Meet a Member of NACCAM
Margery L.S. Gass, M.D.
Margery L.S. Gass, M.D., is a member of NCCAM's National Advisory Council for Complementary and Alternative Medicine (NACCAM). Dr. Gass is professor of clinical obstetrics and gynecology, and director of the University Hospital Menopause and Osteoporosis Center, in the Department of Obstetrics and Gynecology at the University of Cincinnati. She is also a principal investigator for the Women's Health Initiative—a major 15-year NIH research program studying cardiovascular disease, cancer, and osteoporosis in women. Dr. Gass received her M.D. degree from the University of Cincinnati College of Medicine.
Why do women try CAM for help with menopausal symptoms?
Most women view menopause as a normal and healthy phase of their lifespan. If they are experiencing mild-to-moderate menopausal symptoms, they often prefer to try lifestyle changes and CAM before proceeding with approaches that require an appointment with a provider or a prescription.
In addition, some women are philosophically opposed to using hormone therapy, and others have a medical reason for not using hormone therapy—such as a personal history of breast cancer. Making lifestyle changes and using CAM can be ways for women to take some control over their health and increase their quality of life. Lifestyle changes can include minimizing one's exposure to bright lights and to appliances that give off significant heat, in addition to avoiding bedding that traps body heat too well.
What are some things women can do, from midlife through their later years, to help improve their health and prevent disease?
The key for staying healthy at midlife and beyond is very much the same as in younger years, but doing it even more conscientiously: healthy eating, aerobic exercise, muscle toning, staying fit, and avoiding weight gain and unhealthy behaviors such as smoking.
Women should be aware that it gets harder to lose weight when they get older. It is better to get it under control as soon as possible. Many women find they have to eat less and exercise more to maintain the same weight they always had.
They should also be aware that what a fitness trainer has young women do may not be appropriate for women at midlife and beyond. For example, doing a lot of "crunches" or sit-ups to improve your abdominal muscles may help flatten your abdomen but may also aggravate pelvic relaxation—a problem that begins for many women in midlife, when the supportive structures holding up the uterus and bladder begin to stretch out and weaken. This causes prolapse of these organs, a slipping down from normal position. Excessive abdominal exercises can actually worsen this prolapse. On the other hand, toning the muscles along the spine (called the spinal extensors) may help prevent some of the forward curvature of the spine that happens with age. Maintaining regular sexual activity helps keep intercourse more comfortable and enjoyable as a woman ages.
Are there any areas in women's health that you think are especially compelling or promising for exploration of CAM therapies?
Most women view menopause as a normal and healthy phase of their lifespan. —Dr. Gass
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Dealing with the aches and pains of aging is a challenge. In addition, many women have osteoarthritis and fibromyalgia. Effective CAM approaches could have an important role in helping to ease pain and avoid the side effects of conventional medications. Alternatives to hormone therapy are very much needed for the alleviation of severe hot flashes in those women who cannot or do not want to take hormones.
From your service on Council, what do you see as the challenges in CAM research today?
From my perspective, the challenge for CAM research is to put the results of high-quality studies into a broader context. For example, a CAM therapy might not perform as well in a study as a prescription drug with regard to the main outcome, but the participants using the CAM treatment might have fewer side effects, fewer tests, and more peace of mind. Some women would prefer the CAM scenario to that of the prescription drug where there may be greater efficacy but also more office visits, tests, and side effects. It may not be possible to do this in all studies, but it would be helpful to patients and providers if CAM research can go beyond the primary outcome and capture all aspects of the treatment that patients value.
Selected References
- Gass ML, Kagan R, Kohles JD, et al. Bone turnover marker profile in relation to the menstrual cycle of premenopausal healthy women. Menopause. 2008;15(4):667–675.
- Gass ML. Highlights from the latest WHI publications and the latest North American Menopause Society position statement on use of menopausal hormone therapy. Cleveland Clinic Journal of Medicine. 2008;75(S4):S13–S16.
- McKenzie M, Sikon AL, Thacker HL, Gass ML. Putting the latest data into practice: case studies and clinical considerations in menopausal management. Cleveland Clinic Journal of Medicine. 2008;75(S4):S25–S33.
