This book isn't about cancer, and it only touches upon menopause that is induced medically or surgically. Still, I decided to include it here because it talks about how important estrogen is to all different parts of the body, which is relevant because my hormone therapy has actually eliminated all my estrogen production. Here is my 2-star review as posted on Goodreads, followed by some additional thoughts.
This book was written by a naturopathic doctor. I am a strong believer in science and evidence and data, which means I do not generally subscribe to
naturopathy or other forms of alternative medicine. I do, however, acknowledge that the human body is complex, and there is still so much we don't know, which means there may be some aspects of alternative medicine that really do work, and we just haven't done the studies yet.
I appreciate that the author did not try to replace conventional medicine. In the introduction, she explicitly asked the reader to "speak with your doctor or pharmacist about possible interactions with your medical conditions or medications" (p. viii) when trying her recommendations. I also liked that she included "How to speak with your doctor" sections in which she provided helpful language and wording that can be used to bring up topics with medical doctors.
I think the average, healthy woman turning 40 will find valuable information in this book, and I want to emphasize that my rating is a reflection of my personal experience reading it. Here's why I picked it up: While in my early 40s, my treatment for hormone-positive breast cancer involved eliminating estrogen from my body, which meant taking medication that put me into medically-induced menopause, and then later getting my ovaries removed, which put me into surgically-induced menopause. I have experienced all the usual symptoms of menopause, but the most common suggestion for managing symptoms is to get hormone replacement therapy (HRT), which is not an option for me because it would completely undermine my breast cancer treatment. So, I am looking for natural remedies to manage symptoms of menopause.
As it turns out, surgically-induced menopause is quite a bit different from natural menopause, and I was discouraged when the book stated early on that "surgically and medically induced menopause...can produce stronger symptoms than natural menopause and almost always requires estrogen plus progesterone therapy" (p. 9), which I already know is contraindicated for me because of my hormone-positive breast cancer. Just a few pages later, I was encouraged to read, "If you don't want to take hormone therapy, that's perfectly okay because there are other options for many symptoms." (p. 17) I did manage to come away with some helpful suggestions, mostly from Chapter 5 "General maintenance for perimenopause and beyond," Chapter 7 "Rewiring the brain: help for hot flashes, sleep, migraines, memory, and mood," and Chapter 10 "What comes after."
The writing was straightforward, and the content was conveniently broken into easily digestible chunks. Still, I think the information could have been organized better; the author frequently restated the same information and constantly redirected the reader to other chapters, making the text feel disjointed and repetitive. I read the book cover-to-cover because I wanted to know everything, but perhaps this book would best be used more as a reference, where you skip around and read only the sections that are immediately relevant to you. Incidentally, the author referenced Professor Jerilynn C. Prior so often that I wondered if maybe I should go straight to the source and read her works instead!
I would actually rate this book 2 1/2 stars, but since Goodreads doesn't allow for half-stars, I rounded down to 2. I was put off when I read that "the only time estrogen plus progesterone therapy is truly needed is for the prevention of long-term health risks associated with early or medically induced menopause." (p. 128) The word "needed" irked me; given my medical condition as described earlier, even if I "need" hormone therapy for long-term health, I am absolutely not a candidate. The author only mildly dialed back her statement about 10 pages later when she acknowledged, "If you have a personal or family history of breast cancer, you will probably be counseled to avoid estrogen therapy." (p. 139) I guess people with a history or high risk of breast cancer who experience early/medical/surgical menopause are just considered an exception case, and I felt like the message to me was:
Hmm. You don't fit into any of the standard boxes. Looks like you are now doomed to poor health with "an increased risk of osteoporosis, heart disease, dementia, and premature death." (p. 140) (For the record, I was aware of these long-term risks associated with surgical menopause before I had my ovaries removed, but they were outweighed by the more pressing risk of breast cancer recurrence.)
Also, I wasn't comfortable with the way the author made assumptions about what my doctor may or may not know, e.g., when she wrote, "Your doctor thinks progesterone's only job is to protect the uterus, but it has many other benefits." (p. 138) Moreover, for almost the entire book, every time she mentioned talking to "your doctor", I imagined a patient talking to their primary care physician or a gynecologist, but it wasn't until late in the book that one of her "How to speak with your doctor" suggestions included, "Should I have a referral to a gynecologist to discuss this possibility?" (p. 227) The realization that gynecologists were not already implicitly included in all previous references to "your doctor" shocked me! I guess it does not go without saying that if you have concerns about menopause or menstrual health, a gynecologist would be a great place to direct questions; if insurance is a hindrance, look for a
Planned Parenthood near you.
Some additional thoughts:
I've always understood that
getting Lupron and
removing my ovaries were forms of
ovarian suppression, a type of hormone therapy that eliminates most of the estrogen in my body so hormone-positive breast cancer can't feed on it. I also know that
taking an aromatase inhibitor pill (exemestane, and then anastrozole) finishes the job of estrogen elimination by stopping estrogen production in places other than my ovaries, a condition that does not occur in natural menopause. I don't know if I thought random cells were just making estrogen for fun, but it's only after reading this book that I now realize that the aromatase inhibitor is depriving my heart, brain, liver, muscles, and other tissues of the estrogen they need to function properly.
Because this book is based on naturopathy, I made sure to follow up on this idea with a search for corroborating evidence from a
reputable source, which confirmed:
"Although the roles of estrogens in gonadal organs are well understood, recent studies have begun to demonstrate that localized estrogen production plays tissue-specific roles, with or without dependency on circulating estrogen. The cell- and tissue-specific actions of estrogen and ERs are directly involved various age-related diseases. Nevertheless, it remains unclear how the local synthesis of estrogens and their respective receptor functions are controlled in normal aging. We believe that estrogens are no longer just sex hormones, but important therapeutic targets for preventing diseases as disparate as osteoporosis, heart disease, and neurodegeneration."
Well, my oncologist has said that I should expect to take an aromatase inhibitor pill for 10 years total, so I guess I can hope that when I stop, when my various tissues are able to produce estrogen locally again, maybe some of my menopause symptoms will improve, and maybe some organs or systems will be able to function better, in ways I don't even know.
