Guest Post: Menopause–I Chose the Meds

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A guest post by physician Judy Washington:

Menopause was not easy for me. I need to be high functioning at all times as a very busy Family Physician.  I have spent years counseling women about menopause and how to manage it.

Funny thing happened on the way to turning 50.  I experienced menopause. It was a totally mind altering and mind-numbing experience.  I admire those women who can tough it out.  I am not one of them.

The first time I went to a lecture on Bioidentical Hormone Therapy I was 40.  The co-presenter was a beautiful female Family Physician.  She talked about having fatigue, difficulty sleeping and concentrating and feeling like she had a serious illness but all the usual tests were normal.

She started Bioidentical Hormone therapy by consulting with a compounding pharmacy.  Her presentation was about using saliva testing to measure hormone levels.  I jumped right in consulting and started writing prescriptions for patients.  I have never gotten so many grateful hugs.

Then the research brought some doubts about the safety and risks.  After that, I spent time examining the evidence regarding benefits, risks and quality of life.

I was secretly hoping it would never happen to me.  I changed my diet, increased my running, and  started yoga and pilates.  Caving in to overwhelming gastrointestinal distress, I stopped the soy and the other natural stuff because of an allergy to some of the plants and tree nuts.

The symptoms hit and I was knocked off my feet. No really, I had one hot flash that was so bad I almost fainted.

That was while working with a resident.  She said and I quote, “Dr. Washington, are you having a hot flash? My mother gets those.”

Actually, I was held hostage by fatigue, hot flashes, and body aches.  All my blood work was normal.  I had to see patients, teach residents and medical students, perform surgical procedures, prepare lectures and attend meetings.

Well, it is hard when you are burning up one minute, cold the next and you can’t sleep.

My husband was a good sport and very empathetic. Fortunately for me, my best friend is an OB/GYN and a menopause specialist.  Her words of wisdom were, “Do what you think is best, but I am taking the hormones and I have no regrets”.

Well, I started the hormones and haven’t had a moment of regret.   Sorry naturalists.  I chose the drugs. Yes, compounded progesterone in olive oil and estradiol.

This choice is not right for every woman.  It was for me.

I will be 5 years into my decision May 2013.

At that time, I will start to taper my medication dose as recommended by the medical literature.

We will just have to wait and see.  My friend actually is a few years older than me and after a 5 year hiatus is delivering babies again and having a great time.

Judy Washington, MD FAAFP, is a board-certified Family Physician.  She has spent her medical career first in private practice and later in medical education. She is now working as a college health physician.

17 responses »

  1. Thanks, Judy. I always search out female physicians because they usually have a better sense of what I’m going through as a woman. A doctor who has “walked a mile in my shoes” can’t be beat!

  2. Meds get a bad rap in many areas of healthcare – I have taken anti-anxiety drugs for my entire adult life (not anti-depressants – though I’ve take those for periods of time) and I always find it amusing when people ask “aren’t you afraid of getting addicted?” My dosage has not changed, and my need has decreased, but I’d risk the chance of addiction to avoid the terrifying panic that has enveloped me at times.

  3. Hi Judy – so glad to see this post. I am 45, been VERY perimenopausal for more than 5 years. I switched from IUD to the pill to take advantage of the low hormonal bump and also have a compounded testosterone. I find when I use the testosterone all I want to do is eat so I use it sparingly. I am a firm believer in not suffering and feeling as healthy and balanced as possible. In this day of so much fear due to the misinformation/misinterpretation of the WHI study, it is so good to get a professional’s point of view.

  4. I am so grateful that you have shared this information. I am forty-six and have returned to school to finish my bachelors. I am so easily distracted that I feel as if I could be diagnosed with Adult ADD. It is so frustrating at times, especially when I try to write. This is certainly something that I will be addressing with my doctor! Thanks again!

  5. Great article. thank you for sharing your experience. So many women suffer through perimenopause when there are solutions – including HRT and anti-anxiety meds – both of which I’ve needed to ensure my sanity! Appreciating you for putting this out there.

