Trim The Estrogen Surgeon-Writer Places Non-Drug Options Ahead Of Hormonal Therapy For Dealing With Menopause

The biggest applause of the evening seemed to come at the appropriate moment for Dr. Susan Love’s purposes. She was explaining her perspective on menopause to a crowd of more than 75 women (and a few men) at Women and Children First Bookstore in Chicago.

“Menopause is natural; we’re supposed to go through it,” said Love, a noted breast-cancer surgeon and activist at UCLA who has written the new “Dr. Susan Love’s Hormone Book: Making Informed Choices About Menopause” (Random House).

“It’s all in the framing of it. Many of the world’s most powerful women were or are post-menopausal: Eleanor Roosevelt, Margaret Thatcher, now Madeline Albright.

“I have an 8-1/2-year-old at home who is full of energy. But starting at puberty she will struggle with all of the usual physical challenges of hormones.

“So maybe women need just enough estrogen to be willing to domesticate and reproduce the race. Then menopause is our time to reclaim our 8-1/2-year-old selves.”

Many in the audience smiled and chuckled while they clapped, though Love is serious about rethinking menopause. She is widely credited with helping raise public consciousness about breast cancer, and her ideas on women’s midlife confrontation with reduced estrogen levels figure to be equally provocative.

“Medical literature uses words like ovarian failure or reproductive failure,” she said during an interview before her talk. “There we go, telling women they failed again. Drug companies like to consider it a disease that can be treated with their products.

“Doctors are sending the wrong message by referring to hormone ‘replacement’ therapy; we assume the women need the estrogen to be normal. That’s just not the case.”

In fact, some women experience little or no symptoms when moving into menopause. Love sees no reason those women should be automatically placed on Premarin, the brand-name hormonal medicine derived from pregnant mare urine that is the most commonly dispensed brand-name prescription drug in this country.

Even women with marked symptoms - hot flashes, insomnia, new allergies, altered sexual drives, lightheadedness, urinary incontinence, vaginal dryness - should consider less invasive options, Love believes.

“My first strategy is to look at lifestyle issues like exercise and diet,” said Love, 49 and perimenopausal by her own account. “Weight-bearing aerobic activities like running and walking help hold off or decrease menopause symptoms while contributing to bone improvement, reducing risk of breast cancer (including recurrence) and protecting against heart disease. Resistance training is also important for the bones.

“Your diet should be low in fat and high in vegetables. Soy-based foods are also good for all women, including, I think, breast-cancer survivors. Its estrogen content acts more selectively in the body’s organs than Premarin.”

Another major factor is smoking. Love said tobacco is “toxic to the ovaries.” She also recommends little to moderate consumption of alcohol.

If these changes aren’t enough to alleviate symptoms, Love next refers patients to alternative therapies like acupuncture and herbal treatments.

Another tack, Love said, is a breathing technique called “paced respiration” - five breaths per minute in a slow, rhythmic pattern. The technique is practiced for 15 minutes daily until symptoms subside.

Finally, if such treatments don’t bring relief, Love is not opposed to hormonal therapy.

“I think it’s OK up through the first five years of menopause if a woman needs to curb symptoms,” she said. “But then I want to see them taper off.”

Beyond that, Love said research indicates that a hormonal therapy patient raises her breast-cancer risk “half again.” She also rebuts the popular notion that long-term estrogen usage prevents heart disease or the bone-degenerative osteoporosis.

“The preventive effect for heart disease is probably overestimated,” she said.

Love said a study published in the Journal of the American Medical Association in late February showed women who start taking estrogen after age 60 (and as old as 98) can quickly achieve bone density and discourage osteoporosis in similar fashion to women who started hormonal therapy at the onset of menopause.

“Yet the study’s researchers still concluded that women should be taking hormonal drugs as soon as menopause develops rather than waiting until later years,” Love told the bookstore audience. “We have to change the way doctors and patients think. Women have to reclaim menopause.”