AGING GRACEFULLY

Menopause is the natural transition in a woman's life that marks the end of her reproductive years. Typically between the ages of 45 and 55, a woman’s ovaries stop producing hormones and she stops having menstrual periods.

Estrogen is used by many parts of a woman’s body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity.

Change in your Period

This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods happen very close together, less than 21 days

• You have heavy bleeding.

• You have spotting.

• Your periods last more than a week.

• Your periods resume after no bleeding for more than a year.

Hot Flashes

Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week.

Hot Flashes: What can I do?

Sleep Problems

The years of the menopausal transition are often a time when there are other changes in a woman’s life. You may be caring for aging parents, supporting children as they move into adulthood, taking on more responsibilities at work, and reflecting on your own life journey. Add symptoms of menopause on top of all this, and you may find yourself having trouble sleeping at night.

Hot flashes, especially night sweats, and changes in mood — depression in particular — can contribute to poor sleep. Managing these issues may help to manage sleep symptoms as well. Some women who have trouble sleeping may use over-the-counter sleep aids such as Melatonin or Doxylamine. Others use prescription medications to help them sleep, which may help when used for a short time. But these are not a cure for sleep disturbances, such as insomnia, and should not be used long term.

Sleep Problems: What Can I Do?

What is melatonin and how does it work?

Melatonin is a hormone that your brain produces in response to darkness. It helps with the timing of your circadian rhythms (24-hour internal clock) and with sleep. Being exposed to light at night can block melatonin production.

Research suggests that melatonin plays other important roles in the body beyond sleep. However, these effects are not fully understood.

Melatonin dietary supplements can be made from animals or microorganisms, but most often they’re made synthetically. The information below is about melatonin dietary supplements.

Not getting enough sleep can affect all areas of life.

Mood changes

You might feel moodier or more irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. Talk with your primary care provider or a mental health professional about what you’re experiencing. There are treatments available to help.

Your body seems different

Your waist could get larger. You could lose muscle and gain fat. Your skin could become thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Researchers are exploring such changes and how they relate to hormones and growing older.

In addition, for some women, symptoms may include aches and pains, headaches and heart palpitations. Follow up with a doctor. Because menopausal symptoms may be caused by changing hormone levels, it is unpredictable how often women will experience symptoms and how severe they will be.

Vaginal health and sexuality

After menopause, the vagina may become drier, which can make sexual intercourse uncomfortable. Read about options for addressing vaginal pain during sex in Sex and Menopause: Treatment for Symptoms. You may also find that your feelings about sex are changing. You could be less interested, or you could feel freer and sexier because after one full year without a period, you can no longer become pregnant. However, you could still be at risk for sexually transmitted diseases (STDs). Your risk for an STD increases if you have sex with more than one person or with someone who has sex with others. If so, make sure your partner uses a condom each time you have sex.

Some women have vaginal dryness with menopause. This can make sex painful. Women may also experience a tightening of the vaginal opening, burning, itching, and dryness (called vaginal atrophy). Fortunately, there are options for women to address these issues. Talk with your provider at Redefined For Her to discuss treatment options.

Sex is becoming painful: What can I do?

Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a woman’s quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity without pain.

Many find relief from vaginal dryness during sex by using a nonprescription water-based lubricant; however, silicone based lubricants can offer longer lasting lubrication.

Other women try over-the-counter vaginal moisturizers or natural oils like coconut oil or olive olive oil, which are used regularly and not just during sex to replenish moisture and relieve dryness.

Local vaginal treatments (such as estrogen creams, rings, or tablets) are often used to treat this symptom. These treatments provide lower hormone doses to the rest of the body than a pill or patch.

The U.S. Food and Drug Administration has approved two nonhormone medications, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause.

For more information on sex and menopause

Office on Women's Health Department of Health and Human Services

800-994-9662

www.womenshealth.gov

American College of Obstetricians and Gynecologists

800-673-8444

resources@acog.org

www.acog.org

North American Menopause Society

440-442-7550

info@menopause.org

www.menopause.org

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) 212-741-2247

info@sageusa.org

www.sageusa.org

Sexuality Information and Education Council of the United States

202-265-2405

www.siecus.org

Hormone therapy was once routinely used to treat menopausal symptoms and protect long-term health. Then large clinical trials showed health risks. What does this mean for you? -Adapted from By Mayo Clinic Staff

Hormone replacement therapy is medication that contains female hormones. You take the medication to replace the estrogen that your body stops making during menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.

Hormone therapy has also been proved to prevent bone loss and reduce fracture in postmenopausal women.

However, there are risks associated with using hormone therapy. These risks depend on the type of hormone therapy, the dose, how long the medication is taken and your individual health risks. For best results, hormone therapy should be tailored to each person and reevaluated every so often to be sure the benefits still outweigh the risks.

What are the basic types of hormone therapy?

Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause. There are two main types of estrogen therapy:

Systemic Hormone Therapy

• Systemic estrogen — which comes in pill, skin patch, ring, gel, cream or spray form — typically contains a higher dose of estrogen that is absorbed throughout the body. It can be used to treat any of the common symptoms of menopause.

Low-dose vaginal products

• Low-dose vaginal preparations of estrogen — which come in cream, tablet or ring form — minimize the amount of estrogen absorbed by the body. Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause.

If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed (hysterectomy), you may not need to take progestin

What are the risks of hormone therapy?

In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:

• Heart disease

• Stroke

• Blood clots

• Breast cancer

Subsequent studies have suggested that these risks vary depending on:

• Age. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.

