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T A B L E++T A L K

Is it possible to pack a nutritious brown bag lunch? Share your tips and tricks in the Mothers area of Table Talk

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R E C E N T L Y

Turning the tables on Terry Gross
By Lori Leibovich
Salon gets personal with NPR's maestro of conversation
(06/22/98)

Don't complain. Don't explain.
By Gina Hyams
The final days of a difficult father
(06/19/98)

Don't call me Mom
By Susan McCarthy
Why I'm Susan to my kids
(06/18/98)

Are we there yet?
By Ann Hood
What had I left in the Florida of my childhood vacations that I wanted my children to find?
(06/17/98)

Nursing death
By Dawn MacKeen
Can breast-feeding be deadly?
(06/16/98)

BROWSE THE MOTHERS WHO THINK HOT FLASH ARCHIVES

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Mamafesto
By Camille Peri
Why it's time
for Mothers Who Think

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BY JENN SHREVE | Thirty-nine million baby-boomer women have begun, or are entering, menopause. Most will experience one or more menopausal symptoms including hot flashes, insomnia and vaginal dryness. And a large number will be faced with the decision of whether to take hormones such as estrogen, progestin and progesterone. Currently, as many as 32 percent of women in the United States are receiving hormone treatment of some kind.

It's not an easy decision to make: The slim body of information available on hormone therapy is often incomplete, contradictory and downright confusing. Hormones have been shown to alleviate unpleasant menopausal symptoms, and many studies show they reduce a woman's risk of death and suffering from heart disease and osteoporosis. At the same time, so-called hormone replacement therapy is linked to breast and endometrial cancers. And a recent slew of inconclusive studies indicates that taking hormones may reduce a woman's risk of getting ailments such as Alzheimer's disease and strokes, but increase the risks for gall-bladder and thromboembolic diseases.

Dr. Susan Love attempts to dispel the confusion around hormone treatment with her latest offering, "The Hormone Book." Love is best known for "Dr. Susan Love's Breast Book," a women's guide to the prevention and treatment of breast cancer, based on more than 20 years of her work as a breast surgeon. In 1991, she co-founded the National Breast Cancer Coalition, which has drawn national attention to the issue and raised research funding by millions of dollars. She is now a professor of surgery at the University of California at Los Angeles.

Love's career has not been without controversy. A champion of breast-conserving surgery -- a lumpectomy followed by radiation, instead of a radical mastectomy -- she's been accused of risking women's lives for cosmetic reasons. Now critics claim her stance on hormone therapy -- in most cases she thinks it should be used only as a last resort -- is skewed in favor of preventing breast cancer over preventing heart disease, which kills an estimated 485,000 American women a year, nearly 10 times the number who die of breast cancer.

Love's endorsement of herbal and other alternative treatments has also drawn criticism from some members of the medical community. In Sunday's special Women's Health section of the New York Times, Dr. Richard Friedman, director of psychopharmacology at New York Hospital-Cornell Medical Center, dismissed the notion of herbal remedies as "romantic." "Like all ideology, it's dangerous," Friedman was quoted as saying. "The bottom line should be, if it works and it's safe and effective, what does it matter where it came from?"

Love's personal life has raised eyebrows in the traditional, conservative medical establishment as well. An open lesbian, she has lived with her companion, Helen Cooksey, since 1982. In 1988, using sperm donated by Cooksey's cousin, Love gave birth to their daughter, Kate Cooksey Love.

Salon spoke with Love by phone at her office in Los Angeles about the pros and cons of hormone therapy, the misconception of menopause as a "disease" and the possibility of eradicating breast cancer in the next five years.

Hormones and menopause are a change of topic for you after dealing with breasts and cancer for so many years. What made you decide to switch gears?

It's not really that much of a change in topic. The question I was asked most commonly by my patients and by women when I gave talks about breast cancer was: "Are menopausal hormones safe?" I also became very concerned at what I saw as this growing, almost universal use of hormones, and people ignoring the breast cancer risks associated with them. So it's really part of the same breast cancer story, but just a little broader. The other part of the story is that I'm 50 and was flashing myself so I decided to figure it out.

What was it like to be going through something and writing about it at the same time?

It was good. Granted, I don't think every doctor has to get the disease they specialize in, but I do think it gives you much more insight into what you're talking about.

Part of what you do in the "Hormone Book" is clear up confusion about exactly what menopause is. What are some common misconceptions?

The notion of menopause has been that your ovaries just shrivel up, dry up and become useless. That's been the image of postmenopausal women to boot. In fact, that's not the case. Women who go through natural menopause continue to make hormones well into their 80s, albeit at a lower level. We need high levels of hormones to reproduce, but we don't need to have them as high throughout our lives.

You are fairly critical of pharmaceutical companies and, sometimes, of other doctors.

Pharmaceutical companies have marketed hormones to us and to physicians pretty strongly, and the message has not always been totally accurate. At this point in time, we actually have not proven that hormones prevent heart disease, and yet that's the message that's out there. [Proponents of hormone therapy] believe all the observational data that says taking hormones may prevent heart disease, yet they pooh-pooh the observational data that shows it may lead to breast cancer. You can't have it both ways.

Also, the reframing of menopause as a disease or at least as a deficiency needs to change. Calling hormone therapy "replacement therapy" implies that you're replacing something that's missing rather than adding something that's not routinely there.

So calling menopause a disease or a deficiency isn't accurate?

Those words imply that the premenopausal woman is normal and the postmenopausal woman is diseased and needs to be fixed or replaced or put back into a premenopausal woman. That's crazy. Menopause is programmed in and it's programmed in most likely because it's not good for us to have high levels of hormones at all times.

What do you think this misconception stems from?

Maybe part of the reason for this misconception is that the model for how we deal with menopause is having your ovaries out. The assumption is that women who go through natural menopause will experience exactly the same thing as women who have their ovaries out, which is not true. The fact is, since most women have some hormone production well into their 80s, the ovaries don't stop working, they just shift to a different level. Also, maybe that lower level is adequate for preventing things like osteoporosis, one of the main reasons women are prescribed hormone therapy. There's a new study showing that women who have at least 5 picograms of estrogen, which is a very small amount, actually have 50 percent less osteoporosis. So you don't have to be making hormones at the levels of a premenopausal woman in order to prevent osteoporosis.

N E X T+P A G E: The total eradication of breast cancer