The Big M Menopause Causes Dramatic Physical And Emotional Changes, But New And Alternative Treatments Are Helping Women Cope

Edie Wells Rogstad remembers the day as if it were yesterday.

Her husband, Bill, and she agreed she would stay home to answer the business phones while he took the day off to go sailing with friends. She’d meet the group at 3 that afternoon and all would be well.

No big deal, right?

Wrong.

“I hung over the fence sobbing as he pulled out of the driveway. I felt so lost. So alone. So sorry for myself with a deep, deep depression. I know it sounds childish now, but I cried all morning. Then I put the answering machine on and drove out to the lake. I cried all the way to Hayden Lake.”

“What’s the matter with you?” her baffled husband asked from the boat.

From the dock the 45-year-old wife screamed back between alternating rage and sobbing, “There’s nothing wrong with ME. It’s YOU that’s the problem!”

That was the breaking point, the moment when both Wells Rogstad and her husband realized something was drastically out of kilter. Then it all made sense. The rage, the depression, the weepiness, the reluctance to be touched, the wanting to withdraw from family and friends, the “nothing’s wrong with me - it’s you” attitude that colored her whole world.

“I had been a very giving person, but I had changed to where I just felt like telling everyone to ‘do it yourself.’ I felt like no one liked me, and quite frankly I was feeling so nasty, probably no one did,” says Wells Rogstad.

She chuckles now at the memory of her battle with the monster she finally identified as “The Big M” - menopause.

“Part of the symptoms of menopause is that you really think you’re losing your mind,” explains Spokane nurse practitioner Cindy Finke, who has taught menopause classes for Dr. Hershel Zellman, a family physician. “It’s not always a specific thing you can diagnose.”

Finke explains that perimenopause (the three to six years prior to cessation of menstrual cycles) is the time during which women experience the majority of their menopausal symptoms. She says many women and some doctors are shocked when symptoms arrive sometimes years before periods stop.

She also explains that if a woman has had PMS in the past, she’s much more likely to experience the symptoms of perimenopause. And even the woman who’s had a hysterectomy may feel the effects of the body’s pre-programmed hormonal changes.

Wells Rogstad is in good company. Forty million women are currently in menopause.

Coming around the corner is the freight-train of some 74 million baby boomers now entering the menopausal years.

According to American College of Obstetrician Gynecologist’s figures, 3,500 of them per day will stop menstruating. While some will fall within the national average of 51 years of age, many will “pause” as early as 40 or as late as 60. However, with perimenopausal symptoms arriving years earlier (average age of onset of perimenopause is 45), many already have unknowingly begun the process.

For some like Wells Rogstad, their first clue may be a roller-coaster ride of mood swings. Others may experience a myriad of physical symptoms from aching muscles and joints, persistent fatigue, and anxiety attacks to tingling hands and feet, diminished libido and periods of not only extreme warmth (for many women, the notorious hot flash can be simply a warmth that lasts for hours), but also chills.

And then there’s the dreaded “brain-fog,” lapses of memory so bizarre that women interviewed refused to allow their names to be printed in conjunction with it. Examples: Putting full bags of fresh produce in the freezer only to discover frozen lettuce, tomatoes and carrots a week later. Driving down the road and not remembering which side of the road was the “right” side to be on. “Forgetting” a full cart of groceries in Costco. Putting a chicken in the oven for dinner - complete with plastic foam and plastic wrap.

“The overwhelming emotion coming over a woman in perimenopause is loss of control of her body,” Christine Conrad, co-author of “Natural Woman, Natural Menopause” (HarperCollins, $24), said in a recent telephone interview.

As if body symptomology wasn’t baffling enough, the menopausal woman is faced with what can be a confusing maze of diagnosis, treatments, information and controversies.

But the generation of meno-boomers are not a quiet, unquestioning bunch, say those who have joined their ranks. They have not been culturally programmed to “suffer in silence” the wide range of symptoms that beset their mothers.

They also are looking for natural alternatives to the standard treatment regimes prescribed to the generation before them. Many like Conrad and Wells Rogstad want more choices than Prozac, Premarin, or birth-control pills.

