Women should tackle hormonal chaos, seek treatment for perimenopausal symptoms

Women should address the "hormonal chaos" of their 40s and not be afraid to seek treatment for perimenopausal symptoms, advises an internationally recognized expert in reproductive endocrinology from Wake Forest Baptist Medical Center.

Sarah Berga, M.D., professor and vice president for Women's Health Services at Wake Forest Baptist, has participated in the National Institutes of Health (NIH) and the National Center for Research Resources since 1994. As a translational clinician-scientist she investigates areas critical to reproductive and women's health, including the impact of stress and sex hormones upon brain plasticity and aging. Her team pioneered the use of cognitive behavior therapy for stress-induced infertility.

Berga often speaks to community groups on women's health issues and a recurring topic is hormones and the question of "what's new?" It's a subject that women find confusing, she said.

The pendulum has swung in every direction when it comes to hormone therapy recommendations, Berga said, but when it comes to perimenopause women in their 40s should be talking to their doctors and aware of the following:

•Perimenopause is the precursor to 'The Change' and starts in the early 40s. It is often signaled by hot flashes, night sweats and mood swings. Berga said it's best to seek treatment at the onset and not suffer needlessly.

•Doctors are moving to an individualized approach. One size does not fit all. "As clinicians, we have to take all of the new science and the studies and translate it to every day practice working with our patients on what's best for them based on their health and medical history," Berga said.

•Hormones taken at an early stage in menopause can be very beneficial. The NIH Women's Health Initiative study was halted three years early in 2002 because the data showed an increased risk of cancer and heart disease. However, said Berga, a re-analysis of the data has found that the age at which women start hormone replacement therapy and a shorter duration of treatment minimizes the risks. New data shows that the risks only apply to older menopausal women who begin taking hormone therapy late into menopause. "We just have to be very careful by translating the information into everyday practice and applying it to individual women, but overall, we have found that timing makes all the difference."

•Safer hormone therapies are available. A new strategy, termed a Tissue Selective Estrogen Combination (TSEC), takes conventional estrogen (CEE) and combines it with a bone-protective drug to produce a complementary pattern of tissue effects that maximize the benefits of hormone therapy while avoiding the risk. There are also new intrauterine devices that, while developed as birth control, also can be used for menopause care, Berga said.

•Hot flashes and "brain fog" usually drive women to seek help. For example, ability to think, processing information quickly and finding the right word are all cognitive functions that are hormonally dependent, Berga said.

•Going through the change can be depressing enough without actually suffering from it. "There are studies that show that some women who don't take hormones as they transition through perimenopause can suffer from depression, but we think we can prevent that from happening with hormones, or at least help alleviate it," she said.

•Bone always benefits from estrogen - at any age. Berga said there are kinder and gentler estrogens available as women age.

•Hormones affect more than menopause and fertility. "Hormones have so many effects," Berga said, "from contraception, to pelvic pain, bone health and heart health."
When it comes to the idea that menopause is a natural part of aging and perhaps Mother Nature should run her course without hormonal intervention, Berga has a different take on the matter.

"A lot of things are natural, but natural is not an argument in my mind," she said. "Natural is the state we're trying to improve and women need to better understand what's going on with their bodies and the roles hormones can play."