Menopause
A frank discussion about menopause-
And other health issues...
Menopause: Milestone or Tombstone
By Becky Yates, CNM
Hot flashes, night sweats, mood swings, insomnia, memory loss!!! Sounds like “the menopause”. It used to be a subject rarely discussed in public; it was a woman’s private business. Now it is the subject material of productions like Menopause the Musical. Currently touring the country and hilariously portraying the passage of menopause, the cast help women laugh with each other as they experience this life transition. It’s not the silent passage anymore!!
Menopause is not just the subject of theatrical performances. In 1989, the specialty of “menopausal medicine” gained a focus with the formation of the North American Menopause Society (NAMS). Devoted to study and research in the area of menopause and the health of women in the post-menopausal years, this organization also educates and credentials health care providers as menopause clinicians. The several thousand professionals from around the world who belong to NAMS are advocates for the health of women in midlife and beyond. Five hundred NAMS members have become “certified menopause clinicians”. Consumers can find helpful information at the NAMS website www.menopause.org.
With increasing interest and growth of the science of menopause, a new program called “Threshold-Seminars” has been developed by Marianne Jackson, a New Hampshire Ob-Gyn physician. In her clinical practice, Dr. Jackson recognized the great need for an “evidence based educational program” for women about menopause and the aging process. Her vision evolved into a 6 hour seminar called “Menopause and Aging”; she is now training professionals around the country to teach these seminars. These workshops are targeted for women in their 40’s, 50’s, and 60’s.
As a woman faces the reality of her own “menopausal passage” she may become grateful for organizations and programs who have directed their efforts toward women like herself. However, with the first hot flash and sleepless night, the science and academics of menopausal medicine are not foremost in her mind. She is experiencing “the change” and there is no escape. Her symptoms may necessitate that she seek help.
Menopause occurs when the ovaries are no longer able to produce estrogen; although they do continue to produce testosterone. Women arrive at menopause by different routes. Menopause is actually a single event- the last menstrual period in a woman’s life; only after a woman has been without periods for 12 months is she “officially” post-menopausal. The average age of “natural menopause” is 51, although some women experience it earlier or later. There are a few “lucky” women who transition through a natural menopause without any unpleasant symptoms; however, they are very few. The vast majority of women experience some discomforts and for many the symptoms are severe and disruptive to their quality of life. The “perimenopause” is the 5-7 year period of time leading to that last menstrual period; during this time hormones fluctuate widely causing a variety of confusing and unpleasant symptoms.
Some women enter menopause surgically when the ovaries are removed or from a medical treatment which suppresses the ovarian production of hormones. The pre-menopausal woman who enters menopause by one of these routes usually experiences greater symptoms than a woman in “natural menopause” due to the sudden decrease in hormones unless those hormones are supplemented. Any woman undergoing “female surgery” needs to understand what organs were removed. A hysterectomy is just removal of the uterus; if one or both ovaries are removed, the procedure is an oophorectomy. Loss of the ovaries results in a 50% decrease in testosterone levels which may impact sexual functioning in some women. Pre-menopausal women who have a hysterectomy often experience menopause earlier even though the ovaries are still present.
Why is menopause an important “milestone” for women? The personal impact of menopause depends upon how a woman embraces this time in her life. For some women it is perceived as the “beginning of the end”, a sign that they are aging and most of their life is behind them. Other women take a very positive approach to midlife and menopause and find themselves pausing to “take stock” of their lives and make changes to assure quality of life as they age. Such women realize that personal wellness encompasses the physical, emotional, mental, and spiritual areas of life. Juggling the demands of career, family, social commitments, and perhaps caring for aging parents, they recognize that balance is critical to “quality” of life. The realization comes that “this life is not a dress rehearsal” and some positive changes just may be in order.
Medically, the menopause is a milestone because risks for certain diseases increase after this hormonal transition. Annoying changes like “growing hair” in new and unsightly places or forgetting the name of someone you have known all your life are minor compared to developing a chronic disease.
Before menopause the hormone, estrogen, seems to provide some protection against cardiovascular disease. After menopause, the risk for cardiovascular disease approaches that of men. Three times as many midlife women die of cardiovascular disease than from breast cancer, the disease that women most fear!! Thirty eight percent of women will die within a year of having a heart attack or stroke; however, the major causes of heart disease are 80% preventable.
Recent statistics from a NAMS publication for women state that:
-One in nine women aged 45 to 64 has heart or blood vessel disease, after age 65, the number grows
to one in five women.
- After age 55, more than half of all deaths in women are caused by cardiovascular disease.
- Coronary heart disease rates in postmenopausal women are two to three times higher than those in premenopausal women the same age.