“The doctors always say you’re too young to have symptoms,” says Wells Rogstad, who successfully weathered the hormonal storm with her own natural treatments of heavy-duty vitamin E and herbs like black cohosh, sarsaparilla, ginseng, licorice, blessed thistle and squaw vine. She now works in the health food industry and feels a lot of compassion for mature women who wander into her store with desperate symptoms, no diagnosis and, worse yet, no options.

“The doctors should know that once you reach a certain age, you’re never too young to be in perimenopause,” she says.

“I was told by my gynecologist that if I didn’t take Premarin, there was no way to get estrogen,” explains Conrad, who was leery of the commonly prescribed hormone replacement therapy (HRT) derived from horse urine and used by 9 million women nationwide to treat menopausal symptoms.

“While it contains 48 percent helpful human estrogens like estrone and estradiol, 52 percent of its estrogen is strictly equine,” Conrad said.

That troubled the Los Angeles screenwriter, as did questions regarding the link between synthetic estrogens and breast cancer.

Conrad joined Wells Rogstad and others like her in opting for a more natural approach to replenishing diminishing hormones by using the options of natural hormones, vitamins and herbs coupled with a change in lifestyle, diet and exercise. The goal: elimination of problematic symptoms as well as protection against heart disease, osteoporosis and breast cancer.

“I first became interested in natural hormones for treatment of PMS some 15 years ago. More recently this natural approach has proven valuable in treating menopause as well,” says Dr. Will Corell, a Spokane board certified family practitioner whose practice is packed with peri- and menopausal women.

Corell uses a wide arsenal of natural over-the-counter products as a first recommendation for the perimenopausal woman. Often he’ll make his diagnosis with the help of saliva testing, a method he says is superior to the routine blood tests now done by many physicians.

He claims blood serum testing may or may not give an accurate reading on a woman’s hormonal profile.

He also prescribes plant-derived hormones compounded by local pharmacies in creams, gels or tablets, or bio-identical hormone patches with names like Estraderm, Climara or Vivelle. He “opposes” or balances natural forms of estrogen with natural forms of progesterone. They differ from their HRT counterparts in not only their point of origin (plant vs. equine and synthetic origin) but the philosophies behind them as well.

“When it comes to dealing with temporary symptoms such as hot flashes, night sweats and vaginal dryness, Premarin has been shown to be effective. But we do think it’s a crude product,” Conrad writes in the book she co-authored with hormonal treatment pioneer Marcus Laux, an Oregon naturopathic doctor.

“It’s crude in the sense that it was developed during the early stages of hormone investigation and contains estrogens foreign to a woman’s body.”

Dr. Al Morgan, a Spokane naturopathic doctor, agrees. He says prescribing Premarin is merely treating the symptoms, not the cause, of menopausal discomfort. He also says that natural progesterone is often likely a more effective and safer tool in meeting the hormonal demands of the menopausal woman.

“Every woman seems to have her own hormonal need,” explains Morgan, whose Doctor of Naturopath degree took the same educational time commitment as a standard M.D. degree and allows him to write prescriptions for pharmaceutically prepared natural substances and be covered by many insurance policies.

“There are a lot of aspects to the HRT controversy. The one I notice the most is women are concerned: ‘Am I getting too much, too little, or just the right amount?’ Then there’s the side effects and huge concerns about increased risk of breast cancer.”

Morgan explains that natural hormones can be pharmaceutically compounded specifically for each woman’s hormonal “fingerprint,” as he calls it.

“For example,” says Morgan, “if she needs progesterone during the second half of her cycle, I’d prescribe a micronized progesterone derived from the soy bean. The dosage can be adjusted precisely.

When it comes to natural estrogen, soy is the equivalent of heavy artillery for doctors such as Corell and Morgan and patients like Wells Rogstad and Conrad. Its use is common outside the United States; Asian countries that feast on soy products have no words in their language for “hot flash,” for example.

With urinary estrogen levels 1,000 times that of their American sisters, women in many Asian countries rarely fall victim to breast cancer, osteoporosis or heart disease, let alone the bewildering symptoms of menopause.

