Menopause 101

1. Menopause 101 Terrie Thurm, ARNPWomen’s Clinic

2. Menopause: What Is It? Menopause is the permanent end of menstruation. It's a turning point, not a disease, but it can have a big impact on a woman's well-being. Although menopausecan bring physical upheaval, it can also be the start of a new and rewarding phase of a woman's life -- and a golden opportunity to guard against major health risks like heart disease and osteoporosis.

3. What Causes Menopause? • Age is the leading cause of menopause. It's brought on by the function of the ovaries slowing. • Certain surgeries and medical treatment can induce menopause: • Surgical removal of the ovaries (bilateral oophorectomy) • Chemotherapy • Pelvic radiation therapy • Having a hysterectomy (surgical removal of the uterus) without removing the ovaries does not lead to menopause, although you will not have periods anymore.

4. When Does Menopause Start? On average, women are 51 at natural menopause. • A few start menopause as young as 40, and a very small percentage as late as 60. • Women who smoke tend to go through menopause a few years earlier than nonsmokers. • There is no proven way to predict menopause age. It's only after a woman has missed her periods for 12 straight months, without other obvious causes, that menopause can be confirmed.

5. Before Menopause, Perimenopause • Natural menopause happens slowly. The ovaries don't abruptly stop working; they slow down. • The transition to menopause is called perimenopause: • Still possible to get pregnant -- a woman's childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still functioning and she still may ovulate, though not necessarily on a monthly basis.

6. Menopause: What to Expect • Menopause isn't a one-size-fits-all event. It affects eachwoman differently. Some women reach natural menopause with little to no trouble; others have severe symptoms that drastically affect their lives. • When menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough.

7. Menopause Signs: Period Changes • As menopause approaches, a woman's menstrual periods will likely change – changes can vary from woman to woman: • Periods may get shorter or longer, heavier or lighter, with more or less time between periods. • Such changes are normal, but you should see a doctor if: • Your periods come very close together • You have heavy bleeding or spotting • Your periods last more than a week

8. Menopause Symptoms: Hot Flashes

9. Menopause Symptoms: Hot Flashes A hot flash is a brief feeling of heat that may: • Make the face and neck flushed • Cause temporary red blotches to appear on the chest, back and arms Sweating and chills may follow.

10. Menopause Symptoms: Hot Flashes (continued) Hot flashes: • Are common • Vary in intensity and typically last between 30 seconds and 10 minutes

11. Dealing with Hot Flashes • Dress in light layers • Use a fan • Get regular exercise • Avoid spicy foods and heat • Manage stress

12. Menopause Symptoms: Sleep Issues Nighttime hot flashes can hamper sleep and cause night sweats. Try these sleep tips: • Use a fan in your bedroom • Avoid heavy bedding • Choose light cottons or sheer materials for your nightclothes • Keep a damp cloth nearby to cool yourself quickly if you wake up feeling hot and sweaty • Keep pets out of your bedroom; they can give off heat • Talk to your health care provider if your sleep problems are ongoing or bother you

13. Menopause Symptoms: Sex Problems

14. Menopause Symptoms: Sex Problems • Less estrogen  vaginal dryness  uncomfortable or painful intercourse: • Try using a water-soluble lubricant • Libido may also change – many factors besides menopause affect sex drive – including:stress, medicines, depression, poor sleep and relationship problems • Talk to your doctor if sex problems occur – don't settle for a so-so sex life. • Remember, sexually transmitted diseases (STDs) don't end with menopause; "safer" sex still counts.

15. Body Changes –Weight Gain • Many women gain an average of 5 lbsat mid-life, related mostly to aging and lifestyle, not menopause or hormone therapy (HT). • However, menopause may be related to changes in body composition and fat distribution.

16. Mood disorders • Feelings of upset, loss of control, irritability, fatigue, and blue moods (dysphoria) at midlife – may be caused by fluctuating hormone levels that upset neural systems. • Women with a history of premenstrual syndrome, significant stress, sexual dysfunction, physical inactivity, or hot flashes – are vulnerable to depressive symptoms.

17. Mood disorders (continued) • The most predictive factor for depression at midlife and beyond is prior history of clinical depression. • Options to consider in symptom management include: relaxation and stress reduction techniques, counseling, psychotherapy and/or antidepressants.

18. Managing Severe Symptoms Talk to your health care provider about: • Risks/benefits of menopausal hormone therapy (HT), also known as hormone replacement therapy (HRT). • Treatments such as: • Low-dose birth control pills (if you're perimenopausal) • Antidepressants • Medicines to help with hot flashes • Vaginal estrogen cream • Lifestyle tips about adjusting your diet, exercise, sleep and stress management.