• Type of hormone therapy. The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen.

• Health history. Your family history and your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis are important factors in determining whether hormone replacement therapy is appropriate for you.

All of these risks should be considered by you and your provider when deciding whether hormone therapy might be an option for you.

Who can benefit from hormone therapy?

The benefits of hormone therapy may outweigh the risks if you're healthy and you:

• Have moderate to severe hot flashes. Systemic estrogen therapy remains the most effective treatment for the relief of troublesome menopausal hot flashes and night sweats.

• Have other symptoms of menopause. Estrogen can ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse.

• Need to prevent bone loss or fractures. Systemic estrogen helps protect against the bone-thinning disease called osteoporosis. However, a medication category called bisphosphonates, is the usual first medication recommended to treat osteoporosis. But estrogen therapy may help if you either can't tolerate or aren't benefiting from other treatments.

• Experience early menopause or have estrogen deficiency. If you had your ovaries surgically removed before age 45, stopped having periods before age 45 (premature or early menopause) or lost normal function of your ovaries before age 40 (primary ovarian insufficiency), your body has been exposed to less estrogen than the bodies of women who experience typical menopause. Estrogen therapy can help decrease your risk of certain health conditions, including osteoporosis, heart disease, stroke, dementia and mood changes.

If you take hormone therapy, how can you reduce risk?

Talk to your provider about these strategies:

• Find the best product and delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch.

• Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat your symptoms. If you're younger than age 45, you need enough estrogen to provide protection against the long-term health effects of estrogen deficiency. If you have lasting menopausal symptoms that significantly impair your quality of life, your doctor may recommend longer term treatment.

• Seek regular follow-up care. See your provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for screenings such as mammograms and pelvic exams.

• Make healthy lifestyle choices. Include physical activity and exercise in your daily routine, eat a healthy diet, maintain a healthy weight, don't smoke, limit alcohol, manage stress, and manage chronic health conditions, such as high cholesterol or high blood pressure.

If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your provider can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

What can you do if you can't take hormone therapy? You may be able to manage menopausal hot flashes with healthy-lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. There are also several nonhormone prescription medications that may help relieve hot flashes.

For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your provider about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse.

The bottom line: Hormone therapy isn't all good or all bad

To determine if hormone therapy is a good treatment option for you, talk to us about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years.

As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have othersome menopausal symptoms, review treatment options with your doctor on a regular basis.

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older women who are past menopause, are at highest risk. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

Symptoms

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

• Back pain, caused by a fractured or collapsed vertebra

• Loss of height over time

• A stooped posture

• A bone that breaks much more easily than expected
  

When to see a provider

Talk to your provider at Redefined for Her about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures.

Bone Density Scan (DEXA Scan)

DEXA (dual x-ray absorptiometry) scans measure bone density (thickness and strength of bones) by passing a high and low energy x-ray beam (a form of ionizing radiation) through the body, usually in the hip and the spine. This procedure is important for diagnosing (seeing if someone has) osteoporosis or bone thinning and may be repeated over time to track changes in bone density.

The amount of radiation used in DEXA scans is very low and similar to the amount of radiation used in common x-rays. Although we all are exposed to ionizing radiation every day from the natural environment, added exposures can slightly increase the risk of developing cancer later in life.

What You Should Know

Your healthcare provider may recommend a DEXA scan to test for osteoporosis or thinning of your bones. Screening for osteoporosis is recommended for women who are 65 years old or older and for women who are 50 to 64 and have certain risk factors, such as having a parent who has broken a hip. However, there are other risk factors for osteoporosis besides age and gender, such as some intestinal disorders, multiple sclerosis, or low body weight. Your healthcare provider may recommend a DEXA scan if you have any of these other risk factors. DEXA scans should be used when the health benefits outweigh the risks. Talk to your healthcare provider about any concerns you have before a DEXA scan.

• Nearly 1in 5 women and 1 in 20 men over the age of 50 are affected by osteoporosis.

• Osteoporosis increases the risk for broken bones and can have serious effects in older adults.

What To Expect

Before the scan

• Make sure to let your healthcare provider or radiologist (medical professional specially trained in radiation procedures) if you are pregnant or think you may or could be pregnant.

• Dress in loose, comfortable clothing. Don’t wear anything that has metal on it like buckles, buttons, or zippers. Metal can interfere with test results.

• Find information on special considerations pregnant women and children.

During the scan

• You may be asked to remove jewelry, eyeglasses, and any clothing that may interfere with the imaging.

• You will lay on a table and the radiologist or medical assistant will position your legs on a padded box. They also may place your foot in a device so that your hip is turned inward.

• While the image is taken, lay still and follow instructions. You may need to hold your breath for a few seconds

After the scan

• The procedure typically lasts about 15-20 minutes.

• Your healthcare provider will follow up with you with your results. They will show a T-score and a Z-score. The T-score shows how your bone density compares to the optimal peak bone density for your gender. The Z-score shows how your bone density compares to the bone densities of others who are the same age, gender, and ethnicity.

Benefits and Risks of DEXA Scans

DEXA scans are different from other imaging procedures because they are used to screen for a specific

condition.

Benefits:

• Detects weak or brittle bones to help predict the odds of a future fracture

• Determines if bone density is improving, worsening, or staying the same

• Can help you and your healthcare provider come up with plans to improve your bone strength and prevent worsening conditions

Risks:

• A very slight increase in possibility of future cancer, similar to the risks from x-rays.