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Menopause Essentials: impact on short and long-term health

Menopause Essentials: impact on short and long-term health. Margaret Rees EMAS Executive Director http://www.emas-online.org Twitter EMAS ‏@ emas_online Editor in Chief Maturitas Editor in Chief Case Reports in Women’s Health

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Menopause Essentials: impact on short and long-term health

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  1. Menopause Essentials: impact on short and long-term health Margaret Rees EMAS Executive Director http://www.emas-online.org Twitter EMAS ‏@emas_online Editor in Chief Maturitas Editor in Chief Case Reports in Women’s Health Reader Emeritus in Reproductive Medicine, University of Oxford Visiting Professor, University of Glasgow, Karolinska Institute and University of Turku Adjunct Associate Professor Robert Wood Johnson Medical School, at Rutgers University. Conflict of interest: none declared

  2. By 2050 over 1 billion women will be aged over 60 worldwide The average of the menopause is 50 Menos month Pausus to stop Menopause is cessation of ovarian function leading to lack of estrogen, lack of periods and infertility Women represent 54 per cent of the population aged 60 and over and 62 per cent of those aged 80 and over. The World's Women 2015 https://unstats.un.org/unsd/gender/worldswomen.html

  3. https://en.wikipedia.org/wiki/List_of_oldest_living_people

  4. Employment statistics for workers aged 50 and over, by 5-year age bands and gender: Department for Work and Pensions 2015

  5. Many women in today’s workforces will be working throughout their menopausal years. • While the menopause may cause no significant problems for some women, for others it may present considerable difficulties in both their personal and working lives. • Greater awareness among employers, together with sensitive and flexible management can be helpful for women at this time.

  6. Menopause symptoms and long term health • Symptoms • Hot flushes and night sweats • Vaginal dryness • Repeated urinary tract infections • Period problems • Long term health • Osteoporosis and muscle health (sarcopenia) • Cardiovascular disease: heart disease and stroke • Dementia

  7. Premature/ early menopause • Menopause can happen before the age of 50 even in teenagers • Premature menopause is menopause before age 40 and affects 1% of women • Early menopause is menopause before age 45 and affects 6% of women • Women with premature/ early menopause have a greater risk of osteoporosis and heart disease compared to women who have menopause at age 50 or over

  8. Hot flushes and night sweats • Affect up to 85% of menopausal women • Can start before periods stop. • Usually taper off after a few years • But some women will flush for over 10 years, some even into their 80s

  9. Vaginal dryness and urinary tract problems • Tend to go together as estrogen lack affects both the vagina and bladder • Symptoms include • Vaginal dryness, burning, and irritation • Sexual problems due to lack of lubrication, discomfort or pain • Urinary symptoms such as recurrent urinary tract infections, painful urination, urinary urgency

  10. Vaginal dryness • Affects up to 50% women after menopause • But may affect more women as research suggests it is probably under-reported, underdiagnosed and therefore undertreated. • Affects couple’s lives: sexual dysfunction and painful sex • Effective and safe treatments are available • It is a long term condition and symptoms will come back when treatment is stopped

  11. Recurrent urinary tract infections • Recurrent UTIs (rUTIs) are defined as at least three episodes of UTIs in twelve months, or at least two episodes in six months. • Common in older women. • More common in women in residential care. • Can be life threatening • Treatment and prevention (antibiotics, vaginal estrogens) • Cranberry products ineffective • NICE guideline [NG109] Published date: October 2018

  12. . Menstrual problems in the perimenopause • Unpredictable periods • Heavy with flooding and clots

  13. Cardiovascular disease: heart disease and stroke • Cardiovascular disease (CVD) in women is the number one cause of death worldwide. • In Europe CVD is responsible for over 3.9 million deaths a year, or 45% of all deaths. • In men, CVD accounts for 1.8 million deaths (40% of all deaths) • In women it is responsible for 2.1 million deaths (49% of all deaths). • Cancer accounts for just under 1.1 million deaths (24%) in men and just under 900,000 deaths (20%) in women.

  14. Heart disease in women • Presents on average 7-10 years later in women than in men ie in their 60s. • Symptoms of heart attack may be different women leading to delays in seeking medical help • Risk factors include • persistent hot flushes • inflammatory disease eg rheumatoid arthritis • a family history of CVD • migraine in the teens/twenties • pregnancy problems, such as recurrent miscarriage, high blood pressure, pre-eclampsia • untreated premature/early menopause

  15. Stroke • Women have stroke at an older age than men. • Women may have a worse prognosis compared to men. • Risk factors for stroke in include: • high blood pressure • atrial fibrillation • smoking • diabetes • obesity and physical inactivity. • The role of high cholesterol is, disputed   • Types • 85% are ischemic (arterial blockage) . • 10% of all strokes are due to intracerebral haemorrhage • 5% due to subarachnoid haemorrhage.

  16. Osteoporosis • Definition“a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture”.  • Risk increases with age and more common in women • Fractures: hip, spine and wrist (Colles) • Hip fracture is associated with increased mortality especially in the first weeks/ months

  17. Osteoporosis: global and European burden • WorldwideOsteoporosis causes more than 8.9 million fractures annually.  • In Europe 3.5 million cases per year. • The total number of people with osteoporosis in Europe has been predicted to rise by 23%, from 27.5 million in 2010 to 33.9 million in 2025 due to the increasing proportion of elderly people in the population.

  18. Osteoporosis affects 1 in 3 women and 1 in 5 men

  19. Risk factors for assessment of fracture probability • 1.    Age2.    Sex3.    Low body mass index (≤19kg/m2)4.    Previous fragility fracture, particularly of the hip, wrist and spine including morphometric vertebral fracture5.    Parental history of hip fracture6.    Current glucocorticoid treatment (any dose, by mouth for three months or more)7.    Current smoking8.    Alcohol intake of three or more units daily9.    Secondary causes of osteoporosis including:•    Rheumatoid arthritis•    Untreated hypogonadism in men and women•    Prolonged immobility•    Organ transplantation•    Type I diabetes•    Hyperthyroidism•    Gastrointestinal disease•    Chronic liver disease•    Chronic obstructive pulmonary disease • Compston et al; National Osteoporosis Guideline Group (NOGG). UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2017;12:43.

  20. Muscle health: sarcopenia • Sarcopenia, or age-related loss of muscle, leads to functional loss, disability and falls • Affects around 30% of people • More common in women • Increased risk with low protein diet, lack of exercise • May be associated with obesity

  21. Dementia and cognitive decline • Dementia is a progressive, irreversible decline in cognition   • Incidence increases with age • No proven treatments which can slow or cure the disease • Types • Alzheimer's disease (AD) most common, present in 50–75% of cases. • Others include vascular • Risk factors • Cardiovascular disease • High blood pressure, high cholesterol, obesity, and diabetes.

  22. World Alzheimer Report 2015 The Global Impact of Dementia • 46.8 million people worldwide are living with dementia in 2015. This number will almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050. • Prevalence has increased in Asia and Africa, but decreased in Europe and the Americas. • https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf

  23. The national breakdown of dementia prevalence by gender. England’s greater population of people leads to the much higher numbers of people with dementia though a similar gender breakdown is seen across the UK.

  24. Conclusion • Menopause is increasingly a midlife stage • Menopausal symptoms and the consequences of estrogen deficiency are not confined to the perimenopausal years • Health professionals need training starting early in medical and training schools

  25. Further information • EMAS CareOnline 2018; the online menopause text book • EMAS position statements and clinical guides • NICE guidelines [NG23]. Menopause: diagnosis and management. • Attendees to this workshop can benefit from free EMAS membership for 3 months

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