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Menopause

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Menopause

NIH – Menopause “Two common health problems can start to happen at menopause, and you might not even notice. Osteoporosis. Day in and day out, your body is busy breaking down old bone and replacing it with new healthy bone. Estrogen helps control bone loss, and losing estrogen around the time of menopause causes women to lose more bone than is replaced. In time, bones can become weak and break easily. This condition is called osteoporosis. Talk to your doctor to see if you should have a bone density test to find out if you are at risk. Your doctor can also suggest ways to prevent or treat osteoporosis. Heart disease. After menopause, women are more likely to have heart disease. Changes in estrogen levels may be part of the cause. But, so is getting older. As you age, you may gain weight and develop other problems, like high blood pressure. These could put you at greater risk for heart disease. Be sure to have your blood pressure and levels of triglycerides, fasting blood glucose, and LDL, HDL, and total cholesterol checked regularly. Talk to your health care provider to find out what you should do to protect your heart. How Can I Stay Healthy After Menopause? Staying healthy after menopause may mean making some changes in the way you live. • Don’t smoke. If you do use any type of tobacco, stop—it’s never too late to benefit from quitting smoking. • Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals. • Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements. • Learn what your healthy weight is, and try to stay there. • Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health. “

NIH – Menopause (Medical Encyclopedia) “Menopause is a natural event that normally occurs between the ages of 45 and 55. Once menopause is complete (called postmenopause), you can no longer become pregnant. The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly. The specific symptoms you experience and how significant (mild, moderate, or severe) varies from woman to woman. In some women, menstrual flow comes to a sudden halt. More commonly, it tapers off. During this time, your menstrual periods generally become either more closely or more widely spaced. This irregularity may last for 1 to 3 years before menstruation finally ends completely. A gradual decrease of estrogen generally allows your body to slowly adjust to the hormonal changes. When estrogen drops suddenly, as is seen when the ovaries are removed surgically (called surgical menopause), symptoms can be more severe. Because hormone levels fall, changes occur in the entire female reproductive system. The vaginal walls become less elastic and thinner. The vagina becomes shorter. Lubricating secretions from the vagina become watery. The outside genital tissue decreases. This is called atrophy of the labia.“

NHS – Menopause (Video)

NHS – Menopause “Menopause myths • You can’t get pregnant after the menopause FALSE. It can and does happen so carry on using contraception for two years after your last period if you're under 50 and for one year if you're over 50. • You're going to put on weight FALSE. Middle-age-spread is often linked to the hormonal changes at this time of life but as yet there's no proof. Those extra inches could just be part of growing older and being less active. • Your menopause will be difficult because your mum’s was FALSE. There's no evidence to suggest this, although the age at which your mum went through hers could give you a clue as to when to expect symptoms, as the age of menopause tends to be similar in mums and daughters.”

Highlighted Articles

Relationships between menopausal symptoms, depression, and exercise in middle-aged women: A cross-sectional survey (International Journal of Nursing Studies 2008) “Women who were depressed had more menopausal symptoms than women who were not depressed, and women who exercised regularly were less depressed and less symptomatic than women who did not exercise.”

Dietary and lifestyle predictors of age at natural menopause and reproductive span in the Shanghai Women's Health Study. (Menopause. 2008) “RESULTS:: Early menarche, younger age at first live birth, older age at last live birth, longer duration of breast-feeding, and higher parity were associated with longer reproductive years (Ptrend < 0.01 for all). Higher body mass index at age 20, mid-life weight gain, and leisure-time physical activity during adolescence and adulthood predicted later menopause and longer reproductive span (Ptrend < 0.01 for all). Total intake of calories, fruits, and protein was positively associated with later menopause (Ptrend < 0.05 for all) and longer reproductive span (Ptrend < 0.05), except for carbohydrates (Ptrend = 0.06), and long-term tea consumption predicted longer reproductive span (Ptrend = 0.03). Vegetable, fat, soy, and fiber intakes did not significantly affect reproductive span or age at menopause. Smoking was inversely associated with both early age at menopause and shorter reproductive span (Ptrend < 0.01). CONCLUSIONS:: In addition to reproductive factors, intake of fruits and protein, smoking, tea consumption, lifetime patterns of physical activity, and weight gain influenced the onset of menopause and/or reproductive span in Chinese women.”

Night sweats, sleep disturbance, and depression associated with diminished libido in late menopausal transition and early postmenopause: baseline data from the Herbal Alternatives for Menopause Trial (HALT). (Am J Obstet Gynecol. 2007) "RESULTS: Of 341 women, 64% had diminished libido, 18% had moderate to severe depression, and 43% had poor sleep quality. Women averaged 4.6 hot flashes and 1.9 night sweats per day. Depressive symptoms (P = .003), poor sleep (P = .02), and night sweats (P = .04) were significantly associated with diminished libido."

The timing of natural menopause in Poland and associated factors. (Maturitas. 2007) " RESULTS: The overall median age at natural menopause was 51.25 years; 25th percentile 49; 75th percentile 54 years."

Severe Hot Flashes May Be Linked to Chronic Insomnia (2007) "Hot flashes occurred in 12.5% of premenopausal women, 79.0% of perimenopausal women, and 39.3% of postmenopausal women. Chronic insomnia occurred in 36.5% of premenopausal women, 56.6% of perimenopausal women, and 50.7% of postmenopausal women (P < .001). Prevalence of symptoms of chronic insomnia increased with the severity of hot flashes. More than 80% of perimenopausal women and postmenopausal women who had severe hot flashes also had symptoms of chronic insomnia."

