The menopause decision: true stories from the real women

Meet two women who struggled with the question of whether to take hormones. You'll learn through their stories how to figure out what's right for you.

ALL WOMEN FACE A CROSSROADS at menopause: whether or not to replenish lost estrogen and other sex hormones. Some women want proven relief from frustrating problems like hot flashes. Others hope to prevent heart disease, osteoporosis, or other signs of aging linked to low hormone levels. Against these positives, any woman must weigh the downsides of hormone replacement therapy (HRT), like weight gain and possible breast cancer risk.

Compounding matters, there are now dozens of natural and synthetic HRT options. How do you choose? Prioritize, says Stephen Sinatra, M.D., the author of Heart Sense for Women (Plume, 2001) and a cardiologist in Manchester, Conn., who has treated hundreds of women approaching menopause. First, consider how menopause-related problems like hot flashes have affected your quality of life. Then find out if you are at increased risk for estrogen-related ailments like osteoporosis and heart disease. And during this process, of course, work with your health care practitioner to find the best therapy for you.

Two women, Susan Graham and Joan Alix, could hardly have predicted the journey they'd take as they faced the crossroads of menopause. Each tried several forms of hormone replacement therapy before finding their direction. Their stories illustrate how to choose your path and make the right HRT decision.

Susan Graham

SUSAN GRAHAM WAS A straight-A student in high school and college, and in graduate school she easily grasped the complexities of neurology. So the Manchester, Conn.-based licensed practical nurse was more than surprised when, in her mid-30s, she couldn't remember the magazine paragraph she had just read.

As Graham was losing her powers of concentration, intense hot flashes began to overwhelm her. "I felt like I had a chronic sunburn," she says. "[The surges] stopped me in my tracks. I was absolutely drenched." The hot flashes came daily, slowly at first and by evening, every 10 minutes. She also became severely depressed.

When she passed tests for everything from blood cell counts to heart irregularities, Graham was puzzled. In some ways, being a health care professional made it easier for her to handle the constant evaluations and to talk to her doctors. But it also made the lack of answers harder to bear. Besides hot flashes and the bizarre brain fog, Graham had unusually heavy periods. All three are signs that the ovaries have stopped producing regular levels of hormones, so Graham asked her gynecologist if she could be approaching menopause. Her gynecologist said no. (Typically, symptoms don't begin until a woman is 39 to 45 years old.)

Three gynecologists and 18 months later, Graham remembers begging a doctor, "Please humor me and test me for menopause." Finally, at age 39, she got a positive diagnosis.

The Search for Relief

Menopause before age 40, or premature menopause, happens to about 8 percent of women. Graham's doctors immediately checked for known (but rare) causes of premature menopause like brain tumors and lupus. Those tests came up negative. "The most likely explanation is that I simply ran out of eggs," says Graham.

Graham read every book she could find on menopause, which 10 years ago was only a handful of titles. The most comprehensive one touted estrogen replacement. But Graham knew that reports dating from the mid-'70s had associated estrogen with an increased risk of breast cancer. "No women in her right mind takes [that risk] lightly," she says.

Graham decided to try alternative medicine first because of her interest in natural remedies. "I don't like to start prescription medication unless it's necessary," explains Graham. "I figure, if I can handle a problem with a BB gun, why bring out a cannon?" She tried soy and the herbs dong quai (Angelica sinensis), black cohosh (Cimicifuga racemosa), and red clover (Trifolium pratense), as well as acupressure, massage, and yoga.

Unfortunately, even after a few months, nothing worked, she says, "not even one bit."

On to Plan B

Graham decided to try conventional medicine. By then, it wasn't a difficult decision. "I was miserable. My whole being was unraveling--mentally, emotionally, and physically," she says. "My body was screaming for estrogen." Graham also knew that the longer she lacked estrogen, the more vulnerable her small frame would be to osteoporosis. Women can lose up to 20 percent of bone mass in the five to seven years after menopause; at 39, Graham had the potential for living many years with brittle bones.

In 1991, she started Premarin, a combination of several estrogens called "conjugated estrogen." (For a glossary of HRT types, see "The Hormone Options Explained," page 97.) In a few days, she was sleeping all night and her hot flashes had disappeared. In about two weeks, her brain felt sharp again. She felt better than she had in years. But the bliss lasted only three weeks.