O Special Report: What Nobody Tells You About Hormones
By Mary Duenwald
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Sudden outbursts of temper, creeping anxiety, depression, loss of passion, or foggy thinking sends many sufferers in search of psychological help; others rush to trainers when their waistlines start expanding; still others go crazy buying supplements to combat thinning hair and painful joints. And often these women don't realize that the real cause of these symptoms—not to mention hot flashes, night sweats, vaginal dryness, and insomnia—is the onset of menopause, which officially starts after 12 consecutive months of having no menstrual periods.
 
Scientists have yet to figure out why declining levels of estrogen (which occurs when the ovaries stop producing eggs) should have such wide-ranging effects. But they do know that cells throughout the body have receptors for the hormone and that its withdrawal impacts everything from the blood vessels to the brain. "The layperson has very little information about this," Ekins says. "My women are confused. They're having hot flashes. They're bitchy with their husbands, grouchy with their kids, angry at the world, absolutely miserable." And ebbing libido—particularly how it's affecting their marriages—is a huge concern (a course called "Hormones in the Bedroom" drew a standing-room-only crowd a couple of years ago). "My aim is to give women information, so they can visit with their physicians and intelligently come up with a plan," she says. "We do not need to be afraid. We need to be educated."
 
And yet even smart, well-informed women often hit a wall when it comes to deciding which symptoms are menopausal and how to deal with them. Hormone therapy (HT)—specifically supplemental estrogen, alone or combined with progesterone (usually progestin)—is the most studied and effective form of treatment to date for symptoms such as hot flashes and night sweats. But the treatment developed a bad reputation in 2002 after the Women's Health Initiative (WHI)—which conducted the largest, most rigorous study ever on HT—issued alarming findings that taking estrogen and progestin could increase the risk of both breast cancer and heart disease. In addition, it later came out that the hormones didn't seem to help much with sleep, depression, energy, or sexual satisfaction compared with a placebo. "There is still a lot of confusion even among physicians about hormone therapy, and many avoid prescribing it," says JoAnn Manson, MD, chief of preventive medicine at Harvard's Brigham and Women's Hospital and a principal investigator of the WHI study. "It can be a real problem for women to find a doctor who is willing to discuss all the benefits and risks of hormone therapy."
 
To more safely and comfortably navigate this major phase of life, it helps to understand a bit about past hormone research and what science is discovering even as we speak.