Menopause And You: Your Change. Your Life. Take Charge.
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Menopause And You: Your Change. Your Life. Take Charge.
About the Society of Obstetricians and Gynecologists of Canada (SOGC) • 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
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.
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Tonight’s Agenda 1
What happens at “menopause”?
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How can we manage our symptoms?
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What can we do to maximize our health during menopause?
What Is Menopause? • A period of change: • Hormonal • Physical • Emotional
• End of menstruation and child‐bearing years
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
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What Happens During The Menopausal Transition? • Monthly cycle begins to change • Number of stored eggs in the ovaries decreases • Hormone levels fluctuate
Premenopausal years
Postmenopausal years
Estrogen And Progesterone Have Many Effects In The Body • • • • •
Brain Breasts Heart Liver Bones
• • • •
Vagina Skin Uterus Ovaries
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
No two women experience menopause in the same way
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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
Why Do Hot Flashes Happen?
Body becomes more sensitive to small changes in core body temperature
AUDIENCE COMMENTARY…
What Have You Done To Manage Hot Flashes?
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How Are Women Trying To Manage Hot Flashes? • Lifestyle changes • Alternative & complementary therapies • Traditional hormonal therapy • Non‐hormonal prescription therapies
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
Herbal Remedies, Soy & Botanicals • • • • • • •
Soy Black cohosh Alfalfa Dong quai Ginseng Evening primrose oil Multi‐botanical products
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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
Herbal Remedies, Soy & Botanicals
Mean number of VMS per day
Research shows little positive impact:
Ann Int Med Dec 2006 Am J Med 2005;118 (12B): 98S–108S
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
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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
Custom‐Compounded Bioidenticals
What Are “Custom‐Compounded” Bioidenticals? • North American phenomenon • Hormone recipes made by a compounding pharmacist • Bi‐Est, Tri‐Est, progesterone and testosterone cream • DHEA (tablet)
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Why The Interest In “Custom‐ Compounded” Bioidenticals? • 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
Problems With “Custom‐Compounded” Bioidenticals These products… ARE NOT adequately studied in research HAVE NO proof of safety and efficacy HAVE NO
standard manufacturing or quality control
HAVE NO regulation of advertising claims
“Custom‐Compounded” Bioidenticals & Safety • 29 products from 12 compounding pharmacies were tested: • ⅓ failed quality control tests • ¼ failed potency standards
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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
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
What Is Traditional HT? These hormone preparations… ARE
adequately studied in research
HAVE
proof of safety and efficacy
HAVE
standard manufacturing or quality control
HAVE
regulation of advertising claims
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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
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
AUDIENCE COMMENTARY…
For those of you who are taking hormone therapy: How much? How long?
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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
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)
Menopause And HT: What’s The Controversy?
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Breast Cancer: How does taking HT affect your risk of developing breast cancer?
Breast Cancer Facts: Out Of 1000 Menopausal Women… 45 not taking HT will develop breast cancer
47 taking HT for 5 years will develop breast cancer
2 more cases per 1000 women will develop breast cancer
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 60 years old
• Results DO NOT apply to younger, newly menopausal women
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
Menopause And Aging: How Can We Maximize Our Health As We Get Older?
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Preventing Heart Disease 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
Treating Heart Disease And HT SOGC Position • 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
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
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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
Preventing Fractures Exercise and balance training
Improved coordination
Less chances of falling
Better balance
Less fractures
Greater strength
Less damage from fall
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
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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
Prevention Of Osteoporosis • SOGC encourages • Healthy diet • Adequate calcium and vitamin D • Regular exercise
• www.sogc.org • www.menopauseandu.ca • www.osteoporosis.ca
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
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Vulvovaginal Atrophy Symptoms • • • • •
Urge “to go” Frequent urination Vagina dryness Painful sex Recurrent urinary infection
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
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
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Treatment Of Vulvovaginal Symptoms • Stop smoking • Use estrogen vaginally: • Cream Applicator or fingertip
• Tablet Insert twice weekly
• Ring Change every 3 months
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
Sleep Disturbances • Common symptom with aging • Hot flashes can make it worse • Exercise helps
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Mood Troubles • Many women report “moodiness” during menopause transition • Depression is more common among newly menopausal women
Mood Troubles • Talk to your health care provider about mood symptoms • Seek appropriate support and counseling • Treatment is available
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
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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
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!!!
Need Help With Your Diet?
www.dietitians.ca Canada’s Food Guide
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Question Period • For more information, consult: • sogc.org • menopauseandu.ca • menopause.org • sexualityandu.ca • HPVinfo.ca
Thank You!
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Notes
Notes
Menopause And You: Your Change. Your Life. Take Charge.
