March 7, 2003

Understanding Menopause

David Minkow

Menopause caught Velia Sprague by surprise.

“Before it started happening to me, I didn’t even know menopause existed,” the 52-year-old Hayward resident says. When Sprague was in her early 40s, her husband suggested that she tell her doctor about the “strange” symptoms. She was quite relieved when her doctor explained how menopause is the ending of menstruation and that the changes in her body were normal.

“I get these hot flashes that are like a fire burning from my feet up to my head. When this happens, I get real angry and don’t want to talk to anybody,” she describes. “Other times I feel really cold or just begin crying over nothing. It’s a very weird time.”

Sprague’s doctor proscribed hormone replacement therapy (HRT), and she took the drugs —Premarin and Provera— every day for 10 years to alleviate her symptoms. Two years ago, when she went in for a mammogram and described her breast pain, she says that the nurse told her that it was very common for women using HRT. After the mammogram revealed breast cancer, she stopped taking the drugs.

“I really think it was the hormones that caused my cancer,” says Sprague, who these days follows her doctor’s latest advice and drinks a glass of cold water and goes for a walk when she gets a hot flash.

Last July, the link between HRT and breast cancer made headlines when researchers prematurely stopped the Women’s Health Initiative study sponsored by the National Institutes of Health after finding that usage of the HRT drug Prempro (a combination of Premarin and Provera), appeared to raise a woman’s chance of getting breast cancer, heart disease and stroke.

Sprague has since recovered from her cancer and is a member of a breast cancer support group called Vida Con Esperanza, sponsored by the Tiburcio Vasquez Health Center (TVHC) in Alameda County. Community health education coordinator Carlos Lontono says that the women in the support group are asked annually about which topics they want presentations on, and each year menopause is on the list.

“There are a lot of misconceptions about what menopause is,” he says. “Many of our clients think it’s the end of their sexual life.”

Another problem, according to Lontono, is that many Latinas are uncomfortable talking about their reproductive system with health care providers, especially in the presence of another family member, who are often needed to translate.

“We try to inform these women that this is a normal period of life, that they can learn how to recognize the changes and that it’s okay to ask for help,” he says. “The first step is giving them the confidence to just talk about the topic, then we try to educate them about it and, in many cases, get them some medical help.”

Finding the right treatment isn’t easy, says Susan Sykes an OB-GYN with La Clinica de la Raza in Oakland, where 86 percent of the clients are Hispanic, primarily low-income. “There is a large proportion of recent immigrants who don’t want anything to do with hormone replacement therapy.”

Many of her clients use herbal remedies, such as black cohosh and flax seed. Sykes says that there is evidence that some of the herbs work well. But she cautions that it’s very important for doctors to know what their patients are taking because mixing Western drugs and herbs can cause adverse effects. “You can’t just ask them what medicines they are taking, because they’ll just tell you about Western drugs; you have to ask what other remedies are they using.”

According to Sykes, hormone therapy is still a good way to treat menopausal discomforts, but not as a long-term medication. “If used for short periods for specific symptoms, HRT is a very reasonable treatment. It shouldn’t increase their risk of cancer and should give them better control of their lives.”

Sykes, who along with all her co-workers is bilingual, tries to educate Latinas that it’s fine to get treatment for symptoms such as hot flashes. “One of the obstacles is that women think that just because they are done childbearing, that they don’t have to take good care of their bodies,” she says, advocating regular mammo-grams, pap smears, cholesterol tests and diabetes screening.

Lifestyle factors are also important, according to Ellen Gold, professor of epidemiology and preventive medicine at UC Davis School of Medicine.

In 2000, Gold published a report in the American Journal of Epidemiology that looked at ethnic differences in menopause symptoms. The report is part of The Study of Women’s Health Across the Nation (SWAN), which in 1994 began researching the impact of midlife changes on disease risks at seven sites across the country.

“We have definitely seen ethnic differences. Hispanic women, for example, tended to report more vaginal dryness, urine leakage, heart pounding and forgetfulness,” says Gold, principal investigator of the Northern California site. She adds that the fact that the Hispanic women in the study had less education, more financial strain, higher number of pregnancies and larger body mass than the overall population could be contributing factors.

In 2001, Gold released findings that Hispanic women tend to begin menopause at an earlier age than the rest of the population. According to the SWAN study, the average age when women begin menopause—the time when they are completely finished having periods—is 51.4 years.

Velia Sprague, who officially entered menopause when she was 45, wants her daughters, 29 and 27, to be much bettered prepared for how their bodies will change.

“A lot of Latinas don’t have information about health issues because we don’t look for it. Now that I have the information, I’m going to make sure that I pass it on to my girls.”

For more information about menopause you can call The North American Menopause Society at 1-800- 774-5342 or email them at: info@menopause.org

(Note: You can participate in a statewide live radio discussion of menopause issues from 7 to 8 p.m. Wednesday, March 12, to be broadcast locally on KPBS, 89.5 on your FM dial.)

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