Menopause And You:
Your Change. Your Life. Take Charge.
About the Society of Obstetricians and
Gynaecologists 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.
Tonight’s Agenda
1
What happens at “menopause”?
2
How can we manage our symptoms?
3
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
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
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?
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
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
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)
Why The Interest In “CustomCompounded” 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
standard manufacturing or quality
HAVE NO
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
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
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?
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?
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 <48 years
Breast Cancer Summary
We ALL have personal risk factors for
breast cancer
• Being a woman and getting older are the
biggest risks!
• Other factors (including HT) carry less risk
AUDIENCE COMMENTARY…
How many of you are aware of the “Women’s
Health Initiative Study” (WHI)?
What does it mean to you?
The Women’s Health Initiative 2002 (WHI)
NOT a study looking at effects of HT
on menopause symptoms
Diseases of Aging Evaluated
Heart disease
Osteoporosis
Cancer (breast, colorectal)
Dementia
Urinary incontinence
Were The Women In WHI Like The Average
Menopausal Woman?
NO!
• 50% were high risk (smokers, overweight, high
blood pressure, diabetes)
• Average age was 63 years
•⅔ were >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?
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
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
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
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
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
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
½
• About
of women aged 45-64
are overweight
• Risk to your health:
•
•
•
•
Diabetes
Hypertension
Cancer
Stroke
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
Need Help With Your Diet?
www.dietitians.ca
Canada’s Food Guide
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!!
Question Period
More info? consult these sites:
• sogc.org
• menopauseandu.ca
• menopause.org
• sexualityandu.ca
• powderroom.ca
• laughingwithoutleaking.ca
• thebigow.ca
Menopause And You:
Your Change. Your Life. Take Charge.