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Let’s Talk About Menopause

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.

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Let’s Talk About Menopause

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  1. Let’s Talk About Menopause Joanna Wilson, D.O. Board-Certified Internal Medicine North American Menopause Society Certified Practitioner

  2. Proportion of average female lifespan spent in menopause years: 1/3 to 1/2

  3. 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

  4. Defining Menopause Final Menstrual Period 0 * Stages most likely to be characterized by vasomotor symptoms ¥ STages of Reproductive Aging Workshop Adapted from Soules et al., Fertility and Sterility, VOL. 76, NO. 5, November 2001, p. 875

  5. 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 Nulliparity Hysterectomy* Excessive alcohol intake* *=possible assn Determinants of Age at Menopause (Average Age =51 years)

  6. Menopause Metabolic changes

  7. 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

  8. “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

  9. Where you gain weight matters

  10. Metabolic Syndrome HDL under 50 TG over 150 Fasting sugar 100-126 or HgA1c 5.8-6.4 Waist over 35 inches BP over 135 or on blood pressure Rx

  11. Metabolic Syndrome isa warning shot… • 5x increased risk of Diabetes • 3x increased risk of stroke or heart attack

  12. Menopause Cardiovascular risks

  13. Hypertension: Gender and Age Effects Heart Disease and Stroke Statistics 2012:AHA. Circulation Epub 12.15.2011

  14. HDL Cholesterol Levels After Menopause Menopause Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31

  15. LDL Cholesterol Levels After Menopause Menopause Jensen J, et al. Influence of menopause on serum lipids and lipoproteins. Maturitas 1990; 12:321-31

  16. Can’t we use estrogen after menopause to prevent heart disease?

  17. The Women’s Health Initiative Changed How We Felt About Hormones

  18. Women’s Health Initiative (continued)

  19. “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

  20. Women’s Health Initiative vsKronos Early Estrogen Prevention WHI KEEPS Systolic over 120 = 46% Ever smokers = 20% Average age 53 • Systolic BP >120mmHg = 64% • Ever smokers = 50% • Average age 63 Kronos Early Estrogen Prevention Study

  21. 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

  22. Menopause Bone health

  23. 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

  24. Menopause Common symptoms

  25. 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 Prevalence of Hot Flashes Menopause Years Before Years After 3 2 1 1 2 3 Kronenberg F. Ann N Y Acad Sci. 1990;592:52-86.

  26. The Holy Grail: A Good Night’s Sleep • Racing thoughts • Night sweats • Snoring • Apnea • Stomach acid reflux • Aches and pains • Frequent urination • Restless legs

  27. “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

  28. 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

  29. Stress Management • Meditation • Yoga • Daily moderately vigorous exercise • Counseling, support groups • Antidepressants • Vitamin D, folic acid • Nutrition • Resilience

  30. 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

  31. 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

  32. 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

  33. 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.

  34. 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!

  35. Start the next 40 years off right! • Weight management • Cholesterol • Blood pressure • Avoid smoking • Stress control • Nutrition • Sleep • Fitness

  36. Learn More About Menopause • North American Menopause Society at menopause.org Dr. Joanna Wilson Freida Toler, Nurse Practitioner

  37. HerCare Lecture Series Aftershocks of Fifty Shades of Gray January 18 at 4:00

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