I'm reading studies on hormone replacement therapy (HRT) now. The findings are mixed and conflicting. Even the Harvard Women's Health Watch (April 2000) concludes that "Weighing HRT's risks and benefits and making an informed decision ... may now seem more baffling and frustrating than ever ... the decision you make remains highly personal ... it should be tailored to you and you alone."
For instance, not every woman has a breast man. I hadn't wanted one, but getting to menopause means having a past. I arrived at his office after a botched aspiration of a cyst in my breast. An aspiration is the drainage of the fluid in the cyst with a needle and syringe. Fibrocystic breast disease had been an annoyance for years—soreness, lumps and hard-to-read mammograms. My former female gynecologist, the one who left her practice to adopt a baby in menopause, was wonderful and reassuring, occasionally aspirating cysts with dexterity and no pain to me. With her departure, I bounced from clinic to clinic and eventually had an aspiration that showed irregular cells, possibly indicative of ductal carcinoma. I was scheduled for a biopsy.
I was scared. My friend Charlie was in the final stages of breast cancer. She loaned me "Dr. Susan Love's Breast Book," which I read cover to cover. I cried and prepared for the worst. With a topical anesthesia, I was awake during the biopsy and listened to the doctor and her support staff talk about breakfast and golf games and whether they'd gotten enough tissue since there was no obvious lump. When I returned for the diagnosis, I was told it was just fibrocystic breast disease. I was relieved, but I read the report and saw that while there was no evidence of ductal carcinoma, there was atypical hyperplasia. From Susan Love's book I knew that atypical hyperplasia is the stage before a contained cancer, kind of a pre, pre-cancer.
My friend Charlie died.
A general practitioner (maybe pressured by the HMO) assured me she could do everything my breasts needed. It was she who unsuccessfully aspirated and left me with a highly inflamed, painful breast and finally referred me to a surgeon, a man.
He studied my history, my breasts, mammograms and checked densities with ultrasound. He explained that the previous doctor had ruptured a cyst. He said I had complicated breasts, but he'd oversee them as my breast man. He took me seriously and made me laugh. Since that time, he's done aspirations and says my breasts will improve with the decrease of estrogen in menopause. No estrogen replacement!
My breasts do seem less cystic, but the risk of breast cancer increases after menopause. My atypical hyperplasia means a double no to hormone replacement therapy.
If It's Broken Don't Fix It?
So, if I'm being warned against hormone replacement therapy, what will become of me? What happens to women who don't take estrogen?
A menopause stereotype came via email the other day, "Post-Menopausal Barbie ... wets her pants when she sneezes, forgets where she puts things and cries a lot—comes with Depends and Kleenex." I remember Kathy Bates in Fried Green Tomatoes being transformed from a timid, crying wreck to a vital, purposeful woman when she took hormones. I see the ads warning me about the danger of heart disease, osteoporosis, vaginal dryness and loss of bladder control. I guess I need a heart man and a bone man.
And I'd like to hear from women who are not taking hormones. Are you alive? How are you surviving? How often do you wet your pants? How many hip fractures and/or heart attacks have you had? Is there any hope for a normal life without hormones?
I've started reading alternative-health newsletters, articles on different kinds of natural estrogens and progesterones, phytoestrogens and soy.
What? My insurance agent just called to inform me that my car insurance has been canceled. "I thought I paid," I said.
"You did, but too late. They'll reimburse you in October. Meanwhile, you need to come to my office because you're illegal."
"Maybe it's menopause," I offered. I don't mention the Allen gene.
"Well you might as well blame it on that. I went through menopause many years ago and I've felt better ever since."
I seized the opportunity, "Do you take hormones?"
"No, I tried them for a while and they made me as crazy as I was before. You know, PMS every month. I stopped the hormones and haven't had any problems since."
That's a welcome ray of hope for life without hormones. Still, I should assess my risks for heart disease and osteoporosis. But right now I'd better go to her office, sign something and make a deposit on car insurance.