Lydia Collins M. D.Lydia Collins M. D.Transition to Menopause, Transition to Menopause,

the 40’sthe 40’s

www.CascadeWomensHealth.orgwww.CascadeWomensHealth.org

Why is this a topic that deserves Why is this a topic that deserves our attention?our attention?

Neglected time of transition from…Neglected time of transition from…reproductive primereproductive prime

To menopause…To menopause…

Time of great physiological change Time of great physiological change from reproductive prime..from reproductive prime..

……To menopauseTo menopause

Transitional physiologyTransitional physiology

Why not check hormone levels?Why not check hormone levels?

Bioidenticals?Bioidenticals?

Estrogen dominanceEstrogen dominance

Why estrogen dominance?Why estrogen dominance?

Effects of estrogen dominanceEffects of estrogen dominance

• Menstrual changes w shorter cycle lengths, heavier flow and longer duration

• Increased risk of cancers, especially breast and uterine

• Non-cyclical breast tenderness?

• Increased pms?

Erratic hormone levelsErratic hormone levels

Effects of hormonal “chaos”Effects of hormonal “chaos”

• Increasing menstrual irregularities

• Increased pms?

• Hot flashes & night sweats

• Non-cyclical breast tenderness?

• Vaginal dryness

• Symptoms can be intermittent

Other manifestations of physiologic Other manifestations of physiologic changes with agingchanges with aging

• Slowing metabolism w weight gain

• Change in body fat distribution

• Abdominal bloating

• Lactose intolerance

• Sleep disruption

• Changes in sexual function

Final shift in primary source of Final shift in primary source of estrogen in the bodyestrogen in the body

Risks of elevated perimenopausal Risks of elevated perimenopausal estrogen levels & obesityestrogen levels & obesity

• Very heavy and prolonged bleeding• Uterine cancer 2-4x• Breast cancer 1.5x• Kidney cancer 2-4x• Diabetes• High blood pressure• Urinary incontinence• Etc…….

Unique culmination of life stressorsUnique culmination of life stressors

• Teenage children

• Preparing for “empty nest”

• Primary relationship issues

• Career & job stresses

• Aging parents

• Undeniable signs of aging

So what we have is…So what we have is…

• Menstrual changes• Increased pms• Relationship issues• Body fat changes• Vaginal dryness• Slowing metabolism• Night sweats• Abdominal bloating• Changes in sexual fxn

• Aging parents• Hot flashes• Teenagers• Weight gain• Work stresses• Empty nest• Breast tenderness• Getting old

It is our response to this It is our response to this situation that sets the stage situation that sets the stage

for the rest of our lives.for the rest of our lives.

Components of effective responseComponents of effective response

• Medical care when needed

• Acceptance

• A realistic outlook

• Nonjudgmental attention

• Commitment to self-care

• Willingness to make change

• Flexible problem solving attitude

Effective Weight Loss Strategies Effective Weight Loss Strategies National Weight Control RegistryNational Weight Control Registry

• Eat a low-calorie, low-fat diet• Engage in a high level of physical activity• Limit TV viewing• Step on the scale often• Maintain diet consistency• Limit diet variety• Eat breakfast• Limit fast food

Remember…Remember…

• There are no quick fixes• Small changes count• What will work is unique to each person• Detached problem solving helps• Suspend harsh judments• Allow for and enjoy your lapses• Forget media messages• Sometimes big changes are needed

The transitional picture…The transitional picture…

• Menstrual changes• Increased pms• Relationship issues• Body fat changes• Vaginal dryness• Slowing metabolism• Night sweats• Abdominal bloating

• Aging parents• Hot flashes• Teenagers• Weight gain• Work stresses• Empty nest• Breast tenderness• Getting old

““It’s better than the alternative” – It’s better than the alternative” – Cher – Cher – on getting oldon getting old