New Information for Women. Period.

Dad forwarded an article to me recently that set me on a path of learning about hormone therapy. All women should have access to this information so that they can talk to their doctors about their health.

I remember when the results of a large randomized trial called the Women’s Health Initiative were published in 2002. The results showed that hormone replacement therapy caused health risks such as a slightly raised chance of breast cancer after five years and cardiovascular disease. Some of my female colleagues and relatives were very distressed by this news. Many of them had been taking HRT to relieve the symptoms of menopause, which can be debilitating and afflict up to 80% of women in developed countries. HRT was the accepted treatment for these symptoms, and had been for decades. Within a few years the number of women receiving HRT dropped from about 20% to about 5%. Understandably, most doctors became reluctant to prescribe hormone therapy.

A new understanding of the results of the WHI has emerged in recent years, however. It turns out that the median age of women who took part in that study was 63. Many of them already had health issues such as obesity, high blood pressure and were smokers. Women who were experiencing symptoms of menopause were screened out of the trial. So a treatment that was meant for younger, healthier, symptomatic women in their 40’s and early 50’s was tested on a largely different group.

According to The Economist, a re-examination of the data showed that the women who were between the ages of 50-59 who took hormone therapy were 31% less likely to die of any cause during their five to seven years of treatment than women who did not. It turns out that hormone therapy protects bone, brain and heart health and lowers the risk of colon and uterine cancer. There is a small risk of increased incidence of breast cancer after 5 years of use, which was described as “lower than the risk of working as a flight attendant.”

For younger women who have experienced premature ovarian failure, which can be naturally occurring or as a result of medical treatments such as radiation and chemotherapy, hormone therapy is now recommended by The Society of Obstetricians and Gynecologists of Canada. It offers long-term protection for bones, hearts and brains, and eases distressing symptoms.

The Managing Menopause Clinical Practice Guideline 2014 published by the SOGC recommends that doctors offer HT in the appropriate dose, and for the duration necessary, as the most effective treatment for troubling menopause symptoms. Current research confirms that HT is both a safe and effective way to treat symptoms of menopause in women within ten years of natural menopause. There is no absolute limit for the length of time you can take HT.

The Society of Obstetricians and Gynecologists of Canada

As with any medication, your healthcare provider will need to help you weigh the risks and benefits of hormone therapy. Breast cancer history, liver problems and other issues need to be taken into account, and there are certainly women who should not take this therapy. It is important to note that women with an intact uterus must take progesterone as well as estrogen, as unopposed estrogen has been linked to a higher risk of endometrial cancer.

The symptoms of menopause and premature ovarian failure include hot flushes and sweats, joint pain, cognitive issues, anxiety, and difficulty sleeping. They can interfere with work and family life, and cause suffering that may be needless.

There are many sources of information out there. I did notice in my reading that there are still websites espousing out-of-date information. My doctor recommended the resource “Menopauseandu.ca,” which has proven to be excellent.

There are a couple of articles which provide a good survey of the information in the December 12th edition of The Economist. I think you have to have a subscription to view the articles in their entirety but I will provide the links here:

https://www.economist.com/leaders/2019/12/12/more-women-should-take-hormone-replacement-therapy

https://www.economist.com/international/2019/12/12/millions-of-women-are-missing-out-on-hormone-replacement-therapy

The world of medicine is always evolving. We can listen to the experts and review information from studies, but I do realize that statistics only go so far. Sometimes it is very hard to know what to do when making decisions that affect one’s health. My doctor reviewed the literature and feels that I am a perfect candidate for hormone therapy. So I am giving it a try, for my bones and my heart and my brain. If it relieves my other symptoms you may hear me singing in happiness from way across town.

As always, feel free to share, dear reader. There may be a woman out there who needs to hear this information, just as I did.

Thanks, Dad!!

Even when it comes to women’s health issues, Dad’s got your back!!!

Peace Signs and Laser Beams

One of my brother’s fine old windows

Bolstering myself for the strangeness ahead I make an odd lonely peace sign in front of Josh’s window. Driving to the hospital I am so normal. The afternoon traffic laughs at me. Ordinary things like driving and giving your body up to medical science.

This is the first part of my treatment program. I am freshly freckled, my little black markings perfectly aligned. I imagine my tumor, happy and safe in its fleshy bed, is unaware of the coming onslaught. I feel a little sorry for it.

One of my mom’s legendary pieces of advice – when you are facing something difficult, focus on the after.

I will have a nice supper and glass of wine later with Josh and Ozgen. I will lie on the couch and read – imagine such a luxury on a Monday! My husband and children are at home, going to after school activities and slogging through homework. I am in the ether.

In the waiting room wool and needles await. All who sit here are invited to knit a square for a cancer patient’s afghan. I realize too late I chose an over-long pair of needles. I am clumsy and my thumb joint aches. I don’t want to knit the afghan square but there are others here and now I’ve committed. I jump up too quickly when my name is called, send the partially completed square flying into the basket with relief.

Lovely technicians talk to me and I am at ease in my hospital gown. In true Newfoundland fashion, we discuss our places of origin until we discern that I grew up down the street from one of their cousins. They organize my body on the machine, turn up the music and reassure me before they leave.

The machine approaches me confidently and turns all about my body, whirring and clicking. I think lights like eyes are on me but I’m not supposed to move so I don’t really see much. The lighthearted music makes me feel celebratory.

I christen the machine Wall-E. Soon it rests and they come back. They ask me how I’m doing. I tell them my surgery is next Monday. I ask about side effects and they explain that by the time I’m able to feel side effects the surgery will be done and that will cover them up anyway.

“So go out and have a nice dinner, have some fun! Your radiation therapy is 20% finished!” they say. They fuss around me for a moment. I would be lying if I said I did not enjoy the attention.

I float out of the Cancer Center. I am still in one piece. I am still me.

I made it to the after. We all make it to the after, in our way.

So many of my friends write me jokes about getting a laser beam to my ass. I really love them for it. I kind of wish I could show them Wall-E.