Q+A Dr. Bruce Kessel
Menopause is not as bad as you think, insists Dr. Bruce Kessel, president of The North American Menopause Society. The reproductive endocrinologist teaches at the UH medical school, maintains a private practice, and co-wrote Mind Over Menopause.
Q: Sitcoms like to poke fun at menopause-the hot flashes, the sobbing. How close is that to reality?
A: It's not close. The majority of women sail through the menopausal transition. It's really a minority, maybe 10 percent, that have difficulties. The North American Menopause Society did a poll, asking women between the ages of 50 and 65 at what decade were they happiest. Fifty-one percent of them said they were happier in that post-menopausal age group than they were in the 20s, 30s or 40s.
Q: Are sitcoms close to depicting that unlucky 10 percent?
A: There are some patients who have significant symptoms, particularly around the time of menopause transition. The top symptoms are hot flashes, night sweats, vaginal dryness, mood swings, the worsening of PMS or getting PMS for the first time. Menopause does not cause depression.
Q: Two years ago, there was a huge controversy over the safety of hormone therapy. What's the status now-yay or nay?
A: We're prescribing hormone therapy for symptoms now, not for prevention of chronic conditions. At this point, the FDA recommends using the lowest dose for the shortest duration consistent with treatment goals. But many OB/GYNs still consider hormone therapy to be one of the best therapies for hot flashes or night sweats.
Q: So what's a menopausal girl to do?
A: It really needs to be an individualized approach. That could include anything from lifestyle changes, hormone therapy or alternatives that are pharmacologic-drugs that are not estrogen-or nonpharmacologic, such as herbal therapies or relaxation response. Relaxation response can be induced by yoga, meditation or a number of techniques. Some data shows that it will reduce hot flashes by 50 percent. It doesn't work as well as hormone therapy, which reduces hot flashes by about 80 percent, but it could be very helpful.
Q: Are baby boomers dealing with menopause better than previous generations?
A: Every year, more than 2 million women become menopausal. A lot of baby boomers are thinking about the menopausal transition. They're gonna take charge of it, because they're the same group of women that took charge in their child-bearing years of their labor and delivery.
Q: Do Hawai'i women handle menopause differently than the rest of the country?
A: I just started collecting data on the difference in symptoms and sexuality among Japanese, Chinese and Filipino populations in Hawai'i. But there is U.S. data that shows, for example, more hot flashes in African-American and Hispanic women and fewer hot flashes and night sweats in Japanese and Chinese Americans. But we don't know if Japanese and Chinese women actually have fewer hot flashes, of if they just don't perceive them as troublesome.