“I started taking estrogen because I thought I was going crazy. Then the studies on hormone replacement really made me nuts. What’s a woman to do?”

If you are in perimenopause or menopause, you know this feeling. Do you or don’t you seek hormone replacement therapy? If so, do you go with synthetic or bio-identical hormones? And do you stay on it for a long time or just use it as a short-term battle plan against hot flashes and other symptoms? Plain and simple, if you have ever asked yourselves any of these questions, you must read Cynthia Gorney’s weekend article in the New York Times magazine.

Gorney tells her own story, first of the puzzling dark “Pit” she would fall into periodically, then of the experience of how her estrogen patches helped pull her out of that pit and gave her her mind back. But she also explores, deeply and relevantly, the science behind estrogen therapy, the conflicting scientific and emotional views of it, her rollercoaster search for answers, and – in laywoman’s terms – the tsunami of hormone replacement research, the 2002 Women’s Health Initiative study that produced so many warnings and so many worries about HRT.

Gorney writes:

“The patches my gynecologist prescribed worked, by the way. I didn’t understand how, beyond the evident quieting of some vicious recurring hormonal hiccup, and neither did the gynecologist. But she had other women who came in sounding like me and then felt better on estrogen, and I would guess many of them, too, decided after the W.H.I. news that they could surely find other ways to manage their “mood swings,” to use the wondrously bland phrasing of the medical texts. (I’m sorry, but only someone who has never experienced one could describe a day of “I would stab everyone I know with a fork if only I could stop weeping long enough to get out of this car” as a “mood swing.”) We muddled along patchless, my mood swings and my patient family and I, until there came a time in 2006 when in the midst of some work stress, intense but not unfamiliar, I found myself in a particularly bad Pit episode and this time unable to pull out.

“It was profoundly scary. In retrospect, I managed a surprising level of public discretion about what was going on; competence at the cover act is a skill commonly acquired by midlife women, I think, especially those with children and work lives. If the years have taught us nothing else, they have taught us how to do a half dozen things at once, at least a couple of them decently well. Like other women I have met recently with stories like this one, I relied for a few months on locked office doors, emergency midday face-washings and frequent visits to an increasingly concerned talk therapist. But one afternoon I got off my bicycle in the middle of a ride with my husband, because I had been crying so hard that I couldn’t see the lane lines, and I sat down on the sidewalk and told him how much I had come to hate knowing that family obligations meant I wasn’t allowed to end my life. The urgent-care people at my health clinic arranged a psychiatric consult fast, and after listening and nodding and grabbing scratch paper to draw me an explanatory graph with overlapping lines that peaked and plunged, the psychiatrist wrote me two prescriptions. One was for an antidepressant.

“The other — I recognized the name as soon as she wrote it down — was for Climara, my old estrogen patch.”

At the five-year mark on the patch, Gorney started thinking about the “low dose, stop soon” advice given to women regarding hormones. So she did what reporters do best: She went in search of information. Real information , that would be of real help.

Which is why we find her in a brain scientist’s laboratory in the beginning of the story. And why she wrangles her way into a scientific symposium on the timing of hormone therapy, a symposium meant for only research scientists and physicans. And why she explores an National Institutes of Health cognitive trial in Northern California. And interviews gynecologists and geriatricians. And a Harvard medical professor, and a USC scientist, and the author of “Hot Flashes, Hormones and Your Health.” And does a lot of other things that you and I might do if we were suddenly turned loose to find our own personal answers.

That’s enough from me. If you have more time, go read the story. Bookmark it. Print it out. Take it to your doctor’s office. It’s a fine, fine piece for any woman trying to solve her own puzzle.

From the New York Times Magazine:
http://www.nytimes.com/2010/04/18/magazine/18estrogen-t.html?pagewanted=1