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Thursday, Nov 26, 2009
Forget hormone treatments -- menopausal women are raiding health-food stores for dong quai and wild yams.
Mar 9, 2004 | Last December 47-year-old Brooklynite Therese Mageau was in the midst of an afternoon walk on the beach when she suddenly felt an intense heat wave. Sure, she was in Southern California, but the temperature was only in the 60s -- so what was happening? "I felt hot and clammy, like I was getting feverishly sick," Mageau says. "I rushed back to the condo and lay down." Only after two more heat waves hit did she think, "Oh, so this is what a hot flash feels like."
Mageau finally understood what all the menopause fuss was about. "Imagine someone lighting a little flame at the bottom of your leg and suddenly turning up the gas all the way," she says. "People hear about menopause and they think, 'So what? You feel a little warm.' They have no idea."
On the recommendation of friends who caught her fanning herself at a party, Mageau picked up a bottle of black cohosh, an herb marketed as an alternative remedy to the conventional -- and controversial -- hormone therapy of estrogen (or a combination of estrogen and progesterone). Like all menopausal medications, black cohosh and other alternative remedies don't claim to "cure" menopause, just to relieve symptoms like hot flashes, vaginal dryness and headaches. None of it has worked yet, but Mageau hasn't given up hope -- "it's only been a couple of months," she says -- and as long as they're not possibly cancer-causing hormones, she's open to other solutions. "Unless it sounds completely wacky, I'll do anything," Mageau says. "If somebody told me to add a drop of iodine to my water in the morning, I'd do it."
"I'm in a risk group for cancer," she says. "I've never had kids and my mother's sister died of breast cancer. And after the study -- well, I don't want to go there unless I have to."
An increasing number of women agree with Mageau. Ever since July 9, 2002, when a front page article in the New York Times reported that the largest study of hormone therapy (HT, formerly called HRT) was abruptly halted, menopausal women have avoided taking estrogen or progesterone the way pregnant women avoided thalidomide in the '70s. According to the study, the largest and most expensive federal study of women's health ever undertaken (conducted by the Women's Health Initiative and funded by the National Institutes of Health), women on HT were more likely to develop strokes, blood clots, breast cancer and dementia -- rather than see their cardiovascular disease rates drop, as doctors had predicted. In the span of a nightly news segment, some 17 million American women on HT went into a panic: There was shock at the 180-degree reversal, anger at doctors and the pharmaceutical industry, and despair over the prospect of returning to night sweats. "Everyone was caught off guard in a very dramatic way," recalls Dr. Isaac Schiff, chair of the American College of Obstetricians and Gynecologists' task force on HT. "Doctors hadn't even been notified first about the results. We were besieged with phone calls." Wyeth, the manufacturer of Prempro, the hormone drug used in the WHI study, saw sales plummet 50 percent.
Last week, menopausal women received more bad news: an additional WHI study (this one based on the use of estrogen alone rather than the estrogen/progesterone combo of the first study) was also halted unexpectedly. This time, estrogen was found to increase the risk of stroke, while offering no additional protection against heart disease.
For the 55 million U.S. women nearing or in the throes of menopausal mayhem, the case on HT is far from closed. And in the meanwhile, marketers can take advantage of the resulting confusion. Does any of it really work? Who knows -- but navel-gazing boomers caught in the flush of menopausal symptoms are eager to glom on to anything that may cool things down. Add a dose of headline-driven panic and distrust of doctors, and the result is a marketing stampede. Vendors of homeopathic, "nutraceutical" ("nutritional" plus "pharmaceutical"), and alternative medicines have descended like harpies on post-HT patients, exhorting them to try everything from black cohosh to dong quai to wild yams to cool their sweaty brows. Dozens of products hawked through health stores include isoflavones, which allegedly impart the benefits of a high-soy diet because they contain estrogens that occur naturally in certain plants such as beans, soy products and whole grains. Prescription medications like clonidine (for blood pressure), Neurontin (an anti-epilepsy drug) and even antidepressants are being touted as viable alternatives to hormone cocktails. All with the goal of tamping down on menopausal symptoms -- the hot flashes and mood swings, the night sweats and the vaginal dryness.
Jeanette (not her real name) is a 53-year-old high school principal from New York who says that she hasn't slept through the night since hitting menopause. But she swears by wild yams, another magical no-sweat remedy. "It seems to be working," she says, even though no medical studies back the Mexican-grown veggie. "I occasionally still have a hot flash, though much less severe." Before yams, there was "natural progesterone" skin cream ("I got nauseous beyond belief") and Remifemin, a popular black cohosh formula ("just not effective").
But Jeanette was determined to steer clear of HT. "I don't like taking drugs to begin with, even aspirin. I only take homeopathic remedies," she explains. "I don't have breast cancer in my family, but I was still scared." In certain ways, her partner, a breast cancer survivor, both fanned that fear and inspired her. "When my partner went on tamoxifen, the powerful medication used for breast cancer patients, she was thrust into early menopause," Jeanette recalls. The two of them would lie in bed reading "Is It Hot in Here or Is It Me?" (a popular menopause memoir) and giggle hysterically. But menopause wasn't exactly fun: "She had horrific hot flashes but of course didn't take hormones, because of the cancer. I thought to myself, If she can survive it, so can I."
"There's been a tremendous increase in new product development and marketing since the WHI study," says Wulf Utian, executive director of the North American Menopause Society. "All sorts of stuff is being pitched to 'the menopause market.' For many of these companies, whether their products work or not is irrelevant. In fact, most of the stuff in the health-food store are just expensive placebos that women think are safe because they've got 'natural' on the label." According to Utian, "They're preying on a vulnerable and gullible population."
"Of course all these companies are jumping in -- that's their business," says Sheldon Segal, a reproductive endocrinologist at the Population Council. "They saw a huge sales opportunity to take advantage of women's concerns over prescription drugs, and they're taking it."
