TAKING CHARGE OF MENOPAUSE : BOOMERS SEEKING BETTER WAY TO COPE WITH THE `CHANGE'.

Byline: Carol Bidwell Daily News Staff Writer

Menopause wasn't much of a problem for the great-grandmothers of today's baby boomers. Women around the turn of the century generally didn't live long enough to experience it.

Most women in the next two generations - the grandmothers and mothers of the boomer generation - just quietly gritted their teeth and accepted the ``change of life'' as a sign of old age.

But today's women, who live well beyond the menopausal stage, don't have to passively accept the passing of their child-bearing years, say the Los Angeles-area authors of three new books on women's health.

``Remember the T-shirts we used to wear that said, `Question Authority'? We see these changes in ourselves and we try to see if there's a better way of dealing with them than our mothers and our grandmothers did,'' said clinical psychologist Lynne Steinman, 43. ``Baby boomers are not going to sit there and say, `What happens happens.' We think it's important to take charge of menopause, and you need all the information you can get to do that.''

How to cope with the changes that come when a woman's ovaries stop producing estrogen is a subject that's still open to debate.

Even the standard bearers for the medical profession can't decide what's best. Two 1995 studies reported on in the Journal of the American Medical Association reach opposite conclusions on whether giving replacement estrogen to menopausal women increases the risk of breast cancer. In a 1994 report, a committee of the American College of Obstetrics and Gynecology said more than 50 studies failed to show that replacement estrogen increases breast cancer risk; ACOG favors the use of both estrogen and progesterone to protect against an increased risk of endometrial cancer that most doctors agree can result from taking estrogen alone.

Likewise, the three leading authors on the subject don't agree.

Difference of opinion

Steinman, two other psychologists and two medical doctors who make up Pacific Mental Health Centers in Santa Clarita neither recommend nor discourage hormone replacement therapy (HRT; estrogen and progesterone combined) in ``The Taking Charge of Menopause Workbook.'' They merely detail the arguments on both sides so women can decide for themselves.

But Dr. Judith Reichman, 51, a gynecologist at Cedars-Sinai Medical Center who this month will host a two-part PBS TV series, ``More Straight Talk on Menopause & Women's Health,'' based on her book, ``I'm Too Young to Get Old,'' supports prescribing HRT for most women. According to Reichman, the benefits - protection against heart disease, osteoporosis, Alzheimer's disease, uterine and colon cancer - generally outweigh the risks.

On the other hand, Dr. Susan Love, 49, a breast cancer surgeon and adjunct associate professor of clinical surgery at the University of California, Los Angeles, in the newly released ``Susan Love's Hormone Book'' paints a grim picture of the diseases HRT might cause - including increased risk of breast, ovarian, lung and skin cancer, gallbladder problems, blood clots, endometriosis, lupus and asthma.

Whom should you believe?

Yourself, all three authors agree. They advise women to keep up on the latest medical reports, find a doctor who will answer your questions and weigh the risk factors based on the most recent medical findings, your own lifestyle and your family medical history.

``It's easy for a doctor to give a woman hormones, but what's right for one woman may not be right for another,'' said Steinman. ``You have to do what's right for you.''

And, above all, the three women urge, don't let anybody convince you that menopause is a disease that has to be ``cured.''

``It's a natural transition,'' said Reichman. ``Our society has imbued this transition with so much negative symbolism that I sometimes feel like a mother trying to rescue her child from a cult.''

Boomers' time near

About 20 million baby boomers - most of them between the ages of 45 and 54 - will enter menopause in the next decade or so. What used to be delicately termed ``the change'' is defined medically as the cessation of menstruation and the end of a woman's childbearing years, after her stock of healthy eggs dwindles with a corresponding drop in the levels of the female hormone estrogen.

But body changes during perimenopause, the four to seven years leading up to the last menstrual period, are what send most women seeking medical help. Those changes can include hot flashes, insomnia, painful intercourse, short-term memory loss, mood swings and confusion; without treatment, those symptoms can last from a year to 10 years, according to medical sources.

Reichman urges women to find a doctor interested in helping them both alleviate short-term menopausal symptoms and head off future age-caused illnesses. But that can be difficult, she said, because many gynecologists seem to lose interest in menopausal women, for whom they no longer can prescribe birth control or deliver babies.

And that makes her angry.

``If we outlive our ovaries, does that mean we're useless? We're starting to outlive our ovaries by a third to half our lives,'' Reichman said. ``And I'm appalled by the way some doctors talk down to us. If you went to buy a car and the guy insulted you, you wouldn't buy the car from him. Why take that from a doctor?''

