inclination
to discuss life disappointments or stressful life events.
HOLISTIC/CAM MODEL OF MENOPAUSE
holistic approach views menopause as a natural condition that all
women will experience if they live long enough. It includes assessing
all the bio-psycho-social quality of life issues facing them at
status and overall physical well-being;
relationships: significant other, parents, siblings, children,
and important social support networks including community, religious,
and physical activity institutions;
stability: stable and safe housing and neighborhood, adequate
work or career where she is valued and adequately paid.
under the holistic model gives equal weight to medication when necessary,
mental health interventions, complementary practices, and lifestyle
changes. Lifestyle changes for a mid-life woman experiencing distress
at menopause encompass diet, exercise, and reducing stress. Physicians
urge lifestyle changes on their patients but are without the means
to make them happen. Physicians have a hard enough time getting
patients to comply with medication regimes much less enforce a weight
reduction plan, smoking cessation, or exercise routines.
achieve optimal health, an integrated system addresses total body
health. A number of dietary, lifestyle, and supplementation practices
have been shown to improve and relieve women from the common problems
related to the various stages of menopause. Examples are:
health interventions: individual, couple, and/or group counseling
help a woman and/or her partner recognize the relevant issues
causing distress and provide a supportive, confidential setting
to prioritize and work on them. Group work in particular helps
a woman share her feelings, and learn from others while enforcing
necessary lifestyle changes.
and acupuncture: a number of small clinical studies have shown
that the combination of chiropractic manipulation and soft tissue
therapy is an effective symptom management intervention, primarily
regarding back pain, abdominal cramping, and headaches.
dietary supplementation, and exercise: there are specific dietary
aimed at reducing menopause symptoms. Exercise
enhances healthy eating habits, improves mood and reduces anxiety
healthcare community must use the considerable knowledge and tools
that we have for treating aging women in the healthiest, safest,
and most respectful way possible.
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