19. Hormone Replacement Therapy (HT) • Hormone replacement therapy can ease menopausal symptoms. Many prescriptions are available to treat hot flashes and vaginal symptoms. • The FDA recommends taking the lowest dose that helps, and only for the shortest time: • Studies have linked long-term use of hormone replacement therapy to a greater risk of heart attacks, strokes, blood clots and breast cancer.

20. HT summary • formulation, route of administration,and timing of initiation produce different effects • Individual benefit-risk profiles are essential • Absolute risks in healthy women ages 50 to 59 are low • Long-term use or HT initiation in older women, however, has greater risks • Breast cancer risk increases with EPT (estrogen-progestogen therapy) beyond 3 to 5 years • ET (estrogen therapy)can be considered for longer duration of use due to its more favorable safety profile

21. Bioidentical Hormone Therapy

22. Bioidentical Hormone Therapy "Bioidentical hormone therapy" for menopausal symptoms can refer to certain FDA-approved prescription drugs: • Take the lowest dose for the shortest time • Can also refer to custom-compounded hormones: • Derived from plants prepared at compounding pharmacies to match each patient • Some doctors claim that compounded bioidentical hormones are safer, but these aren't FDA approved

23. Bioidentical hormones • Many well-tested, gov’t-approved HT products contain bioidentical hormones • Usually refers to compounded formulations • Compounded preparations and salivary hormone testing not recommended • Compounded HT not tested for efficacy, safety, batch standardization or purity • Some compounders make unsubstantiated claims about safety and effectiveness • Compounded HT should include patient information

24. Alternative Menopause Treatments Interested in trying alternative or complementary treatments for menopause symptoms? • There isn't a lot of well-designed research on this topic, so the research isn't firm enough to draw conclusions about treatments such as black cohosh, dong quai, red clover and soy. (NIH) • Talk it over with your provider. Let them know about any supplements you take, so they can check for drug interactions.

25. Menopause Health Risks With menopause comes a greater chance of: • Osteoporosis • Heart disease (#1 cause of death for U.S. women) • Loss of estrogen may play a role for heart disease after menopause, but hormone replacement therapy is not recommended to reduce the risk of heart disease or stroke. Heart and bone health is important throughout a woman's life, but menopause means it's really time to step up and get serious about it, if you haven't already!

26. Osteoporosis

27. Definition of osteoporosis A disease characterized by low bone mass and deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Normal Bone Osteoporosis

28. A gender-related condition • Osteoporosis is the most common bone disorder affecting humans • The risk of hip fracture doubles for every 5 to 6 year increase in age from ages 65 to 85 • Of the 10 million Americans estimated to have osteoporosis: • 8 million are women (80%)

29. Postmenopausal osteoporosis • Peak bone mass in some women is reached by age 20 • By age 80, many women have lost 30% of their peak bone mass • Osteoporosis is characterized by compromised bone strength – increasing risk of fracture

30. FRAX (Fracture Risk Assessment Tool)

31. When is drug therapy needed? • History of vertebral, hip, fragility or low-trauma fracture • Bone mass density values consistent with osteoporosis (T score ≤ –2.5) • 10-year FRAX risk of major osteoporotic fracture of at least 20% or hip fracture of at least 3%

32. Lifestyle modifications • Maintain a healthy weight • Eat a balanced diet • Obtain adequate calcium and vitamin D • For calcium: 1,200 mg/d from food (preferably) and/or supplement • For vitamin D: RDA is 600 IU/d until age 70 and 800 IU/d after age 70 • Participate in appropriate exercise • Avoid excessive alcohol consumption • Do not smoke • Develop measures to prevent falls

33. Menopause: Staying Healthy Living a healthy lifestyle is important throughout a woman's life. It’s not too late to start at menopause! • Get a checkup that includes measuring your blood pressure, cholesterol and blood sugar. • Make appointments for routine screenings such as mammograms. • Menopause is also a great time to upgrade your diet, physical activity and stress management skills. Your doctor can give you pointers as you work together to plan for a healthy menopause.

34. Active Menopause Is a Must One of the best steps a woman can take before, during and after menopause is to get regular physical activity: • This includes aerobic exercise for her heart and weight-bearing exercise for her bones – both of which may help ward off weight gain and provide a mood boost. • Even if a woman hasn't been very active in her younger years, it's never too late to start!

35. Sources • North American Menopause Society • www.webmd.com • National Institute on Aging

36. Questions?