Q+A Dr. Bruce Kessel

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.

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.

Jimmy Forrest

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.

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?

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.