Wednesday, January 28, 2009

Menopause Factoids

  • You are one of 40 million American women who is experiencing menopause
  • Hot flashes occur in 75% of menopausal women and impact quality of life
  • The average age for menopause is 51 years with the normal usual range being from 45 to 55 years
  • Between 10 and 20 percent of women have no menopausal symptoms, 60 percent experience mild to moderate symptoms and 10 to 20 percent severe symptoms
  • In a telephone survey of 886 women 22.1% used an alternative therapy to manage menopausal symptoms and of these women 89-100% found them to be somewhat or very helpful
  • In a survey of women attending a San Francisco health conference only 29% of menopausal women surveyed use HRT alone. Many of them (32%) used dietary supplements alone and the most commonly used were soy (29%), ginkgo biloba (16%), and black cohosh (10%)
  • Between 10 and 20 percent of women who have had a hysterectomy have early menopause, referred to as surgical menopause, between 1 - 4 years earlier than their expected menopause
  • Some types of chemotherapy, common treatments for breast cancer patients, have been known to cause menopause-called medical menopause-in women. Whether temporary or permanent, it is estimated that 50% of CMV chemotherapy patients under 35 go into menopause and the number jumps to an astounding 100% for women over 45

How should I prepare for menopause?

Menopause is a significant, natural lifestage. For some, it is a formidable time due to irritating and life-altering physical and emotional changes. For others, it is a time of personal growth and renewal. Here are some suggestions to help you make your menopausal years positive:

  • Educate yourself-there is now a multitude of information online, in books and from your healthcare professional
  • Talk to friends and relatives for encouragement and advice. Make them aware of certain symptoms so that they can support you and understand your needs
  • Join a menopause or midlife support-group. Changemenopause.com is a blogging site that's meant to support you, provide you with an outlet for voicing your concerns and frustrations, garner advice from other women and initiate conversations
  • Eat nutritious foods and engage in regular exercise
  • If you smoke, try quitting. Smoking, aside from being associated with heart disease and cancer, also causes more rapid bone loss and worsens hot flashes
  • Reduce alcohol consumption to a moderate amount
  • Make social activities and personal time a priority
  • Pamper yourself-indulge in a massage, start a new hobby, get a housekeeper; this is the time in your life to allow yourself some luxuries
  • Consult your health care professional about any health concerns
  • Stay sexually active-Decrease in libido is a commonly reported side effect of menopause. Elements such as body image, sleep disturbance, medications, incontinence, stress, lower levels of certain hormones and any problems with your partner can greatly affect a woman's desire to be sexually active To increase desire and sexual potential you can:
    • Apply vaginal moisturizers and lubricants to ease the discomforts of intercourse
    • Talk to your partner about the symptoms and issues you are experiencing
    • Experiment with techniques for sexual stimulation or erotic toys, videos and massage
    • Consult a sex therapist
    • Make changes to your sexual routine to increase interest level for both you and your partner

How you can help yourself cope with the symptoms of menopause?

There are many ways of dealing with the menopausal life transition, though it often depends on the severity of the symptoms. Many women cope with mild symptoms and do not find medication necessary; however, there are many others that are constantly searching for relief through a multitude of available therapies and treatments.

Regular exercise can alleviate menopausal symptoms because it promotes wellbeing, enhances relaxation and sleep, and reduces stress. In addition, adopting a healthy diet including foods rich in phytoestrogens such as soy products or linseed may be beneficial. Some women have found relief from hormone therapy, while others shy away from it because of reports on potential health risks, or after experiencing unpleasant side effects during use. Other women prefer to take herbal or plant hormone therapies. Those with moderate to severe symptoms should consult with their physician or a qualified naturopath or herbalist, with an interest in women's health.

What is Osteoporosis?

Osteoporosis occurs when bones lose their strength and density, and become fragile and fracture more easily because of calcium loss. This disease particularly affects women in their middle and later years.

Post-menopausal women should consume at least 1200-1500mg of calcium daily (about three dairy servings). Women who have difficulty digesting dairy, have a vegan lifestyle or cannot achieve this intake through food alone, should use calcium supplements. Although calcium does not prevent bone loss, it is important in the overall prevention of osteoporosis when combined with exercise, estrogen and other therapies. If you are taking another supplement, it is recommended that you split the daily dose of calcium since the body can only absorb a limited amount of calcium at one time.