Not surprisingly, the health-food industry and some mainstream grocers are clamoring to meet the needs of the meno-marketplace as well. They’re stocking their shelves with things like green and black cohosh teas and tablets, Siberian ginseng, soy-based milks, tofu and miso, and licorice root - all derived from plants high in the building blocks of natural estrogens and progesterones.

Many are now also carrying over-the-counter hormonal products like Pro-Gest, a wild yam-derived cream reportedly carrying one of the highest concentrations of natural progesterone without a prescription, and Remifemin, a tablet form of the estrogen-laden Black Cohosh plant. It is said to have been used effectively for PMS and menopausal symptoms in Europe for over 40 years.

Both can represent a “first-step, over-the-counter” therapy for women who are beginning to suspect their hormones are playing games with their bodies, claim Morgan and Corell. But both urged women to consult their health-care practitioners first.

For those who don’t get adequate answers from their doctors, Wells Rogstad’s advice is stern:

“Start reading everything you can on the subject. It’s your body. You have to take care of it,” she says.

Conrad is even more adamant: “A woman cannot afford to be passive when it comes to issues vital to her health and quality of life. She can’t risk simply putting herself in the hands of others or accepting what is standard practice.”

As in many medical issues, the “natural approach” is not without its own controversies.

“If you get a bad headache, you can go outside and chew on willow tree bark and make your headache go away,” says Dr. Robert Lehman, Spokane board certified obstetrician-gynecologist and University of Washington professor. “Or you can just take an aspirin. You’re getting the same compounds.”

Arguing that plant-based hormonal supplements are the same as equine or synthetic-based compounds, Lehman favors the “equine or synthetics” for their strength and long-lasting abilities.

“I don’t have any concerns about the risk of breast cancers. There’s just no data to back up the risk,” Lehman says. “To me, the issues of protection against osteoporosis, heart disease, and perhaps Alzheimer’s, are far more important.”

Natural proponents counter that their methods offer the same protections without the risks of putting synthetics or “artificials” into their bodies.

That leaves health-care educators like nurse supervisor Pat Isakson anchoring to middle ground. She runs Holy Family Hospital’s health center, a comprehensive health data base and menopausal information counseling service that’s free of charge to the public. It is filled with menopausal research material, a library of books the public can check out, and scores of computer programs to dig up all aspects of the menopause controversies.

“We discuss all the pros and cons,” says Isakson. “We even have a theory that all this boomer-related menopause is the cause of global warming,” she says, laughing.

“But seriously, decisions about treatments for menopause should definitely be made on a personal basis. I don’t think there can ever be a blanket statement for all women.”

Emphasizing the “pause” in the word menopause, many boomers - whether selecting natural treatments or traditional HRT - are finding they’re taking more time out to nurture their own needs. Regardless of their medical orientation, they’re finding natural tools to help them.

They’re increasing their rest to combat hormonal fatigue, upping their intake of fresh foods, supplemental vitamins and herbs, and adding weight-bearing and aerobic exercises to strengthen aging bones and cardiac health.

With the extended family network and neighborhood coffee klatches a thing of the past, the “hormonally-challenged” of the ‘90s (as some good-naturedly call themselves) find the Internet the equivalent of the neighbor next door. Those who use it claim it’s a support system loaded with chat rooms and bulletin boards geared strictly toward the menopausal segment of society: a place to find immediate answers to questions from cyber-neighbors who have “been there, done that.”

It also gives them a grass-roots sharing of information that allows them to hear about natural options and resources they might not learn in a more conservative medical environment.

Wells Rogstad knows only about what’s worked for her.

“When you finally recognize it’s menopause and then know how to treat the symptoms, it’s really very simple,” she says.

Conrad adds; “In less than three months of using a natural plant-based estrogen/progesterone cream, I no longer had joint pain, hot flashes or any other menopausal symptoms. After six months my estrogen levels were retested.

“Not only had they improved, I now have the estrogen levels of a young menstruating female.

“A further osteoporosis test showed my osteoporosis has been completely reversed. I now feel great.

“I found a safe and gentle way to replace estrogen that also appears to be a better way. Without the risk.”