Restoring sex drive

HRT not only can protect against diseases many women fall prey to with aging, but can restore a woman's vitality and energy, sex drive and natural sleep patterns, she said. Although the decision to take or reject HRT is an individual one, Reichman said she generally urges women to give it a try unless they've been treated for breast cancer within the past five years.

Love, who spoke last week at a Beverly Hills luncheon sponsored by a cancer counseling and support group, agreed that HRT can provide women almost instant relief from hot flashes, insomnia and other irritating symptoms of menopause, and admits that there are no studies that show replacement hormones cause health problems when used for five years or less.

But, she contends, not enough long-term testing has been done to prove that HRT helps rather than hurts a woman's health when used for many years.

A few generations ago, when the human life span was shorter, taking hormones as a matter of course may not have mattered as much. Now, with the average American woman living until her mid-70s to mid-80s, women who opt to take hormones for the rest of their lives, as some doctors recommend (others advocate tapering off after menopausal symptoms disappear), could end up taking them for 25 years or more, or up to the last third of their lives.

``I fully admit that I'm scared of hormones because of my experiences treating women with breast cancer,'' she wrote in her book. ``You need to know exactly what you're risking. To give all women drugs to prevent heart disease when we don't have randomized, controlled data to show that they work seems crazy to me.''

If HRT does prevent osteoporosis and heart disease, maybe it should be prescribed for women in their mid-60s who are likely to soon develop those problems, rather than giving hormones to all women on the chance that they will develop those ailments years later, she suggests. (Only one in 25 women ever will get osteoporosis, she says, but a woman's natural estrogen causes breast cancer, and extra estrogen increases that risk.)

``You might end up trading a broken wrist for breast cancer,'' Love said.

Instead of popping a hormone pill, Love suggests that women seek relief from menopausal symptoms - and ensure their long-term health - by changes in diet (including ingesting soy products such as tofu), exercise, bone-building drugs, herbal remedies, vitamins, meditation, massage, biofeedback and acupuncture.

Although even the experts differ on how to slide comfortably through menopause, don't despair, Steinman advises women.

``It's up to you to be an equal member of your medical team,'' she said. ``And that requires some assertiveness on a woman's part. But that's something our generation is pretty good at.''

Where to find additional information

Dr. Judith Reichman's PBS series ``More Straight Talk on Menopause & Women's Health'' will be broadcast later this month. The first program, ``Assessing Our Health,'' explains how dwindling estrogen can affect women in their 40s and 50s. The second show, ``Charting the Course,'' explains what medical tests and treatments women over 40 need to stay healthy and vital. The two hourlong shows will air back to back beginning at 8 p.m. Wednesday and 2:30 p.m. Saturday on PBS.

``I'm Too Young to Get Old'' (Random House; $25), on which the series is based, covers not only menopause but other women's health issues, including sexuality and pregnancy after 40; urinary incontinence; and the risks of cancer, heart disease and stroke.

``Dr. Susan Love's Hormone Book'' (Random House; $25) provides charts and graphs to show the incidence of heart disease, osteoporosis and other diseases in postmenopausal women, along with checklists to help a woman determine her risk factors for these diseases and decide whether to try hormone replacement therapy or to seek out alternatives. It also provides sources for herbal and other alternative remedies and a list of organizations that deal with women's health issues.

``The Taking Charge of Menopause Workbook'' (New Harbinger Publications; $17.95) is filled with checklists of changes women may experience as menopause approaches and issues they should discuss with their doctors, plus a long list of resources for more information on menopause. Half the volume deals with the psychological aspects of the physical process, even offering advice for husbands on understanding what their wives are experiencing.

The authors of ``The Taking Charge of Menopause Workbook'' have two book signings scheduled: at 7:30 p.m. March 27 at Barnes & Noble Booksellers, 731 San Fernando Road, Burbank, and at 3 p.m. April 20 at the Barnes & Noble store at 8800 Tampa Ave., Northridge.

CAPTION(S):

Drawing, 3 Photos, Box

Drawing: (Cover--Color) A NATURAL TRANSITION

MENOPAUSE

Photo: (1) `We think it's important to take charge of menopause, and you need all the information you can get to do that.'

Lynne Steinman

(2) `I fully admit that I'm scared of hormones because of my experiences treating women with breast cancer.'

Susan Love

(3) `We're starting to outlive our ovaries by a third to half our lives. And I'm appalled by the way some doctors talk down to us.'

Judith Reichman

Box: Where to find additional information (See Text)