No More Hot Flashes...And Even More Good News

Introduction

No More Hot Flashes and Other Good News was a New York Times best-seller in 1983. That was a special thrill for me, for it meant my theories about women and their health care were on target. Over the years, No More Menstrual Cramps and Other Good News (1980) and No More Hot Flashes and Other Good News (1983) have been considered classic books on women's health, helping to create the basis of the women's health movement. Indeed, a number of medical schools have assigned both books as required reading, and many universities today use the books in their Psychology of Women classes. Departments of radiation therapy and many physicians have also used the books for patient information.

It seems amazing that until 1996 No More Hot Flashes and Other Good News was selling steadily and remained very much up-to-date. Perhaps this was because it was ahead of its time. When the book was published, my views on hormone replacement therapy, lumpectomy and radiation therapy for breast cancer, and second opinions and medical alternatives to hysterectomies were considered radical by some. But lumpectomy and radiation therapy have become the procedure of choice for early breast cancer, many doctors now agree that some type of replacement therapy should be considered for the majority of postmenopausal women, and finally, there really were too many unnecessary hysterectomies.

Now we hear this information all the time, in magazines, on talk shows, television, and radio. However, I was publicizing women's health issues, and television and radio were airing my seminal research on menstrual pain,1 all the way back in the seventies. In Seattle, I did the first television program ever on menstrual pain and had scores of women follow me back to my hotel room in hopes of getting more information. I did three separate solo hours on Donahue, was on Oprah three times, and did more television, radio, and print interviews than I care to remember.

I lectured throughout the United States and in London, Berlin, and Cape Town to physician audiences back when physician audiences were one hundred percent male and not very sympathetic to women's health issues. I have seen many changes in medical and surgical care over my thirty years in practice, and equally important, I have seen tremendous change in women as patients. Almost all of it is good. I cannot say that we do not have a way to go, to more equal research, to more equal care, but we are well on our way.

Those of us who are fifty or older share common experiences, for example, our mothers' secrecy about their age. Now women are more open about their age and often announce it while referring proudly to their well-toned bodies and muscular legs. Then there are the changing attitudes about marriage. When I was twenty-one, although I was a busy second-year medical student, I felt I was over the hill and overdue to get married. I married at twenty-two. Most of my patients today are well into their thirties and still single. And few of them feel guilty. In just three decades, mind-sets about an institution as basic as marriage have done a 180-degree turn.

I belong to a generation that has had to adjust to tremendous social change. Social values, morals, economic pressures, and feminist consciousness-raising have radically changed our everyday world. Our choice is either to accept change and forge ahead with our younger sisters or be left behind. New health issues have come to the forefront. AIDS has become a fact of life, not only for the younger single woman, but for the older woman who seeks a sexual relationship. I give virtually the same lecture on AIDS protection to the fifteen-year-olds and the sixty-year-olds in my practice. This information is equally relevant to both.

Heart disease in women is finally getting the attention it deserves as the number one killer of women. Give a lecture on menopause, and you will have a standing-room-only group of women and a few questioning men. The baby-boomer generation has had their first hot flashes and menopause has become an important issue to a new generation of women.

I was and still am dedicated to educating women about their health options and would like to share with you some of what I have learned in thirty-plus years of practice and twenty years of advocacy for better women's health.

Since my last book, my time has been filled with another all-consuming project. It was apparent to me by the late seventies, that women were at a double disadvantage: as the patient in the doctor/patient relationship, and the female in what was mostly a male/female role. Worse, their care was fragmented. The medical establishment had divided women's bodies into two parts, medical or reproductive. I was a family doctor and accustomed to thinking holistically: that women were total human beings, not thyroids, pelvises, or breasts. Not only were women not receiving comprehensive care, but also issues of special interest to women were neglected. In addition, it was important to have women participate in the treatment decisions that would affect their bodies and their lives. Women needed a place where their complaints would be taken seriously. In 1980, I began to plan a women's center where family doctors and specialists interested in women and women's health problems could pool their efforts to give women the best care available, a center where preventive medicine was key. There, women would have the results of their mammography, or sonography, within minutes.

It took five years to get a bank loan. Male bank presidents just couldn't understand how such a center could make any money when "we were eliminating half of the population right off the bat." But in 1985, the Penny Wise Budoff, M.D., Women's Health Center finally opened, because my husband finally found one bank president who believed in me and my idea.

