Trucker MD
Women's health and hormone replacement therapy

John McElligott, MD
Jeffrey Heinrich, Ed. D, PA-C

Female professional drivers make up somewhere in the neighborhood of 5.2 percent of all truck drivers in the U.S., according to the census data. That means there are as many as 200,000 of them out there behind the wheel.

It is estimated that the average age of female drivers is less than their male counterparts at about 45 years of age. More women are choosing this profession every year.

While the differences between men and women are obvious, until the 1970s the medical community viewed males and females as being the same except for the reproductive system. But men and women are different – biologically, psychologically and socially. In the 1980s, advocates for women’s health began to define female health issues more broadly and an increased emphasis was placed on female research studies.

So what are the benefits?

  1. Fewer hot flashes;
  2. Night sweats improved;
  3. Fewer sleep difficulties;
  4. Less vaginal drying and atrophy associated with sex;
  5. More energy and a sense of well being.

The Women’s Health Initiative (WHI) was established by the National Institutes of Health in 1991 to study causes of postmenopausal quality of life, disability and death. The WHI was one of the largest prevention studies ever to be conducted in the United States. As a result of all these studies, we have three decades’ worth of data on hormone therapy, diet, calcium and vitamin D supplements, breast, uterine and colorectal cancer, to name a few.

Why are female drivers different from the average women who were included in these research studies? As a general rule, women in the general population have easier access to medical care than the female long-distance driver who spends endless hours on the road. A lack of medical insurance among women truckers also plays a big role in not pursuing medical care.

The lifestyle of truck drivers, which differs greatly from that of the general population, needs to be taken into account. Drivers can battle long work hours with associated fatigue, boredom, loneliness and even depression. Stress, smoking, obesity, poor diet, lack of exercise and sitting the greater part of most days play a unique role in the health of female drivers.

Treatments available
for women who are under the care of a physician:

  1. Botanical products exhibit estrogen action. These botanicals are derived from soy and herbs, but their safety has not been determined. They are over-the-counter products.
  2. Antidepressants can relieve the hot flashes in some cases. WHI reports moderate effectiveness.
  3. Lifestyle changes can be helpful in mild cases of hot flashes. This includes reducing stress, avoiding spicy foods and staying away from caffeine. More activity, exercise and good sleep also help reduce the symptoms of menopause.
  4. Estrogen therapy can be delivered by pill or topical cream applied to the vaginal area. Estrogen alone is risky and needs close follow-up. Patients need to be selected carefully and must be properly informed of the risks.
  5. Estrogen with progesterone carries risks that are similar to estrogen alone, such as heart disease and breast cancer.

With age, certain changes happen naturally in women, regardless of one’s profession. Hormone levels that protect females from heart disorders and other diseases steadily decline. When a woman becomes premenopausal, these protective barriers decline. And when menopause has started, lifestyle risk factors become very important.

If a woman’s risk factors include smoking, obesity, inactivity or a family history of heart disease or strokes, then starting this patient on hormone replacement (HRT) becomes very difficult. If none of the aforementioned risk factors are present and the woman is in excellent health, starting HRT is more feasible.

HRT in high risk patients has been associated with an increased risk of heart attack, breast cancer, endometrial cancer, blood clots, gallstones and possible cognitive impairment. The benefits with HRT must be carefully weighed with the patient’s risk factors and needs.

HRT is commonly used to treat the symptoms of menopause with one or more female hormones. The hormones used are estrogen and progesterone. Women who have had their uterus removed are treated with only estrogen. HRT can be prescribed as a pill, injection, patch or vaginal cream.

Women truckers have unique health concerns, so it’s imperative you have a “go to” doctor – one who is familiar with your medical history and health needs. The long-distance relationship between you and your doc can be problematic, but you must find ways to make health care a part of your life. LL

A good site for more information is www.fda.gov. Look under the drug section, particularly the section titled: Estrogen and estrogen with progestin therapies for postmenopausal women.