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Menopause’s Mysteries

Menopause’s Mysteries. L. Z. Killinger, DC. Recommended Reading. The Wisdom of menopause: Creating Physical and Emotional Health During Change- Christine Northrup The Seven Sacred Rites of Menopause- Kristi Meisenbach Boylan ($9.50 Amazon.com). Why is this important?.

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Menopause’s Mysteries

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  1. Menopause’s Mysteries L. Z. Killinger, DC

  2. Recommended Reading • The Wisdom of menopause: Creating Physical and Emotional Health During Change- Christine Northrup • The Seven Sacred Rites of Menopause- Kristi Meisenbach Boylan ($9.50 Amazon.com)

  3. Why is this important? Over 1 in 3 US women are over 50 years old! That means this is a hot topic for your patients!

  4. What Patients May Experience • Missed periods (pre-menopause) • Chills/Hot flashes or sweats • Flushes • Dizziness • Wooziness • Palpitations • Sleep disturbances • Sexual symptoms • Mood swings, anxiety, panic attacks, overreacting! • Maybe: Depression, memory loss, skin wrinkling, fatigue, thinning of hair, stiffness in joints and muscles

  5. When Does It Occur? • Average Age: 50-51 Years old • Usual medical treatment: Hormones ERT/HRT (WARNING!) • Assessment: • Blood test: Follicle Stim. Hormone (FSH) • Menopause Defined: No menstruation for 12 months = The definitive diagnosis

  6. Can we predict menopause? • Missed periods: Most reliable predictor • Missed a period: 65% will have menopause within 2 years; 100% within 4 years • Other predictors like hot flashes, not nearly as reliable. Source: Taylor, et al. Menopause. J N Amer. Menopause Soc. 11: 40-45.

  7. Perimenopause • Age 44-51: ( The 8 yrs before menopause • Estrogen declines more rapidly (Adjust w/care!) • Decline in childbearing potential (Careful!) • First, menses comes more often (YIKES!) • Then, menses becomes irregular • Bleeding may become heavier • Hot flashes-usually 1-4 years before menopause (worse at night) • Insomnia, irritability, forgetfulness, sexual symptoms

  8. Post-Menopausal Health Risks • Increased risk of: • Heart disease • Osteoporosis • Uterine cancer • Breast cancer • Ovarian cancer • Depression • Colon cancer, etc, etc.

  9. What can we do? • Bone Density Loss: Counsel pts. about physical activity, diet, and supplementation, and lifestyle choices • Heart Disease Risk Increases: Counsel pts on physical activity, Mediterranean diet, supplements, etc. • Depression/Anxiety: Counsel pt about physical activity, socialization, volunteering, etc.

  10. What can we do ? • Uterine cancer-Low fat diet, control weight and diabetes, regular pelvic exams. • Colon cancer-Fiber 30 g/day, regular screenings, calcium supplements • Breast cancer-physical activity, weight loss, low fat diet, lower alcohol intake, no smoking! Regular exams/self-exam!

  11. Trends:Breast Cancer Survival Rates • 1974-79: 10 % survived 5 yrs • 1980-84: 14% • 1985-89: 22% • 1990-94: 29% • 1995-2000: 44%

  12. Why are survival rates up? • EARLY DETECTION!! • Mammography • Treatment (chemo.) in earlier stages Source: Giordano SH. Cancer. Jan 04; 100:44-52

  13. Why not take HRT? • The Women’s Health Initiative study (large study on HRT for postmenopausal women) cancelled the arm of the study in which women were taking HRT (Estrogen/Progesterone combined) • After 5 years women taking HRT had increases in several diseases. • The risks of HRT were shown to outweigh the potential benefits (Slightly decreased incidences of colon cancer and hip fractures)

  14. Increased Risks of HRT (When taken for > 5 years) • Heart Attack: 3.7/1000 women instead of 3 • Stroke:2.9/1000 women instead of 2.1 • Blood Clots in Legs or Lungs: 3.4/1000 instead of 2.6 • Breast Cancer: 3.8/1000 instead of 3 • But, decreased risk of osteoporosis and perhaps colorectal cancer • JAMA 2002;288:872-881.

  15. Herbs and Menopause • For thousands of years eastern healers have observed that some herbs have a positive impact on female troubles, including menopause • Although used for centuries with success, such products are now being scrutinized using the scientific method (Experimental studies, placebo studies, controlled clinical trials)

  16. Herbs for Menopause • Soy products (isoflavones) • Black cohosh • Wild yam • Clover • Ginseng • Licorice • Dong quai • AND…Vit B6, B9, etc.

  17. Which Herbs/For What? • Herbs For Bone Loss: • Wild Yam: natural progesterone source • Chaste Berry-LH/Progesterone stimulant • Red Clover: All 4 isoflavones • Daidzen, Genistein, Formononetin, Biochanin • Source: Nestel et al. J Clin Endocrinol Metab. 1999; 84(3):895-8.

  18. More Herbs • Black Cohosh: <Remifemin> Used for relief of general menopausal symptoms, nervousness, anxiety, hot flashes, vaginal dryness • Resources: Whiting, Clouston, Kerlin. M J Australia 2002;177(8):440-443. • Leiberman: J Women’s Health 1998;7(5):525-529.

  19. More Herbs • Passion flower: Sedative and anti-spasmodic, for female anxiety, restlessness, insomnia, and night sweats of menopause • Alfalfa: Hot flashes, insomnia, night sweats, dizziness, etc. • Soy isoflavinoids (eat more soy!)

  20. “Tending and Befriending”: How Women Handle Stress • Recent study showed that men and women respond to stress differently (Duh!) • Men either behave aggressively, or seek solitude • Women ‘tend and befriend’: Clean, organize, call friends, call on female friends • Women that have close female friends live healthier, longer after traumatic injury/event, etc.

  21. So, what does this mean to us? • Encourage women, who are stressed over menopausal changes to do what comes natural: ‘tend and befriend’ • Avoid caffeine: Increases insomnia, night sweats, breast cysts, bone loss, etc. • Avoid alcohol-Increases breast cancer risk, depression, bone loss, etc • Volunteer, socialize, stay active, eat right, try natural remedies, talk to others

  22. Encourage a Diet “Consciousness” • Increase water consumption • Decrease fats in diet • Increase fruits/veggies in diet (for female cancer prevention in general) • Increase fiber in diet-protects colon health (helps w/ mood?) • Increase Calcium, Vitamin D, Soy

  23. Encourage Physical Activity!(So, you thought we might get through a day without hearing this again, eh?) • Decreases stress • Increases muscle mass and bone density • Decreases pain • Improves mood/decreases depression • Decreases blood pressure and heart disease risk • Improves overall health status, balance, self -image, sex drive, etc!!! • (Stay tuned for more benefits!)

  24. Advantages of Menopause • Freedom from birth control (finally!) • Sex with no fear of pregnancy • Protection from anemia (chronic problem with many menstruating women) • Feeling of independence for women • Hormonal “stability” after a lifetime of fluctuation

  25. Resources • Www.healthywomen.org (National Women’s Health Resource Center) (202-537-4015) • www.4women.org (National Women’s Health Information Center) 1-800994-WOMAN (9662) • 1-800 MENO-ASK National Menopause Foundation

  26. Thank You!

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