September is Menopause Awareness Month
September is Menopause Awareness Month! Menopause is an issue of great importance to the
5,000 women per day who enter menopause in the United States and Canada. It's also important to the families of all of these women. Menopause is simply the cessation of menses (menstruation) as a result of the body's decreased estrogen production. This can be due to aging or any
number of other reasons including some we don't fully understand. The average age of menopause
in the US is 51, but it can occur as early as the 20s or as late as the 60s.
Why is it important to have menopause awareness? Because the same thing that
causes periods to stop also causes menopausal symptoms in two out of
three menopausal women. The ovaries stop producing estrogen, potentially causing
hot flashes, night sweats, sleep disturbances, mood swings, vaginal dryness,
and decreased libido. Regardless of whether or not a woman has menopausal
symptoms, the decrease in natural estrogen production increases a woman's risk
for several conditions including heart disease, osteoporosis, and Alzheimer's disease.
This connection between the cessation of menstruation and the increase in risks for
heart disease, osteoporosis, and Alzheimer's, among others, led to the theories (correct in some cases, recently proven incorrect
in others) that estrogen replacement therapy (ERT) would be an effective treatment
for these diseases. We know that estrogen alone can significantly
increase the risk of cancer of the lining of the uterus (endometrial cancer).
To prevent this, we have given concomitant progesterone therapy to all women
taking estrogen, UNLESS they have already had a hysterectomy.
The results of the Women's Health Initiative (WHI) and other studies in the
past year have clarified that ERT with or without progesterone does in fact
reduce the risk of osteoporotic fractures and reduces the risk of colon cancer.
However, we have also learned that combined estrogen plus progesterone (HRT)
can actually increase the risk of coronary artery disease, heart attacks, stroke,
and breast cancer, as well as breast cancer deaths. Other studies have also
suggested an increased risk of dementia, the mental changes similar to those
in Alzheimer's disease. The biggest outstanding question now is whether these
studies also apply to women taking estrogen alone and whether there's a differential
effect in results based upon a woman's individual genetic make-up and/or the age
at which she begins therapy. In the next few days we will summarize some of
the recent, and slightly confusing, studies in this area that have been featured
in the media over the past two months.
Many doctors believe these studies raise more questions than they answer.
What is newly agreed upon is that HRT has no benefit in preventing cardiovascular
disease. What is still generally agreed is that if healthy menopausal women
need short-term HRT to treat menopausal symptoms, that's probably fine. What
is also agreed upon is that there is no one right answer for all women. This makes
preparation, education, and information all the more important. You don't go
into menopause overnight, so don't prepare for it overnight. Your friends and
family are good sources of information and support, but your doctor is the best
source of medical information about menopause for you. Ask questions
now to help form a good treatment plan later. And now, more than ever
before, an ounce of prevention is worth a pound of cure.
Created: 9/2/2003  - Donnica Moore, M.D.