Does menopause lead to any increased health risks?

Yes, during and after menopause, women are at higher risk for stroke, heart attack, osteoporosis and weight gain. Lifestyle changes, such as diet and exercise, can help combat these risks. There are also supplements available, which address these health issues.

Do all women experience menopause in the same way?

To each woman, menopause is a unique experience. In addition to the varying severity of symptoms, the onset of menopause can occur at almost any age. For example, a woman who encounters menopause at 48 may have a friend who doesn't enter this stage until 56 years of age. These situational factors can lead some women to feel alone and misunderstood.

In addition to differing physical and emotional effects, reactions to treatments vary for each woman, which can lead to difficulty in determining a timely relief strategy. A treatment that works for one woman may not work for another. Also, some women may find that initially an option does not provide much relief, when in actuality it is possible that dosage levels and treatment duration may need adjustment in order to feel results.

Research has shown that a woman's experience with menopause is influenced by many factors, including genetics, diet, lifestyle and lack of education and discussion about this life transition.

Many women grew-up unaware of menopause because their mothers rarely spoke of it or simply referred to this time in their life as "the change". Today, menopause is no longer a taboo topic. Increased awareness and information has assisted women in understanding their individual needs and options for care.

What are the available natural alternatives for relieving menopause?

Many women have found that alternative therapies and natural supplements are most effective in alleviating their menopausal symptoms. A few of the most popular natural alternatives are soy phytoestrogens, black cohosh and red clover. Further studies need to be conducted to determine what risks, if any, are associated with natural therapies.

Phytoestrogens:

Often referred to as phytoestrogens or plant-estrogens, isoflavones are not hormones, but are similar in shape to the estrogen produced within our bodies and have the ability to bind to the same estrogen receptors as the actual hormone does. Isoflavones are a class of flavonoids that are plant- derived compounds.

Soy

Soy products contain natural compounds called isoflavones, which are similar in chemical structure to estrogen. These compounds may decrease or even eliminate menopause symptoms, such as hot flashes. Foods rich in soy include soybeans, tofu, tempeh and soymilk. Because of their weak estrogen- like effects, soybean isoflavones may be an option for relieving menopausal symptoms.

Isoflavones found in soybeans have three main types: genistein, daidzein and glycitein. Genistein has been the most widely researched isoflavone while research on daidzein has been catching up. Most isoflavones found in soy are in their inactive form called glycosides, which must be converted into the free-form before they can be absorbed by the body. The active form is called an aglycone. There is wide variability from person to person on how well isoflavones are absorbed, with poor absorption leading to insufficient results.

In Japan, where soy foods are consumed daily, women are only one-third as likely to report menopausal symptoms as women in the United States or Canada. Even though their estrogen activity is weak, isoflavones may be potent enough to reduce menopausal symptoms. In fact, research has shown that women who ate soy flour daily experienced about a 40 percent reduction in menopausal symptoms.

Since estrogen helps protect against osteoporosis and heart disease, women are at greater risk for both of these problems after menopause. Adding soy foods or an isoflavone supplement may provide some benefit.

Typically, soy foods are divided into two categories: non-fermented and fermented soy products. Traditional non-fermented soy foods include fresh green soybeans, whole dry soybeans, soy nuts, soy sprouts, whole-fat soy flour, soymilk and soymilk products, tofu, okara and yuba. Traditional fermented soy foods include tempeh, miso, soy sauces, natto and fermented tofu and soymilk products.

In fermented soy, a potent form of soy, which can be used as a treatment for menopause, isoflavones are broken down into their "free" active form for improved absorption. In Asian countries, the longstanding dietary principles of Koji fermentation have been used to make foods such as miso soup. Koji Fermentation not only creates aglycones that assist in menopausal relief, but also makes other health nutrients available, such as powerful antioxidants that are not available in soy itself. This unique combination has helped women achieve results when other soy products and natural menopause remedies failed.

