Presentation on theme: "Let’s Talk About Menopause Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner."— Presentation transcript:
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 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+2 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
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
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
“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
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
Years BeforeYears After Menopause Prevalence of Hot Flashes 321123 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
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 Wilson Freida Toler, Nurse Practitioner
HerCare Lecture Series Aftershocks of Fifty Shades of Gray January 18 at 4:00