  6. GREAT POST AND COMMENTS – THANK YOU ALL!
    Hallo to My Tribe! When peri-menopause started I felt all kinds of crazy all the time. It was like the worst PMS without a break. Add to that several life-stressors: parent dying, stressful job that I eventually got fired from, lo- spot of then ten-year marriage (now 24-year marriage and stronger than ever!), break-up of best-friendship, and loss of another important relationship in my life. Enter crushing anxiety and clinical depression, stage left. The first time I went on antidepressants, I remember saying to my therapist “Is this the way normal people feel?” I realized then that I had been suffering from anxiety since adolescence, I just didn’t know I was different than anyone else. I have been on Lexapro since, and while I don’t appreciate some of the side effects, the benefits I get far outweigh fatigue, crazy dreams, and occasional periods of mild depression for a week or so.The worst part is the stigma and bad press about how they are over prescribed and dangerous coupled with the seemingly constant advice that if I ate better and exercised more I wouldn’t need them. Similar to having a child with ADHD and deciding to medicate them. This is what I know: Decisions to medicate are personal and individual. Everyone talks about the side effects of medicating those that don’t need it. Few talk about the problems of not medicating those that need it. With both cases, a child with ADHD or a person with depression/anxiety, not treating it leads to self-medicating with substance abuse, (I know this from perosnal experience, too!) Today, I choose the medication!

    • Hi, it was very interesting to hear your story, as I can empathize totally. In 1992, I lost my late husband and I was 34 yr.old. My body went into major shock and needless to say, I was thrown into perimenopause, but because my blood work was normal, doctors just thought I was nuts. Of course, I did too! Between periods being so erratic, with months in between…. horrible feelings of anxiety and then panic, I did think I was on the road to the nut house. I finally started going to a therapist, who also told me I had anxiety since my young years and that the death of my late husband triggered these severe feelings. Hence, when I told her it was all hormonal, I just knew it, she didn’t agree and/or felt it really didn’t matter. I kept seeking out Gynecologists, hoping someone would know I was going through the “change” and would be able to pinpoint the problem, but was told it will take it’s course, there was nothing they could do. I felt as though I was hitting my head against a wall. After years, no joke, of increasing panic attacks that wouldn’t stop… years mind you, I finally felt as though my heart was going to give out. I went to a cardiologist, and after interviewing me for 30 min. he got up, left the room and returned with a package of pills. He told me it might take 10 days before I felt anything… within 20 min. of taking the first tablet I started to feel action. I lost my serotonin and my body wasn’t producing it, hence, when I would have a panic attack, there wasn’t any relief, so it would just continue. He gave me Zoloft and I was monitored and after a year, I just could feel I didn’t need the drug anymore, so they whined me off, which took about six months. That was over 12 years ago. Said that when I was 45 I went into full blown menopause, 10 years ago, and it wasn’t until after that I actually started to have hot flashes.. which mind you, I still have (10 years later) and yes, those PMS feelings still. Go figure… I got the fact that the “change” was a huge change to my life, but really? Drugs won’t help at this stage but hearing about other peoples stories makes a nice connection. Woman’s studies are lacking big time in this country, and we need more, that’s for sure.

  7. I have been going through hell since I turned 40. I just turned 50. I am currently not on anything for depression and dealing very well for the first time in years, however, these past two days have scared me into thinking it may be coming back. Are you telling me all this could have been avoided with hormone replacements? If so I’m making an appointment with my doctors, the same one who had me on depression meds all those years.

  8. Judy, I would love your advice. I am on 1 mg of Estrodial after having a total hysterectomy in August. This past month I am realizing I feel like crying all the time, I can’t sleep, no real hot flashes yet, but I am feeling a bit too warm most of the time and I have no sex drive (sorry for TMI but I need help). If I were your patient would you recommend I change my dosage or is this just how things are supposed to be?

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