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Menopause

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Drug Side-Effects and Interactions

Hormone Replacement Therapy and the Increase in the Incidence of Invasive Lobular Cancer. (Breast Dis. 2009)

The risk of stroke in postmenopausal women receiving hormonal therapy. (Climacteric. 2009)

Incontinence may be Worsened by HRT in Postmenopausal Women "Our main finding, which comes in particular from one huge trial, is that one type of HRT - systemic conjugated equine estrogen (CEE) - may make urinary incontinence worse," said June Cody, a methodologist at the Cochrane Incontinence Review Group at the University of Aberdeen in Scotland. "In addition, in this large trial, women who did not have incontinence at first were more likely to develop incontinence than those who took a placebo," the researcher added. “

Danish study looks at link between HRT, cancer “Menopausal women who took hormone replacement therapy increased their risk of ovarian cancer by 38 percent, Danish researchers reported on Tuesday. The study of more than 900,000 Danish women aged 50 to 79 found about one extra ovarian cancer for roughly 8,300 women taking hormone therapy each year. At the time they got sick, 9 percent of the women were taking hormone therapy, 22 percent were previous users and 63 percent did not take it. The researchers calculated that current hormone use conferred a 38 percent higher risk of contracting the disease compared to non-users over the eight-year study. “

Hormone Therapy Still Risky When Started Soon After Menopause “A further analysis of data from the Women's Health Initiative (WHI) trials indicates that the risks of hormone therapy still generally outweigh the benefits, even when initiated soon after menopause. WHI trials examining the use of conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) were stopped early in 2002 and 2004, respectively, after these interventions were linked to increased risks of breast cancer and stroke and appeared to provide little benefit for heart disease. “

Menopause Drug Tied to Breast Cancer Recurrence "A large study of tibolone, a drug used to treat menopausal symptoms and to prevent osteoporosis, was halted early after researchers found that the synthetic steroid significantly increased the risk of recurrent breast cancer among survivors of the disease."

Hormone Therapy Linked to Brain Shrinkage but Not Stroke

Drugs

Oestrogen therapy for urinary incontinence in post-menopausal women. (Cochrane Database Syst Rev. 2009)

"Timing Hypothesis" for Hormone Therapy: Still Viable, or Time to Let Go?

Long term hormone therapy for perimenopausal and postmenopausal women. (Cochrane Database Syst Rev. 2009) “AUTHORS' CONCLUSIONS: HT is not indicated for the routine management of chronic disease. We need more evidence on the safety of HT for menopausal symptom control, though short-term use appears to be relatively safe for healthy younger women.”

Women's Testosterone Patch May Not Work

2 Years of Hormone Use May Be 'Safe' "The risk for lobular cancer doubled after three years of estrogen-plus-progesterone use, and ductal cancer doubled in risk after 10 years of use, the study found. With estrogen-only therapy, the likelihood of developing lobular cancer increased 50 percent after 10 years of use, but there was no increase in the risk for ductal cancer, even after 20 years. However, the study found that women who used an estrogen-progesterone combination for less than two years had no increased risk, possibly representing a safe period for combination therapy, the researchers said. Nor was added risk found for women who had used the hormone combination but had been off the therapy for two or more years. The researchers said that this suggests a window of two to three years for the risks associated with the estrogen-plus-progesterone combination to become apparent after initial use and to diminish after the therapy is halted."

Exercise

Effect of 6-months of physical exercise on the nitrate/nitrite levels in hypertensive postmenopausal women. (BMC Womens Health. 2009) “CONCLUSIONS: Our study shows that changing in lifestyle promotes reduction of arterial pressure which was accompanied by increase in nitrite/nitrate concentration. Therefore, 6-months of exercise training are an important approach in management arterial hypertension and play a protective effect in postmenopausal women.”

Physical activity patterns and prevention of weight gain in premenopausal women. (Int J Obes (Lond). 2009)

Fitness tips for menopause: Why physical activity matters

General Information

Study: HRT Could Be Risky “Women who take hormone replacement therapy (HRT) may have a higher risk of developing lung cancer and dying. Data from researchers at Los Angeles Biomedical Research Institute at Harbour-UCLA Medical Center suggest that HRT, oestrogen plus progestin in postmenopausal women, carries more health risks than benefits.”

Asian spice could reduce breast cancer risk in women exposed to hormone replacement therapy “In the study, researchers found that curcumin delayed the first appearance, decreased incidence and reduced multiplicity of progestin-accelerated tumors in an animal model. Curcumin also prevented the appearance of gross morphological abnormalities in the mammary glands. In previous studies, MU researchers showed that progestin accelerated the development of certain tumors by increasing production of a molecule called VEGF that helps supply blood to the tumor. By blocking the production of VEGF, researchers could potentially reduce the proliferation of breast cancer cells. Curcumin inhibits progestin-induced VEGF secretion from breast cancer cells, Hyder said.”

Breast Cancer Decline “Now a new study out of the Northern California Cancer Center suggests more of this decline occurred in richer and more urban areas, and they point to greater news coverage of the breast cancer-hormone therapy link in those communities as one reason why. A report issued in 2007, for example, correlated the number of news articles on the link with urban residence and a greater likelihood women would either stop using hormone therapy or never begin it in the first place. “

Breast Cancer Risk Declines Quickly After Stopping Hormone Therapy: WHI Data in NEJM

Testosterone Improves Sexual Function in Women Not Taking Estrogen

Are Bioidentical Hormones Better? (Dr. Weil)

Bioidentical hormones: Are they safer?

Oprah and Bioidentical Hormones: FAQ

Steer Clear of "Bioidentical" Hormone Therapy

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Fish Oil: A Miracle "Cure" for Menopause?

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