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Poor Mrs. Rochester,
living in an era before hormone therapy, has been on my mind lately, as I
have tried, unsuccessfully, to wean myself off estrogen. Like me, she was
probably dazed from too many sleepless nights, frightened by palpitations
with no apparent cause and unable to concentrate on the simplest task or
read a sentence from start to finish. Hot flashes? No doubt Mrs.
Rochester was peeling off clothes and putting them back on, feeling hot
and clammy one minute and cold and clammy the next, waking in a tangle of
damp sheets. But, chances are, if anyone had asked her, Mrs. Rochester
would have said her wayward thermostat was a minor inconvenience compared
to being unable to think straight. Being locked in the attic
was no picnic, for sure, especially while her husband was fooling around
with young Jane. But at least Mrs. Rochester did not have to go to work
alongside men who considered her ditzy, women her own age who were sailing
effortlessly through their own menopause and those half her age who smugly
assumed that this would never happen to them. Pondering Mrs. Rochester's
situation led to a eureka moment after months of gathering misery. I
wasn't losing my mind, as I had been thinking in recent months. I was in
estrogen withdrawal. So, after polling my physicians, I have fallen off
the wagon, given into my craving. I need these little pills to have a
life. At first, the weaning
seemed relatively painless. I cut back by one pill every three days. No
problem. When I went to one pill every other day, the hot flashes started,
intermittently. I would snap awake, heart pounding, at I didn't eliminate the
next pill for months, following a doctor's schedule for gentle tapering. I
was tired all the time. But what did I expect at 56? So I cut the dose
again. One milligram of Estradiol every third day. I was almost clean. And
like a recovering alcoholic, I was drinking coffee, pots of coffee, which
seemed to fire synapses in my brain that were otherwise barely sputtering. My head was fuzzy. I was
running around the house in a panic looking for my car keys when they were
in my hand. I knew this wasn't Alzheimer's, because I knew the keys were
keys, and I knew what they were used for. But something was up. There I'd be, sitting at
the kitchen table with the morning newspaper, unable to read even a
sentence. Somewhere between the capital letter and the period, I became
lost. Usually, I did things quickly. Now I had to budget twice as much
time for everything. Not quite 14 hours to do 7 hours' work, but something
like that, compounding the weariness. Only then did I connect the dots. I
had felt this way before, 10 years ago, when I was perimenopausal. When my mother's
generation hit menopause, hormone therapy was new and promised to keep
faces unlined and hair shiny like the Breck girl. It would prevent those
hot flashes, and we would remain frisky in bed, keeping our men happy and
less inclined to stray. A generation of postwar women, in flared skirts
while scrubbing the kitchen floor, jumped at the chance to stay young. Their daughters were more
impressed with the claims that estrogen seemed to prevent many diseases
like heart attacks, osteoporosis and, maybe, Alzheimer's. Smooth skin and
lustrous hair were nice, but we could lean on plastic surgeons and
hairdressers for that. We were serious people — doctors, lawyers,
journalists, corporate executives. We didn't take estrogen because of
vanity. We took it because it was healthy, like going to the gym or eating
tofu. In retrospect, it is easy
to say that anything too good to be true probably isn't. Little by little,
the wondrous curative properties of hormone therapy have been mostly
discredited by the National Institutes of Health, which conducted a large
study. The first round, involving women taking a combination of estrogen
and progestin — estrogen, alone, is known to cause uterine cancer —
was stopped in its tracks in 2002 because of surprising and potentially
dangerous findings. Hormone replacement therapy had no salutary effects on
the heart or brain, the study found, and it increased the risk of breast
cancer and strokes. Other, more innocuous ways, could keep bones strong. Women in droves — half
of those using hormone replacement, by some accounts — threw out their
pills and patches. Many did fine without the hormonal boost and probably
never needed it in the first place. Some suffered but soldiered on.
Others, with florid symptoms and no family or personal histories of breast
cancer, resumed the medications after calculating risks and rewards. I didn't have to take
sides yet. Women who have had hysterectomies can take estrogen unmediated
by progestin, with its many well-documented side effects. "Our"
kind of hormone replacement was better, safer. We were the fortunate few
who did not have to choose between heart attacks and hot flashes. Sure,
that's a simple-minded dichotomy. But how many of us really understand
whether eight extra strokes per 10,000 elderly women is a lot or a little? "Our" half of
the study was chugging along when I decided, with all my doctors on board,
to wean myself from estrogen anyway. If the hot flashes came back with a
vengeance, if I couldn't sleep or think straight, I would go right back
on. Which is what I was about to do when the second shoe dropped. Women in
the N.I.H. study taking unopposed estrogen were also gaining no cardiac
benefit. They did not share the risk of breast cancer. But a few more of
them would have strokes and, maybe, dementia. Now it was my turn to
agonize. Strokes or sleeplessness? Dementia or oh-that-dizzy dame? I
called in the experts, the three doctors I see regularly. All are women.
All told me, without an instant's hesitation, to resume my normal dose of
estrogen immediately, and a little extra for a while, until I stopped
feeling so awful. Two doctors are past their
own menopause. Each takes hormones. They are not happy about an increased
risk of certain diseases. But they know the risk is tiny, and they can
balance the books by being vigilant in other ways like having regular
mammograms and watching their cholesterol. They have the advantage of
understanding the subtleties of footnoted peer-reviewed public health
studies whose message, they told me, was that women who need estrogen
should take it and those who don't should not. The third doctor is younger, knows about hot flashes only through hearsay. She may blink and miss her own menopause, as many women do. But if she has a hard time, she knows exactly what to do: take the pills that weren't there for Mrs. Rochester. Copyright © 2004
Global Action on Aging |