Osteoporosis is more common in post-menopausal women due to the absence of estrogen; bone is lost rapidly in the early years following menopause. Each year more than 1 million osteoporotic fractures occur in US women. Fracture incidence is greater than the number of heart attacks, strokes, breast cancer cases, and gynecologic cancers combined! Approximately 50% of individuals with hip fracture lose the ability to walk independently, and the mortality rate is 24% for women within 1 year of fracture!! Osteoporosis is the cause of approximately 90% of hip fractures in white women.
Much to their dismay, post-menopausal women tend to gain weight in the abdominal area due to changes in the hormonal balance; this deposit of fat around the middle increases risk for cardiovascular disease and diabetes. The increase in “abdominal fat” resulting in an increase in waist circumference is a sign of the “metabolic syndrome” which is characterized by a decrease in HDL’s (the good cholesterol) and increase in triglycerides, blood sugar, and blood pressure. Women with a waist circumference over 35 inches have an increased risk for diabetes and cardiovascular disease. Post-menopausal weight gain is also associated with increased risk for breast cancer due to the estrogen produced by the fat cells. Exercise and diet can counter some of the hormonal influences on fat distribution by decreasing the accumulation of fat around the abdomen-“the apple shape”.
Alzheimer’s disease is also more common in women than in men. Only 5% of women have Alzheimer’s by the age of 65 but that statistic increases significantly by age 85. Research demonstrates that estrogen does have beneficial effects in the brain; however, the possible role of supplementation regarding cognitive function and decline is still an area of investigation.
Does life after menopause sound bleak? It doesn’t have to be a “death sentence”. Many of the chronic diseases that could potentially affect women can be prevented or lessened in severity by lifestyle changes, preferably before one even sees menopause on the horizon.
Statistics show that U.S. women are living longer, many live well into their 80’s. That means 30 or more years after menopause. However, longevity is no guarantee of one’s quality of life. Genetics certainly have a role in one’s risk for disease and potential longevity but environment, personal habits, and lifestyle play a much stronger part. “Genetics load the gun but the other factors pull the trigger”. Understanding this emphasizes the need for each woman to evaluate where she is at midlife and where she hopes to be during the last decades of her life.
To assess one’s risk factors and quality of life during the midlife transition, women need to ask themselves some questions and discuss these issues with their healthcare providers.
1. Do I already suffer from any chronic disease like cardiovascular problems, diabetes, osteoporosis,
and cancer?
2. What are my inherited health risks for chronic diseases?
3. Are my lifestyle and personal habits increasing my risks for disease?
4. How is my nutritional status? Am I eating a healthy diet-low in saturated fat, trans-fat, and
refined carbohydrates and high in fruits, vegetables, lean protein, plant proteins, fish, and whole
grains ?
5. What about supplements? Do I get enough calcium and Vitamin D for bone health? Do I need
B vitamins and omega-3 supplements for cardiovascular disease prevention?
6. Am I overweight or underweight? If overweight, is my weight around the middle?
7. What is my physical activity level? Do I get the recommended amount of exercise? Am I getting
the right kinds of exercise for my heart, mind, and bone health?
8. Do I smoke?
9. Do I drink more than 7 drinks a week?
10. Am I abusing any drugs or medications?
11. Am I getting sufficient and restful sleep?
12. What are the stressors in my life?
13. Could I decrease the stress or manage it more effectively?
14. Am I taking care of myself spiritually?
15. How healthy are my relationships with family and friends?
16. Is my job or career the best for me at this time in my life?
17. How is my sexual health? Am I experiencing any changes or problems with the practice of my
sexuality? Is past or current sexual behavior placing me at risk for disease?
18. Have I or others noticed changes in mood that might be signs of depression, anxiety, or irritability?
19. Am I getting the recommended health screenings?
-Pap smears for cervical cancer
-Mammograms for breast cancer
-Colon cancer screening
-Cholesterol for cardiovascular disease risk
-Blood pressure checks
-Glucose testing for diabetes
-Bone density screening for osteoporosis
-Thyroid function screening
20. Am I experiencing symptoms in midlife that are disruptive? Do I need help with hormonal or
alternative therapies to ease the symptoms?
21. What are the risks and benefits of the various therapies for managing the symptoms of the
menopausal transition?
These are important and often sobering questions, but the woman who addresses these issues and seeks to correct areas where change is indicated is taking a proactive approach to menopause and her health in the years after this event. Preventive action and lifestyle modification greatly reduce one’s chance of falling victim to a chronic disease.
As women, none of us can avoid menopause, but we can embrace it knowledgeably, taking preventive actions to maximize quality of life in the years beyond. Menopause is a milestone in every woman’s life; however, it does not have to be the time for ordering a tombstone.
Albemarle, NC 28001
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