Compliance is a major problem in the practice of medicine today. Having multiple services under one roof makes patient compliance more likely. It's hard to miss your mammography appointment when the doctor walks you down the hall to the X-ray technician. Perhaps equally important is the fact that each patient in the center has one chart, no matter how many physicians she may see over the years. One chart helps to assure that there is no overprescription or medications that don't mix. A complete history of prior illnesses, therapies, and lab tests is on one chart so that duplication of lab tests or X rays is avoided. One chart helps to coordinate care between primary care doctors and subspecialists who may see the same patient.

In 1992, the center became part of North Shore University Hospital/New York University Medical Center. At about that same time, I had the privilege of speaking to more than five hundred CEOs and trustees of the major voluntary hospitals across the United States about the benefits of establishing multispecialty women's centers. In addition, since 1985 doctors and administrators from many states as well as Canada have toured the facility in order to learn how to set up their own centers. I have been happy to see this concept spread as I feel strongly that dedicated multispecialty centers offer the very best and most convenient care for women.

Meanwhile, I have gotten older. Haven't we all? Getting older is not easy. It's often been said that "the golden years are not for sissies." No More Hot Flashes is not a glossy, upbeat book about how fabulously happy postmenopausal women are, or how they have fantastic sex. This book is honest, written by a doctor who is also postmenopausal and who has cared for thousands of women and their physical and mental concerns for the past three decades.

I think that nearly all women who decide to take hormone replacement can have a positive experience. The problem is, few doctors have a major interest in menopause. They use one estrogen and one progesterone. When a patient complains of side effects, she is simply told to stick it out, or the dose of the same drug is increased or decreased. Well, that's not the way it should be. This is the art of medicine. By choosing the correct estrogen to begin with, and making modifications as needed, nearly every woman who chooses to take hormonal therapy should be satisfied.

You therefore need to know when you are in good hands, or equally as important, when you are not. How will you know? Basically, you have to work to become educated. You have to know what questions to ask to ascertain whether or not your care is up-to-date. This book was designed to help you do just that. Get educated about your body and learn what your choices are before you make decisions.

It used to be a lot easier. Doctors made all the decisions and patients complied. Part of the difficulty now is that women are asked to help make these decisions. How to become a partner in your care is the thrust of this book. It will take you from your physical examination to the intricacies of necessary lab tests. It also will arm you with in-depth knowledge about your health. If you have been diagnosed with one of the problems discussed in this book, you should read every detail in that chapter. Where chapters will give you more information than you need, use what you need today and save the rest for reference. I hope you'll never need it.

We have an enormous challenge ahead of us. We must give equal care to women . . . no longer is second-class research or second-class care acceptable. But the good news is, when we improve health care for women, we will improve health care for men as well. What is good for the goose is good for the gander. Coordinated care, easy access, instant results, preventive medicine plus time to talk are benefits that are not limited to women's health. We all know that.

I have always felt a keen responsibility for the precious seat I was granted in medical school. I have had tremendous energy, and for many years continued to see patients and do research during the day and write at night. I love what I do, and I love my patients and am thrilled that I had the chance to become a physician. And so I am excited to continue to type on my computer long into the nights until this book contains all that I think any mature woman needs to know about her body and how to take care of it.

For the first time, women have the clout that is needed to influence and shape their health care. This is the time to acknowledge that you really do have the ability to optimize your future. Read the book, take good care of yourself and enjoy.

Note 1. P.W. Budoff, "Dysmenorrhea, New Treatment," letter, American Journal of Ob/Gyn, September 15, 1977; idem, "Mefenamic Acid in the Treatment of Primary Dysmenorrhea," Journal of the American Medical Association 241, no. 25 (1979): 2713-16; idem, "Mefenamic Acid for Dysmenorrhea in Patients with Intrauterine Devices," Journal of the American Medical Association 2, no. 7 (1979): idem, "Zomepirac Sodium in the Treatment of Primary Dysmenorrhea Syndrome," New England Journal of Medicine 307 (1982): 714-19.

Copyright 1998 by Penny Wise Budoff. M.D.
Excerpt posted with permission from http://www.twbookmark.com

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