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Documentary Reveals the Good, Bad, Ugly of Menopause

iStockphoto/Thinkstock(NEW YORK) -- "When I think of menopause, I think of hate, pure clean hate," one woman said in the new documentary Hot Flash Havoc.

"I told my wife if she goes through menopause again, we're getting a divorce," a husband said.

Nevertheless, "you're very lucky to reach menopause," another woman said. "If you don't reach it, you have some troubles."

Hot Flash Havoc, a film of "menopausal proportions," is a documentary meant to examine menopausal symptoms, reveal the history and society's view on menopause and even question the results from an ongoing National Institutes of Health initiative, which, in 2002, discouraged women from taking estrogen plus progesterone to treat symptoms of menopause.

For some women, menopause symptoms are much more than the occasional hot flash. Depression, low libido, night sweats and panic attacks are only a few of the many indications that storm through the body of a menopausal woman.

The controversial documentary will be released to the public March 30.

The beginning of the documentary creates a playful dialogue on the experiences and expectations of menopause and menstruation.

For one woman, the roundabout way in which she was told about her feminine health left her confused for decades.

"Your Aunt Tilly is going to visit you once a month, and she's going to hang around for about 30 years," the interviewee described how her menstrual cycle was explained. "When Aunt Tilly dies, you'll know about it cause she won't come around no more. Who the hell is Aunt Tilly?"

The majority of the film documents the benefits of estrogen replacement therapy, commonly taken to curb hot flashes and other menopausal symptoms. It particularly criticizes a NIH Women's Health Initiative study, which, in 2002, found that women taking estrogen were at higher risk of certain cancers and heart disease. Researchers halted the clinical trial altogether in 2002 because of the noted increased risk.

Filmmakers and menopause experts interviewed in the documentary argue that the 2002 study results were misrepresented, and led millions of menopausal women to unnecessarily stop taking hormones that otherwise curbed debilitating symptoms sometimes associated with menopause.

And research released last week in the Lancet reignited this debate when a study found that estrogen-only hormone replacement therapy might lower the risk of breast cancer for some postmenopausal women. While the findings were specific to women who have had a hysterectomy, have no increased risk of breast cancer and no increased risk of strokes and blood clots, advocates of hormone therapy welcomed the results.

"Menopause has been this secret filled with shame, anxiety and confusion for centuries," said Heidi Houston, executive producer of the film. "The movie is intended to give information so every woman can make informed decisions about treating menopause and allow women to become health care advocates for themselves."

Prior to the 2002 study, some preliminary research found that the menopausal hormone therapy actually helped to decrease the risk of heart disease, but the preliminary data found the treatment did not decrease risk and put women at increased risk of some invasive breast cancers and stroke. Prior to the study results, hormones were one of the most prescribed drugs in the country.

But the use of estrogen dropped by 71 percent from 2001 to 2009, according to the North American Menopause Society.

"Women with a uterus who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it," Dr. Jacques Rossouw, acting director of the WHI at the time, explained in 2002. "If they are taking this hormone combination for short-term relief of symptoms, it may be reasonable to continue since the benefits are likely to outweigh the risks. Longer term use or use for disease prevention must be re-evaluated given the multiple adverse effects noted in WHI."

Dr. Marcia Stefanick, a researcher on the WHI study, told ABC News that the questions the initiative set out to answer were not specifically on menopause, but about the health risks and benefits of menopausal hormones for older women, "for whom they were being prescribed to prevent common diseases of aging women (i.e. heart disease, osteoporosis and dementia)."

"As it turns out, menopausal hormone therapy did not reduce heart disease in older women and it increased strokes," Stefanick said.

The treatment indeed helps to curb hot flashes. It also helps prevent vaginal dryness and preventive bone loss, she said. While temporary use of the treatment likely has mild risks, women deserve to know them, Stefanick said. And menopausal hormone therapy taken for several years has shown an even greater risk of the adverse health conditions.

But critics of the study said the patient population was skewed. While the study included more than 16,000 women ages 50 to 79, the average age of women in the study was 63. On average, women begin menopause around 51 years of age, when most women will experience the most severe of their symptoms.

"There was no question that there were more risks for women over 60 years of age," Dr. June La Valleur, director of the Mature Women's Center at University of Minnesota Medical Center, wrote in an email. "Women need to have options and to say that no one should use estrogen or estrogen/progestin therapy for menopausal symptoms is absurd."

Dr. Alan Altman, president of the International Society for the Study of Women's Sexual Health and a menopausal expert interviewed on the documentary, told ABC News, "Women were instilled with fear that wasn't necessary and they need to understand that they can let that fear go and make a good, educated decision about menopausal hormone treatment."

New WHI data came out in 2008 and found that three years after women stopped taking the hormone therapy, increased risk of heart disease diminished. But women were still at a slightly increased risk of stroke, blood clots and cancer.

As for Houston, the executive producer said the motivation for the documentary came from her own challenges in dealing with menopause and not knowing all her options.

"Menopause is a natural change that is going to happen to everyone," Houston said. "I believe we have the right to have all the information available to us so we women can make our own choices. Whatever a woman's choice is, whether she wants to take hormones or not, it doesn't matter, as long as she has the options so she can decide on how to have the best quality of life."

Copyright 2012 ABC News Radio

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