1. Menopause And You: Your Change. Your Life. Take Charge.

2. One of North America’s oldest organizations devoted to the specialty of obstetrics and gynaecology Advance the health of women through leadership, advocacy, collaboration, outreach and education The Society embraces values and beliefs that lead to improved patient care www.sogc.org About the Society of Obstetricians and Gynaecologists of Canada (SOGC)

3. Tonight’s Highlights Menopause is a normal part of aging… … But it can be a challenging time for many women Take charge of your transition. Gather accurate, complete information to help decide on how to navigate your transition.

4. Tonight’s Agenda What happens at “menopause”? How can we manage our symptoms? What can we do to maximize our health during menopause? 1 1 2 2 3 3

5. What Is Menopause? A period of change: Hormonal Physical Emotional End of menstruation and child-bearing years

6. When Does Menopause Occur? Typically between 42 and 56 years of age Defined as the day when a woman has not had a period for 1 year

7. Premenopausal years Postmenopausal years What Happens During The Menopausal Transition? Monthly cycle begins to change Number of stored eggs in the ovaries decreases Hormone levels fluctuate

8. Estrogen And Progesterone Have Many Effects In The Body Brain Breasts Heart Liver Bones Vagina Skin Uterus Ovaries

9. No two women experience menopause in the same way What Happens With Hormonal Changes? Hot flushes / night sweats Irregular periods Vaginal / vulvar / bladder changes Loss of bone / osteoporosis Mood changes Change in cholesterol / blood vessels Mental function Sexuality Sleep disturbances Joint discomfort

10. Hot Flashes And You May start as early as late 30s Peak in the early 50s May last into mid-70s First 5 years tend to be the worst

11. Why Do Hot Flashes Happen? Body becomes more sensitive to small changes in core body temperature Body becomes more sensitive to small changes in core body temperature

12. What Have You Done To Manage Hot Flashes? AUDIENCE COMMENTARY…

13. Lifestyle changes Alternative & complementary therapies Traditional hormonal therapy Non-hormonal prescription therapies How Are Women Trying To Manage Hot Flashes?

14. Lifestyle Changes Avoid triggers (hot drinks, alcohol) Breathing techniques Ceiling/bedside fan Cool evening shower or bath Dress in layers - dry wicking clothing Turn down thermostat

15. Herbal Remedies, Soy & Botanicals Soy Black cohosh Alfalfa Dong quai Ginseng Evening primrose oil Multi-botanical products

16. Herbal Remedies, Soy & Botanicals Why the buzz? Interest in traditional healing & “natural” products Mistrust of medical options But do they work? Not according to reliable research “Natural” does not equal “safe” Can interfere with medications

17. Herbal Remedies, Soy & Botanicals Ann Int Med Dec 2006 Am J Med 2005;118 (12B): 98S–108S Research shows little positive impact: Mean number of VMS per day

18. What Are Bioidenticals? Hormone preparations Chemically synthesized from plants in a laboratory Chemically identical to our body’s own estrogen and progesterone Available by prescription

19. Lock And Key Concept Estrogens work by turning on a receptor Receptor = lock Estrogens = keys New key copies can be made to open the lock

20. Custom-Compounded Bioidenticals

21. North American phenomenon Hormone recipes made by a compounding pharmacist Bi-Est, Tri-Est, progesterone and testosterone cream DHEA (tablet) What Are “Custom-Compounded” Bioidenticals?

22. Women have been told – falsely – that they are safer than traditional HT Fear of cancer and traditional Hormone Therapy Advertising Broad availability (e.g., Internet sales) Celebrity spokespeople / media attention Why The Interest In “Custom- Compounded” Bioidenticals?

23. Problems With “Custom-Compounded” Bioidenticals These products… ARE NOTadequately studied in research HAVE NOproof of safety and efficacy HAVE NO standard manufacturing or quality control HAVE NOregulation of advertising claims

24. “Custom-Compounded” Bioidenticals & Safety 29 products from 12 compounding pharmacies were tested: ⅓ failed quality control tests ¼ failed potency standards

25. SOGC Position On “Custom-Compounded” Bioidenticals SOGC does not endorse the use of custom-compounded bioidenticals Lack of good evidence on efficacy and safety Concern about quality control

26. What Is Traditional Hormone Therapy (HT)? Standardized dosages of estrogens and progestins Prescribed to treat symptoms of menopause (hot flashes, vaginal dryness) Also effective for prevention of osteoporosis

27. What Is Traditional HT? These hormone preparations… AREadequately studied in research HAVEproof of safety and efficacy HAVE standard manufacturing or quality control HAVEregulation of advertising claims

28. HT And Hot Flashes Many studies show that: Frequency reduced by up to 75% Severity reduced HT is the most effective therapy for menopausal hot flashes

29. HT: If I Take It, What Kind And How? Depends on your symptoms: Oral or transdermal (patch, gel) for general symptoms Vaginal preparations preferred for vaginal symptoms

30. For those of you who are taking hormone therapy: How much? How long? AUDIENCE COMMENTARY…

31. HT: If I Take It, How Much, How Long? No 2 women are the same The kind of HT and duration of therapy depends on a woman’s: Medical history Severity of menopausal symptoms Personal preferences

32. Non-hormonal Medical Therapy Prescription medicines that are not hormones E.g., antidepressants, blood pressure drugs, neurologic drugs May improve hot flashes (e.g., by altering body temperature thresholds)