Red Clover

Red clover, a member of the legume family, is rich in phytoestrogens compounds, which function like estrogen in the body, and bioflavonoids. Because of all of these characteristics it is thought to help alleviate a number of perimenopausal and menopausal symptoms like hot flashes, night sweats, and other symptoms linked to estrogen levels. Some studies on a proprietary extract of red clover isoflavones, although not thoroughly convincing, indicate that it may significantly curtail instances of hot flashes in menopausal women.

Black Cohosh:

A group of clinical studies have demonstrated positive results in the use of black cohosh in the treatment of menopause symptoms in studies that lasted as long as six months. Menopause symptoms such as hot flashes, night sweats, irritability, mood swings and sleeplessness have shown improvement with black cohosh.

It is not clear how black cohosh works. Some researchers think black cohosh contains plant estrogens and therefore has hormonal effects, but the latest reports have found no estrogens or hormonal effects. Black cohosh is generally well tolerated and side effects are uncommon. It may produce nausea, vomiting, dizziness and headaches. Black cohosh should not be taken during pregnancy as it has not been studied extensively. It is suggested that it may stimulate contractions and lead to premature labor

Other:

Other alternative treatments for relieving menopausal symptoms and side effects include: evening primrose oil, dong qua?i, ginseng, St. John's wort, chasteberry, calcium and magnesium

What are ERT, HRT and Bioidentical Hormones?

A few of the most widely used and talked about medical treatments for menopausal symptoms are Hormone Replacement Therapy (HRT), Estrogen Replacement Therapy (ERT) and Bioidentical Hormone Replacement Therapy (BHRT). Although these treatments vary, their common purpose is to aid the body in regaining hormonal balance due to the decreased hormone production that occurs during menopause. Below are how they differ:

Estrogen Replacement Therapy (ERT):

Estrogen Replacement Therapy refers to the use of estrogen alone to treat menopausal symptoms. ERT is the standard hormone replacement therapy for women who have had a hysterectomy.

The most commonly prescribed ERT in the United States includes mixtures of several forms of estrogen. Estrogen can be taken in several ways-pills or tablets, vaginal creams, vaginal ring inserts, implants or shots and adhesive patches.

Risks associated with ERT include stroke, breast cancer, endometrial cancer, gallstones and ovarian cancer. Lesser side effects include headache, nausea, vaginal discharge, weight gain and spotting of the skin, particularly on the face.

Hormone Replacement Therapy (HRT):

Hormone Replacement Therapy is used to treat menopausal symptoms that occur from fluctuating levels of natural hormones in the body, particularly estrogen.

HRT actually evolved from ERT. Based on research that found estrogen alone increased the risk of endometrial cancer, progestin - a natural or synthetic form of progesterone - was added to keep the endometrium from thickening. This significantly reduces the risk of endometrial cancer, a cancer of the lining of the uterus.

HRT is not appropriate for all women. If you decide to take HRT you should have a number of initial tests which may include:

  • Breast examination
  • Internal pelvic examination
  • Blood pressure
  • Thyroid function
  • Body mass index (BMI) measurement
  • Blood Pressure test, Cervical smear and breast screening every year regularly during HRT treatment

HRT is derived from synthetic-or man-made-hormones. Although one can choose from a variety of HRT brands, the drugs are mass-produced as universal dosages, versus bioidentical hormones, which are customized for each patient. Recently, the National Institutes of Health (NIH) Consensus Panel from the State-of-the-Science conference released a statement confirming that hormone replacement therapy poses serious health risks. Some health risks that have been associated with HRT include breast cancer, heart attack and stroke.

Bioidentical Hormone Replacement Therapy (BHRT):

BHRT stands for Bioidentical Hormone Replacement Therapy (also known as natural hormone replacement). The hormones are taken from yams and/or soy. Once they are extracted from their natural source, the hormones are made to be identical to the moleculer structure of the ones produced by your body.

HRT differs from BHRT in the type of hormones used. Any type of hormone may be prescribed in HRT. Most commonly, doctors use hormones extracted from the urine of pregnant horses or hormones assembled in a laboratory. Neither is identical to the molecular structure of a woman's hormones. Insufficient relief or unpleasant side effects can occur due to ineffective hormone ratios or mismatched chemical structures.

For many years, physicians have been prescribing Bioidentical Hormone Replacement Therapy as an alternative to a synthetic hormone. An advantage of this therapy is that it can be customized-for strength and dosage-in order to achieve hormonal balance through the lowest dose possible.

