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Let’s Talk About Menopause Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner.

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Presentation on theme: "Let’s Talk About Menopause Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner."— Presentation transcript:

1 Let’s Talk About Menopause Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner

2 Proportion of average female lifespan spent in menopause years: 1/3 to 1/2

3 Menopause Update 2012 Key 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

4 Stages: Terminology: ReproductiveMenopausal TransitionPostmenopause EarlyPeakLateEarlyLate * Early * Late Perimenopause Duration of Stage: variable 1 yr 4 yrs until demise Menstrual Cycles: variable to regular 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 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

5 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 – Nulliparity  Hysterectomy*  Excessive alcohol intake* – *=possible assn

6 METABOLIC CHANGES Menopause

7 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

8 “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

9 Where you gain weight matters

10 Metabolic Syndrome HDL under 50 Fasting sugar or HgA1c BP over 135 or on blood pressure Rx Waist over 35 inches TG over 150

11 Metabolic Syndrome is a warning shot… 5x increased risk of Diabetes 3x increased risk of stroke or heart attack

12 CARDIOVASCULAR RISKS Menopause

13 Hypertension: Gender and Age Effects AgeMen (%)Women (%) and older Heart Disease and Stroke Statistics 2012:AHA. Circulation Epub

14 HDL Cholesterol Levels After Menopause Menopause Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31

15 LDL Cholesterol Levels After Menopause Menopause Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31

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17 CAN’T WE USE ESTROGEN AFTER MENOPAUSE TO PREVENT HEART DISEASE?

18 The Women’s Health Initiative Changed How We Felt About Hormones

19 Women’s Health Initiative (continued)

20 “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

21 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

22 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

23 BONE HEALTH Menopause

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25 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

26 COMMON SYMPTOMS Menopause

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29 Years BeforeYears After Menopause Prevalence of Hot Flashes 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.

30 The Holy Grail: A Good Night’s Sleep Racing thoughts Night sweats Snoring Apnea Stomach acid reflux Aches and pains Frequent urination Restless legs

31 “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

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33 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

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35 Stress Management Meditation Yoga Daily moderately vigorous exercise Counseling, support groups Antidepressants Vitamin D, folic acid Nutrition Resilience

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37 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

38 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

39 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

40 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.

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42 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!

43 Start the next 40 years off right! Weight management Cholesterol Blood pressure Avoid smoking Stress control Nutrition Sleep Fitness

44 Learn More About Menopause North American Menopause Society at menopause.org Dr. Joanna Wilson Freida Toler, Nurse Practitioner

45 HerCare Lecture Series Aftershocks of Fifty Shades of Gray January 18 at 4:00


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