33. Menopause And HT: What’s The Controversy?

34. Breast Cancer: How does taking HT affect your risk of developing breast cancer?

35. 47 taking HT for 5 years will develop breast cancer 45 not taking HT will develop breast cancer Breast Cancer Facts: Out Of 1000 Menopausal Women… 2 more cases per 1000 women will develop breast cancer

36. Risk Factors For Breast Cancer ↑ risk 2 affected first-degree relatives (e.g., mother, sister) Obesity Start period at young age Significant HT use (>5 years) 1st child >age 30 Alcohol use (>2 drinks/day) ↓risk Regular exercise Menopause <48 years

37. Breast Cancer Summary We ALL have personal risk factors for breast cancer Being a woman and getting older are the biggest risks! Other factors (including HT) carry less risk

38. How many of you are aware of the “Women’s Health Initiative Study” (WHI)? What does it mean to you? AUDIENCE COMMENTARY…

39. The Women’s Health Initiative 2002 (WHI) Diseases of Aging Evaluated Heart disease Osteoporosis Cancer (breast, colorectal) Dementia Urinary incontinence NOT a study looking at effects of HT on menopause symptoms

40. Were The Women In WHI Like The Average Menopausal Woman? NO! 50% were high risk (smokers, overweight, high blood pressure, diabetes) Average age was 63 years ⅔ were >60 years old Results DO NOT apply to younger, newly menopausal women

41. Heart Disease: Does Age Matter? Women in their 50s have: ½ the risk of women in their 60s and ¼ the risk of women in their 70s

42. Menopause And Aging: How Can We Maximize Our Health As We Get Older?

43. 94% of risks are things you can change: 1. Obesity 2. High blood pressure 3. Smoking 4. Stress 5. Diet (fruits and vegetables) 6. Alcohol 7. Blood lipid levels Preventing Heart Disease

44. Treating Heart Disease And HT HT is not recommended for preventing heart disease HT does not increase risk of cardiovascular disease when used by women within 10 years of menopause SOGC Position

45. Osteoporosis 1 in 4 women over 50 has osteoporosis Estrogen helps maintain bone strength Crucial time: 2 to 4 years around the last menstrual period

46. Osteoporosis: Why Should I Care? “Silent” disease – a fracture might be the first sign or symptom Fractures of the spine and hip can severely restrict your quality of life 1 in 4 hip fractures result in death within 1 year www.osteoporosis.ca

47. Preventing Fractures Less chances of fallingLess fracturesLess damage from fall Exercise and balance training Improved coordination Better balance Greater strength

48. Calcium Essential for good bone health Average Canadian diet – only 500 mg per day Recommended intakes (from diet and supplements): Peri-menopause - 1000 mg/d Post-menopause - 1500 mg/d Should be taken in divided doses Calcium therapy alone is not enough to prevent fracture

49. Vitamin D Important to maintain bone health Most recommend intake of 1000 IU/day Deficiency due to limited sun exposure / use of sunscreen Food sources not adequate May be more important than calcium

50. Prevention Of Osteoporosis SOGC encourages Healthy diet Adequate calcium and vitamin D Regular exercise www.sogc.org www.menopauseandu.ca www.osteoporosis.ca

51. Prevention Of Osteoporosis HT is not the first choice for osteoporosis prevention… BUT it will prevent bone loss and fractures in women who are using HT for symptom control

52. Urge “to go” Frequent urination Vagina dryness Painful sex Recurrent urinary infection Vulvovaginal Atrophy Symptoms

53. The Vagina: Time Does Not Heal ½ of women have symptoms early on in menopause Unlike hot flashes, urogenital atrophy worsens with time Related to lack of estrogen

54. Healthy Vagina, Healthy Vulva: Practical Tips Things to avoid: Harsh soaps, contact irritants (e.g., chemicals, perfumes) Over-bathing Dampness / bladder leakage Mini pads Recommended tips: Wear 100% cotton underwear Kegel, Pilates, Yoga exercises Weight loss www.thebigow.ca

55. Treatment Of Vulvovaginal Symptoms Stop smoking Use estrogen vaginally: Cream Applicator or fingertip Tablet Insert twice weekly Ring Change every 3 months

56. Let’s Talk About Sex Older couples have sex less often Sexual response changes with age HOWEVER Regular sex helps maintain vaginal health Sex is rarely about hormones only

57. Sleep Disturbances Common symptom with aging Hot flashes can make it worse Exercise helps

58. Mood Troubles Many women report “moodiness” during menopause transition Depression is more common among newly menopausal women

59. Mood Troubles Talk to your health care provider about mood symptoms Seek appropriate support and counseling Treatment is available

60. Weight Gain During Menopause Will happen if you don’t maintain an active lifestyle Average weight gain 5-10 lbs About ½ of women aged 45-64 are overweight Risk to your health: Diabetes Hypertension Cancer Stroke

61. Nutrition Recommendations Balanced diet Reduce total fat intake / cholesterol intake Control weight Calcium 1000 – 1500 mg / day Vitamin D at least 400-800 IU / day Limit alcohol intake Limit caffeine intake

62. Need Help With Your Diet? www.dietitians.ca Canada’s Food Guide

63. Good News: YOU ARE IN CONTROL! Menopause is a time of transition, not a disease Options for symptom management include lifestyle changes and, if needed, appropriate medication Regular exercise is one of the most important things you can do for yourself. Begin today! Follow a healthy eating plan, and maintain a healthy weight Reduce alcohol intake Stop smoking! NOW!!

64. Question Period More info? consult these sites : sogc.org menopauseandu.ca menopause.org sexualityandu.ca powderroom.ca laughingwithoutleaking.ca thebigow.ca

65. Menopause And You: Your Change. Your Life. Take Charge.