THE MENOPAUSE MINEFIELD
With Guest Expert: Dr. Vivien Brown
Should I have a mammogram or not?
What about perimenopause: is HRT the way to go or is it a health risk?
Should I stay completely natural and go the naturopathic route?
And what about vaccines, and anti-depressants and…
OMG – you get the picture. Life is super busy these days and juggling our health with all of our other commitments can be a stretch.
I know my opinions on all of these topics (and they’re not always in line with ‘popular’ opinion), so when I had a chance to sit down with Dr. Vivien Brown to hear what she had to say about keeping healthy into and through menopause, I jumped at the chance. She is not only the Vice President of Medical Affairs at Medisys Health Group Incorporated – a large provider of healthcare services within Canada – but she is also a recipient of the 2012 Family Physician of the Year award for the region of Toronto, Canada. I figured there could be no better person to talk with about some of the most up-to-date medical opinions on women’s health at midlife and beyond.
Use It or Lose It
The first thing I wanted to know (of course) was what Dr. Brown considered to be the very best way for women to stay libidinous and “juicy” as they go through perimenopause and beyond. Dr. Brown’s answer didn’t surprise me – “use it or lose it”. Our libido changes and can decrease as we age if we are not diligent. As women, I always maintain that ’our orgasms start between our ears’ and that becomes even more true as we move through this stage of our lives. The stresses of work and children and life mean that the thought of initiating intimacy can seem daunting or just plain exhausting.
Dr. Brown’s advice is take the plunge, so to speak. Sex is a habit that you don’t want to break and for women, it is a cycle. Once you start having sex regularly, you will want to keep going and will find it easier to get into the experience; but if you stop, it is hard to work up the momentum again. Although it may seem daunting to initiate, most women enjoy the experience once they are in it, so you may have to be completely ‘unromantic’ about it and actually schedule time for intimacy. If you make a point of finding the time, you will likely enjoy it while you are in the experience and it gets simpler to keep the momentum.
Is It Hot In Here?!
Then we moved on to another topic near and dear to my heart – HRT (Hormone Replacement Therapy). One of the really surprising things that I learned from Dr. Brown was that a lot of the ‘fear’ of HRT causing cancer and heart problems came from the way the original trials were done more than 10 years ago. The original studies used high doses of hormones on women of an average age of 63 – the majority were smokers and overweight. Not surprisingly, the conclusions of those trials led to linking HRT with heart disease and cancer. How could it not, with a group so predisposed to those problems to begin with!
In newer studies, Dr. Brown explained, the test subjects have been conducted with overall younger (50-55), healthier and more active women, which has led to much more positive results under the right circumstances. They were given low doses of hormones, topically and orally, and compared against groups given no hormones. Many women responded remarkably well and the group that was on oestrogen alone even showed a lessened risk of breast cancer.
I know that for myself, HRT has been something I have been avoiding. My body does not do well with chemicals and my doctor and I work together (with my naturopath) to figure out what is best for me – something that Dr. Brown fully supports. She jokes that women’s health should be a “team sport” and that doctors now are open to women having the ultimate decision concerning their health when the decisions are well thought out and well researched .
The ‘Booby’ Trap
Mammograms: another potential minefield of women’s health and one where there has been a lot of controversy over the last couple of years. Dr. Brown recommends following the current Canadian guidelines which mean no mammograms for women under the age of 50 unless there is a lump detected, or if there is a close first degree relative who has had breast cancer (daughter, sister, mother). After 50 mammograms are done every 1-2 years depending on the doctor’s recommendation and the density of the woman’s breast tissue.
Having grown up with needing a lot of xrays (including mammograms), I don’t personally want more radiation going into my body if I can help it. It can be tempting to request a ‘baseline’ mammogram in your ‘40s but you need to remember that there are a fair number of false positives in this testing and based on that, the discomfort and the radiation, are they worth it? I know it isn’t for me. In fact, for some people I take it to an ‘extreme’ and avoid the new airport security scanning and choose to get a hand scan. I know of way too many frequent flyers (including the airline personnel) that have some serious and pervasive health issues and they are starting to do the same thing.
Oh, My Aching Back!
Here is where I learned something new about peri/menopause. You know those aches and pains in your joints? Those are (potentially) symptoms of your decreasing oestrogen levels. I think sometimes we forget that there are more symptoms to peri/menopause than hot flashes!
Many women have a lack of energy, depression, insomnia and vaginal dryness. But, the #1 complaint that Dr. Brown gets is achiness and pain in the joints (and here I just thought it was my old fibromyalgia health issues flaring up). Oestrogen acts as a lubricant in your joints and when your levels decrease, as in perimenopause, you can get stiffer and more uncomfortable. So, Dr, Brown suggest mentioning it to your doctor and don’t just write it off as the perils of ageing.
The Eye of the Needle
Somehow I didn’t think at the age of 50+ I would still be talking vaccinations with my doctor but the ‘new’ HPV vaccine had changed all that. I wanted to ask Dr. Brown what the common medical opinion was for who should be getting the shot.
There has been so much controversy over whether we should be vaccinating our daughters, that we don’t even think of ourselves – yet Dr. Brown says that the HPV vaccine has been approved for women up to 45 years of age, and should be a ‘consideration’ for those of us who are single, (or newly single) and who are regularly sexually active. The point she makes is that, for the first time, we now have a vaccine which can actively reduce the risk of cancer: cervical cancer by 70%, oral cancers by 35%, as well as penile and anal cancer. Add to that a vaccine for Hepatitis B, which reduces the risk of liver cancer as well, and maybe you can give yourself extra peace of mind while you are out there in the world (my interpretation of the possible good ‘side effects’).
Deep Cleansing Breaths
If you look at the statistics, 80% of women in perimenopause will have symptoms and 20-30% of those women will feel disabled by them. Just like with pregnancies, every woman goes through it differently and will need different solutions. While I have become over the years not shy about sharing my personal health symptoms with the world, I am usually part of the 80% that can get on with things despite what my body is doing (why did nobody ever tell me that hot flashes are followed by bone-deep chills?!!). Dr. Brown agrees that a big reason for that is because although stress is my achilles heel, I generally live a healthy life, I eat well, I exercise, I do things that help my mental health and I keep blissing out in the bedroom.
Whether you choose to follow more closely the naturopathic route like I did or follow the traditional medicine route, being in touch with your body and speaking to a professional about your symptoms is the most important thing you can ever do. Your menopause may not be just like anybody else’s but there is never a reason to endure it alone!?
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