BHRT treatment involves the use of several different hormones: estrone, estradiol and estriol and, and where appropriate, progesterone and testosterone.

The first step to BHRT is to have a complete hormone analysis. In addition to the test results, factors such as height, weight and body composition are used in order to create a personalized formula. The effects are monitored and the formula can be adjusted, as needed, until the individual has achieved relief.

Availability of BHRT services varies from state-to-state. Contact your health insurance or health care provider for more information. Further studies need to be conducted to determine what risks, if any, are associated with bioidentical hormone therapy.

Most of the medical community views BHRT in the same category as ERT and HRT when it comes to the level of risk. There is also the view that lack of standardization and FDA supervision in BHRT is a negative aspect associated with this menopausal hormone treatment option.

What are available treatments for menopause symptoms?

There are various options for relieving symptoms caused by menopause. Drugs and natural supplements, as well as lifestyle changes include, but are not limited to:

  • Estrogen replacement therapy (ERT)
  • Hormone replacement therapy (HRT)
  • Bioidentical Hormone Treatment
  • Phytoestrogens-soy and red clover
  • Black cohosh
  • Prescription drugs-such as contraceptives and drugs that address depression
  • Supplements-such as calcium and vitamin D to combat osteoporosis
  • Exercise-can help strengthen cardiovascular health, fight fatigue, keep
  • bones strong, maintain weight and stop insomnia
  • Diet-eat plenty of healthy foods such as fruits, vegetable and whole grains; avoid caffeine, sugar and saturated fats; some people may need to reduce caloric intake by 200-400 calories in order to combat weight gain
  • Kegel exercises-for urinary incontinence
  • Clothing-dress in layers if you experience hot flashes; comfortable, loose clothing can help with night sweats
  • Avoid smoking and excess alcohol
  • Maintain healthy blood pressure, using medications if necessary
  • Get regular pelvic and breast exams
  • Keep a hot flashes and night sweats diary to identify possible influences

What are the symptoms of menopause?

The most common menopausal symptoms are hot flashes, night sweats and vaginal dryness. Other symptoms that can occur include:

  • mood changes
  • anxiety
  • diminished memory or concentration
  • sleep disturbances
  • fatigue
  • mild depression
  • palpitations
  • decreased libido
  • muscle pains
  • crawling skin
  • urinary incontinence

Women who have had a history of depression or severe PMS (pre-menstrual syndrome) may be more susceptible to certain symptoms. Women who experience the symptoms listed above during perimenopause, will most likely experience them at a greater degree during postmenopause.

What is postmenopause?

The postmenopausal phase usually begins at one full year after the last menstrual cycle. During postmenopause most of the discomfort of the menopausal changes have faded to some degree and symptoms such as hot flashes are less intense and energy and emotional levels become more balanced. While postmenopause usually begins around age 50, some women become postmenopausal in their mid-40s, while others do so in their later 50s. Since postmenopausal women produce less estrogen, there are some still symptoms that they might experience. About 10 percent to 15 percent of postmenopausal women will experience vaginal dryness, which can lead to painful intercourse. Women who have had a hysterectomy and undergone surgical menopause may experience incontinence and decreased libido. And some women will find that the hot flashes and night sweats that started during perimenopause persist for a few years. Most women, however, feel much better once the hormonal "storms" of perimenopause abate and talk of increased energy and new vitality.

What is menopause?

Menopause is the end of a woman's reproductive life. The ovaries no longer produce eggs and monthly menstruation cycles have permanently ceased for at least 12 months. During the menopause transition, many women experience uncomfortable, irritating or life-disrupting symptoms. The average age for menopause is 51 years with the typical range being from 45 to 55 years.

What is Perimenopause?

Perimenopause is the stage prior to menopause when ovarian hormone production begins to decline and fluctuate. Periods may become erratic and other symptoms may ensue, such as hot flashes, mood swings, decreased fertility, loss of sex drive and body or skin changes. Typically, perimenopause is the period about three or four years before menopause, but this can vary from woman to woman. Perimenopause is a good time for women to examine their lifestyle and make appropriate improvements to eating habits, frequency of physical activity and overall wellbeing.