Health in Your 50s
Today’s menopause: not your mothers hormone replacement therapy.
If you’re approaching 50, you may be thinking about major health milestones. Yes, there are many health concerns for women in their 50s—increased risks of heart disease, cancer, diabetes and osteoporosis, perhaps your first colonoscopy, maybe urinary incontinence or a twinge of arthritis. But these concerns may span the decades from the 40s and beyond the 60s for some and never even affect others.
Yet all women experience menopause at some point, and generally around 50. Much like that half-century birthday, menopause is a milestone.
So what’s going on that makes menopause so important? Yes, all women experience it, but not all in the same way. What should you expect—in addition to the hot flashes, night sweats, sleep disturbances, vaginal dryness and mood swings?
Short answers: You may experience some or none of those symptoms and your experience may range from mild to severe. In other words, your mileage may vary. While all these changes are normal, there are treatment strategies that may help you survive them.
As you may know, menopause is when the ovaries stop producing estrogen and progesterone. Yet, the ovaries don’t just stop working one day out of the blue! Around the time of menopause—51 is the average age in the U.S., unless it results from surgery, chemotherapy or radiation—the amount of hormone the ovaries produce fluctuates greatly, and it’s this “hormone roller coaster” that leads to some unpleasant symptoms.
The obvious solution would seem to be to replace these hormonal highs-and-lows by taking hormone replacement medications. Hormone therapies (HT), using either estrogen alone or combined with progesterone, have been proven to be very effective in treating menopause symptoms.
Hormone Replacement Therapy—Replaced
Hormone replacement therapy (HRT) used to consist of high-dose estrogen taken daily, with no planned end date. The idea was not only to control the symptoms of menopause, but also to improve health—primarily by preventing cardiovascular disease (heart attack and stroke) and reducing the risk of cancer and bone-thinning.
What was discovered from large national studies, however, was the opposite: The incidence of heart attack and stroke actually increased, as well as the risk of breast cancer and blood clots. These results drastically changed how HT medication is prescribed today.
Hormone Therapy Today
Today, the typical estrogen dose for hormone therapies is much lower. Most women start HT around the time of menopause, and follow it for only a few years. In fact, best practice is to use the lowest dose of hormone needed for the shortest time necessary.
The therapy is also now widely available in several forms. Pills are still prescribed, but so are gels, sprays, vaginal rings and patches, which are not metabolized by the liver and are generally recommended when possible. The method of delivery and the length of time you should take the medication should be discussed with your physician.
Insurance coverage matters too, as not all forms of the medication are covered by all plans. Check with your provider. And if you’re a smoker or have a history of high blood pressure or diabetes, you may be steered away from HT entirely because of its connection to cardiovascular disease.
If you haven’t had a hysterectomy (removal of the uterus), HT should consist of both estrogen and progesterone to protect against risk of endometrial cancer. If you had one, estrogen alone may work for you.
Some caveats: You should not have hormone therapy if you have had a stroke, heart attack or breast or endometrial cancer; or have liver cancer or a history of blood clots in your veins or lungs.
Lifestyle changes offer important alternative ways to deal with menopause symptoms. For example, you can dress in layers and peel off clothes when hot flashes hit. Light clothing from natural fibers will allow your body to cool off faster. Placing cold packs under your pillow, and flipping it over often, is another technique. And, of course, fans and air conditioners help.
To combat other symptoms, try yoga, meditation and massage—great ways to de-stress. You may know that avoiding heavy and spicy meals as well as alcohol and caffeinated drinks will reduce hot flashes and problems sleeping.
There are non-hormonal options to try as well. Antidepressants have been found to treat not only depression and mood swings, but effectively reduce hot flashes. In addition, soy products, red clover, black cohosh and evening primrose may also provide relief. Although these natural remedies have not been scientifically proven to significantly help with the symptoms, some have found them to be helpful when all else failed.
As for symptoms of vaginal dryness, consider using water-based or silicon-based lubrication for intimate moments. Over-the-counter vaginal moisturizer can provide longer-term relief.
Plan and Adjust
Remember that every woman is different. Some coast through menopause, while others experience severe symptoms that make daily life miserable.
Quality of life matters. Your best plan is to address your symptoms and develop a treatment plan with your doctor. Together, you can decide if your current plan is working or needs a tune-up.
For more information, visit the National Institutes of Health website.
Dr. Lo, a board certified obstetrician/gynecologist with Suburban OB/GYN, is a member of the American College of Obstetricians and Gynecologists. Dr. Lo has offices in Ridley Park and Springfield. Linda Echols, Ph.D., MBA, CRNP, also contributed to this article. 610-521-4311; CrozerKeystone.org.
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