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Let’s Talk About Menopause. Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner. Proportion of average female lifespan spent in menopause years: 1/3 to 1/2. Menopause Update 2012 Key Points. - PowerPoint PPT Presentation
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Let’s Talk About Menopause
Joanna Wilson, D.O.Board-Certified Internal Medicine
North American Menopause Society Certified Practitioner
Proportion of average female lifespan spent in menopause years: 1/3 to 1/2
Menopause Update 2012Key Points
• Recognize the metabolic changes of the body due to menopause
• Appreciate the emergence of cardiovascular risk factors in menopause
• Understand the impact of menopause on bone density
• Discuss the common symptoms of menopause
Stages: -5 -4 -3 -2 -1 +1 +2
Terminology:
Reproductive Menopausal Transition Postmenopause
Early Peak Late Early Late* Early* Late
Perimenopause
Duration of Stage:
variable variable1yr
4 yrsuntil
demise
Menstrual Cycles:variable
toregular
regular
variable cycle length
(>7 days different from
normal)
2 skipped cycles and an
interval of amenorrhea
Amen x 12 mos none
Endocrine: normal FSH FSH FSH FSH
0
* Stages most likely to be characterized by vasomotor symptoms¥ STages of Reproductive Aging Workshop
Final Menstrual Period
Defining Menopause
Adapted from Soules et al., Fertility and Sterility, VOL. 76, NO. 5, November 2001, p. 875
Determinants of Age at Menopause (Average Age =51 years)
Unaffected by:– Race – Socioeconomic status– Number of pregnancies– Oral contraceptive use– Education– Physical characteristics– Age of menarche– Age of last pregnancy
Affected by: Smoking– Family pattern– Chemotherapy– NulliparityHysterectomy*Excessive alcohol intake*
– *=possible assn
METABOLIC CHANGESMenopause
Weight Gain in Menopause“Metastatic Fat”
• Body composition changes: muscle fat• Resting Metabolic Rate drops by 250 cal/d• “Metastatic fat”– More inflammation in blood vessels– Accumulates in liver and muscle– Increases risk of breast cancer
“I don’t know how I gained all of this weight!”
• Decrease in activity level• Sleep deprivation increases salt and carb
cravings- 600 cal/day increase• Less attention to diet
Where you gain weight matters
Metabolic Syndrome
HDL under 50Fasting sugar 100-126 or HgA1c 5.8-6.4
BP over 135 or on blood pressure Rx
Waist over 35 inches
TG over 150
Metabolic Syndrome isa warning shot…
• 5x increased risk of Diabetes• 3x increased risk of stroke or heart attack
CARDIOVASCULAR RISKSMenopause
Hypertension: Gender and Age Effects
Age Men (%) Women (%)
20-34 11.1 6.8
35-44 25.1 19.0
45-54 37.1 35.2
55-64 54.0 53.3
65-74 64.0 69.3
75 and older 66.7 78.5
Heart Disease and Stroke Statistics 2012:AHA. Circulation Epub 12.15.2011
HDL Cholesterol Levels After Menopause
90
100
110
-24 -18 -12 -6 0 6Months
% o
f le
vel a
t -6
mo
nth
s b
efo
re m
eno
pau
se
Menopause
Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31
LDL Cholesterol Levels After Menopause
90
100
110
-24 -18 -12 -6 0 6Months
% o
f le
vel a
t -6
mo
nth
s b
efo
re m
eno
pau
se Menopause
Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31
CAN’T WE USE ESTROGEN AFTER MENOPAUSE TO PREVENT HEART DISEASE?
The Women’s Health Initiative Changed How We Felt
About Hormones
Women’s Health Initiative (continued)
“The Timing Hypothesis”• Arteries are healthier in the presence of a woman’s
estrogen, progesterone, testosterone• The absence of hormones ages arteries
• It is likely that early use of hormones can prevent or improve early artery aging
• Starting hormones years after menopause worsens risks of heart attack and stroke
Women’s Health Initiative vs Kronos Early Estrogen Prevention
WHI• Systolic BP >120mmHg =
64%• Ever smokers = 50%• Average age 63
KEEPS• Systolic over 120 = 46%
• Ever smokers = 20% • Average age 53
Kronos Early Estrogen Prevention Study
What can we do now?Fitness Not Fatness
• Avoid eating out• Avoid sugar (soda,
desserts)• Diet type for body type• Cardio exercise for heart
health, mood– 70 min/week vigorous
exercise– 120 min/week moderate
exercise• Resistance training for
weight loss, bone health
BONE HEALTHMenopause
Risks for low peak bone density and loss with age
• Smoking• Sedentary lifestyle• Low body weight• Chronic steroids• Rheumatoid Arthritis• ≥3 Alcoholic drinks/day• Early menopause without hormone therapy
afterwards
COMMON SYMPTOMSMenopause
Years Before Years AfterMenopause
Prevalence of Hot Flashes
3 2 1 1 2 3
Hot Flashes and Night Sweats
• > 75% of women report hot flashes within the 2-year period surrounding their menopause
• 25% remain symptomatic for > 5 years
Kronenberg F. Ann N Y Acad Sci. 1990;592:52-86.
The Holy Grail: A Good Night’s Sleep
• Racing thoughts• Night sweats• Snoring• Apnea• Stomach acid reflux• Aches and pains• Frequent urination• Restless legs
“Doc, I think I’m losing my mind.”
forgetfulness “cloudy” thoughts “Menopause Fog” inattention• Often due to variations in estrogen• Multi-tasking, depression, sleep deprivation• Try: daily physical exercise, mental exercise,
quality sleep
Psychological Symptoms of Menopause
• Anxiety is frequent• Stressors: children leaving (or returning!) ill
parents, work, financial, marriage, physical changes
• Menopause does not cause depression– Depression is more likely to recur if present prior to
menopause
Stress Management• Meditation• Yoga• Daily moderately vigorous exercise• Counseling, support groups• Antidepressants• Vitamin D, folic acid• Nutrition• Resilience
Hair Changes in Menopause
• Female pattern hair loss (FPHL): thinning on the crown– Low estrogen with
relative high testosterone state
– Treatment may include spironolactone or topical minoxidil*, biotin 3mg/d
Dental Health During Menopause
• Fluctuations of sex hormones around menopause cause changes in gums and teeth
• Rate of systemic bone loss is a predictor of tooth loss
Pelvic tissue changes• Ureteral thickening recurrent bladder
infections, increased urinary frequency• Vaginal pH rises alters vaginal bacterial
balance vaginal infections• Loss of pelvic floor tone incontinence,
muscle spasms
Last, But Not Least: Sex
• Majority of women state their sexual relationships did not change during menopause
• Most common complaints: low libido, vaginal dryness
• Sexually Transmitted Infections• Contraception
North American Menopause Society Gallop Poll 1998.
Vaginal Changes (Ugh!)
• Mild : Skin thinning, smoothing and loss of elasticity
• OTC moisturizers: vitamin E, OTC creams/ suppositories• OTC lubricants: olive oil, water, silicone
• Moderate: Labial and perineal fusion, ureteral thickening and whitening, and dryness
• Rx: Low dose estrogen tablets, cream, ring inside the vagina
Use it or lose it!
Start the next 40 years off right!
• Weight management• Cholesterol• Blood pressure• Avoid smoking• Stress control• Nutrition• Sleep• Fitness
Learn More About Menopause
• North American Menopause Society at menopause.org
Dr. Joanna WilsonFreida Toler, Nurse Practitioner
HerCare Lecture Series
Aftershocks of Fifty Shades of GrayJanuary 18 at 4:00