Menopausal women are wary of hormone therapy

The pendulum shift resulted from the government’s landmark Women’s Health Initiative study, which in 2002 reported higher rates of breast cancer, heart disease, and strokes in postmenopausal women who took a combination of estrogen and progestin compared with those who took placebos. Some 75 percent fewer women are taking hormones during menopause now, and the pullback appears to have contributed to a significant decline in breast cancer rates.

While many women sail through menopause with mild symptoms or none at all, others find themselves trying to muddle through, sinking into depression or suffering sleepless nights from never-ending hot flashes. Yet they’re too scared to consider hormone therapy — even though, experts agree, it’s still the most effective treatment.

“The WHI results were almost like shock and awe, very frightening,’’ says Dr. Isaac Schiff, chair of gynecology at Massachusetts General Hospital. “After peeling back the data, though, we see that those who start hormones relatively early after menopause don’t have an increased risk for heart disease, and if they take hormones for a short time, probably don’t have an increased risk for breast cancer.’’

No question, though, that potential breast cancer risk sounds scary. The WHI trial found that those who take hormones for at least five years have a 33 percent increased risk of breast cancer compared with those who don’t. And some recent evaluations of the WHI data indicate those hormone-induced breast cancers may be more life-threatening.

But Schiff prefers to give his patients absolute risk numbers. “I tell my patients if you have 1,200 women ages 55 to 60, you would expect three of them to develop breast cancer every year. If you took those women and put them all on hormones for at least five years, four out of 1,200 will develop breast cancer’’ every year.

Given all that, however, women are correct in being wary of hormones and should only take them if they really need them and only if they’ve recently started menopause since, Schiff says, the risks are greater in older women. Where hormone therapy can be a lifesaver, though, is for those women who become extremely irritable or depressed when their periods become erratic during perimenopause, possibly due to rapidly fluctuating hormone levels. Schiff says in these cases, hormone therapy may be more effective than antidepressants at lifting moods.

DEBORAH KOTZ

Sophie08 wrote: No HRT for this lady, a nice soothing glass of white wine, some soft jazz used to do the trick. I started menopause in my early 40s. My husband used to duck. LOL. My period [finally] ended in July 2008 as well as the menopausal roller coaster. I was 55. Drugs are not always the answer.

babydog18 wrote: I am one of those people who expect to be “flashing’’ for the rest of my life. I experience six-plus per night and I don’t know how many during the day. This has been going on for over six years, with no end in sight. I am afraid to risk HRT. If eventually this changes, how old is considered TOO OLD to start HRT?

Deborah Kotz responds: That’s a tough question. Are you still having periods at all? I think a doctor would be more comfortable prescribing it within the first year or two of periods stopping altogether, the official onset of menopause. Dr. Schiff told me he might be willing to prescribe a very low dose of estrogen cream (along with progesterone pills for women who haven’t had hysterectomies) for women with extreme hot flashes who are older and never took HRT earlier in life. But you might be in a gray area, so it’s important to get a doctor’s advice.

Get a Botox shot for wrinkles -- at the dentist?

“I’ve been doing it for about a year, and we’ve had enormous interest,’’ says Helaine Smith, a Boston cosmetic dentist who took a two-day training course in Brookline, and voila! She was ready to erase frown lines and crow’s feet.

“People want service and convenience,’’ says Smith, who fixes broken teeth with porcelain veneers. And they’re happy to get their face fixed along with their smile.

Before deciding where to go for injections, you might consider that dermatologists and plastic surgeons spend years learning about the skin.

There are plenty of botched Botox jobs, though, so you still need to ask around to see who’s good.

Given all that, would you consider getting Botox from a dentist? D.K.

Danielsan wrote: One does not need four years of training to inject botox, to prescribe zit cream, or to administer a flu vaccine.

DestroXXIV wrote: Is this news? My eye doctor has been doing it for years.

egomaniac wrote: That’s the key point, your eye “doctor’’ has been doing it. Granted, at the low doses for cosmetic use, the risks should be minimal but I’m not sure I’d want someone with no medical training to inject a potentially lethal toxin (it is called “botulinum toxin’’) into my body after only learning about it from a two-day course.

Study: Some workers would be happier on unemployment

Australian researchers surveyed more than 7,100 working-age people and found that overall, unemployed individuals had poorer mental health than those with jobs. When they examined the data a little more closely, however, they found that workers with certain jobs — ones with meager wages, unrealistic demands, and little security — would actually be better off without one. At least until those unemployment benefits run out.

Worker retention may soon become more of a priority as large companies recover from the recession. And that could boil down to improving manager skills, which Google is attempting to do. Its recent company surveys identified a good boss as someone with a mild temperament who makes time for one-on-one meetings and helps staffers talk through problems — rather than solving them with directives. D.K.

ooooom2 wrote: In other news, a new study finds people are happier when someone else pays their bills.

lizzo wrote: My husband has offered jobs to several unemployed people who have turned them down, explicitly saying that they can make more money on unemployment.

bimmergal wrote: “Meager wages, unrealistic demands, and little security’’ sounds like 99% of all retail jobs, especially in big box stores. No wonder people are happier not working.