MEMO: These 3 sidebars appeared with the story:

1. SYMPTOMS OF MENOPAUSE hot flashes fatigue (sometimes extreme) night sweats vaginal dryness, odor, or atrophy mood swings irritability insomnia depression hair growth on face painful sex, loss of sexual desire urinary tract infections weird dreams lower back pain itching of the vulva bloatedness flatulence indigestion osteoporosis sore heels aching ankles, knees, wrists, shoulders thinning scalp frequent urination snoring sore breasts palpitations urinary leakage swollen veins dizzy spells, vertigo panic attacks migraine headaches skin feeling crawly memory lapses

2. NATURAL OPTIONS Books: “Natural Woman, Natural Menopause,” Marcus Laux, N.D., and Christine Conrad (HarperCollins, l997) “Dr. Susan Love’s Hormone Book,” Susan M. Love, M.D., with Karen Lindsey (Random House, 1997) “Without Estrogen: Natural Remedies for Menopause and Beyond,” Dee Ito (Random House, 1994) “Breezing Thru the Change,” Ellen Brown and Lynne Walker (Frog, 1994) “What Your Doctor May Not Tell You About Menopause,” John Lee and Virginia Hopkins (New York:Warner, l996) “Screaming to Be Heard,” Elizabeth Vliet (M. Evans & Co., 1995) “Menopause Without Medicine,” Linda Ojeda, Ph.D., (Hunter House Inc. 1995) “Menopause Naturally (Preparing for the Second Half of Life),” Sodja Greenwood, M.D., (Volcano Press Inc. 1992) “The Estrogen Decision,” Susan M. Lark, M.D., (Westchester Publishing, 1994) “Menopause and Beyond: A Fitness Plan for Life,” Leora Myers (Adelaide, l995) “The Simple Soybean and Your Health,” Mark Messina (Avery, l995) “This Is Called Perimenopause: Preparing for the Change,” Dr. Nancy Teaff (Strawberry Field Publishing, l995)

Internet: For quick, immediate answers and networking with “meno-sisters,” look for keywords “chat rooms” and “bulletin boards.” Probably the Net’s busiest boards and chats are on the Power Surge Network and Menopause Adventures. Power Surge: http/ /members.aol.com/dearest/ intro.htm#quick Power Surge on AOL: Keyword: Thrive@Health Menopausal (links): http:/ /members.aol.com/wlvdearest/ links.htm Meditopia: http/ /www.meditopia.com/menopause/ case.html Menopause Adventures on AOL: Keyword: Talkwomen. Go to: Staying Fit & Healthyscroll to: Menopause Adventures

Support: Call 466-6368 for information on the newly-formed Spokane Menopause Support Group.

Where to find it: Progest Natural Progesterone Cream: (900 milligrams progesterone); (800) 783-2286 Progestone-900 Wild Yam Cream: (New - 900 milligrams USP progesterone, plus 1,995 milligrams wild yam extract), Vitamin Express; (800) 742- 2030 Remefemin: (black cohosh estrogen precursor tablets), Pilgrim’s Nutrition, Huckleberry’s or Vitamin Express; (800) 742-2030 Soy milks, tofus, miso: local health food stores and all major grocery stores. For best success, try the flavored milks served cold. Proponents claim 4 ounces of soy milk or tofu has the equivalent estrogen content of a day’s dose of Premarin.

3. THE HORMONES INVOLVED Estrogen: There are 300 known functions for this important hormone. Best known for controlling reproductive function and female characteristics and helping maintain cardiovascular health and bone strength later in life. It is not a single hormone but a “family” of hormones, the three principal members of the family being: Estrone, which converts to Estradiol: Primarily implicated in possible increased uterine or breast cancer risk. Said to have cancer preventive characteristics. Progesterone: A natural ovarian hormone to sustain the uterine lining and support the fertilized egg. Also believed necessary to “balance” estrogen. Androgen (includes testosterone and DHEA): hormones secreted by the adrenal glands and ovaries that promote masculine changes in the body. In the menopausal woman, they go up, explaining characteristic changes seen in older women. Source: “Natural Woman, Natural Menopause,” Marcus Laux, N.D., and Christine Conrad (HarperCollins, 1997)