let’s talk about menopause
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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 PresentationTRANSCRIPT
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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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Proportion of average female lifespan spent in menopause years: 1/3 to 1/2
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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
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Stages: -5 -4 -3 -2 -1 +1 +2Terminology:
Reproductive Menopausal Transition Postmenopause
Early Peak Late Early Late* Early* Late
Perimenopause
Duration of Stage: variable variable 1
yr 4 yrs untildemise
Menstrual Cycles:variable
toregular
regular
variable cycle length
(>7 days different from
normal)
³2 skipped cycles and an
interval of amenorrhea
Amen x 12 mos none
Endocrine: normal FSH áFSH áFSH áFSH
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
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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
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METABOLIC CHANGESMenopause
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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
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“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
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Where you gain weight matters
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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
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Metabolic Syndrome isa warning shot…
• 5x increased risk of Diabetes• 3x increased risk of stroke or heart attack
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CARDIOVASCULAR RISKSMenopause
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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
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HDL Cholesterol Levels After Menopause
90
100
110
-24 -18 -12 -6 0 6Months
% o
f lev
el a
t -6
mon
ths
befo
re m
enop
ause
Menopause
Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31
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LDL Cholesterol Levels After Menopause
90
100
110
-24 -18 -12 -6 0 6Months
% o
f lev
el a
t -6
mon
ths
befo
re m
enop
ause Menopause
Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31
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CAN’T WE USE ESTROGEN AFTER MENOPAUSE TO PREVENT HEART DISEASE?
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The Women’s Health Initiative Changed How We Felt About Hormones
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Women’s Health Initiative (continued)
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“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
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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
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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
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BONE HEALTHMenopause
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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
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COMMON SYMPTOMSMenopause
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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.
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The Holy Grail: A Good Night’s Sleep
• Racing thoughts• Night sweats• Snoring• Apnea• Stomach acid reflux• Aches and pains• Frequent urination• Restless legs
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“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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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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Stress Management• Meditation• Yoga• Daily moderately vigorous exercise• Counseling, support groups• Antidepressants• Vitamin D, folic acid• Nutrition• Resilience
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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
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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
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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
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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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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!
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Start the next 40 years off right!
• Weight management• Cholesterol• Blood pressure• Avoid smoking• Stress control• Nutrition• Sleep• Fitness
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Learn More About Menopause
• North American Menopause Society at menopause.org
Dr. Joanna WilsonFreida Toler, Nurse Practitioner
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HerCare Lecture SeriesAftershocks of Fifty Shades of Gray
January 18 at 4:00