If you are like most women today, you will live a third of your life after menopause.
PacifiCare urges ...... What Your Doctor May Not Tell You About Menopause:.
Menopause: Understanding Your Options
Women’s Health Solutions® If you are like most women today, you will live a third of your life after menopause. PacifiCare urges you to educate yourself and stay informed so that you can get the most out of life.
Form #: PEW9361-001
TABLE OF CONTENTS
■
Introduction
1
■
Test Your Knowledge
2
■
Stages of Menopause
3
What Perimenopause Means
3
What Menopause Means
3
Hormone Replacement Therapy
4
Menopause Treatment: A Major Turning Point
4
Why Are Hormones Used After Menopause?
5
The Women’s Health Initiative (WHI) Study
5
Questions and Answers About the WHI Study
6
Should You Try Hormone Replacement Therapy?
7
Alternatives to Hormone Replacement Therapy
7
Discontinuing Hormone Replacement Therapy
8
Different Women, Different Experiences
9
■
■
Self-Care Kit
13
Hot Flashes and Night Sweats
13
Osteoporosis
14
Moods
14
■
Talking to Your Doctor About Menopause
16
■
Annotated Bibliography
17
■
Notes
19
■
INTRODUCTION
Never has it been more important for a woman to understand her options for maintaining good health and well-being during and after menopause. New scientific findings are challenging conventional wisdom, and alternative approaches are being revisited. To quote Susan Love, M.D., author of Dr. Susan Love’s Breast Book and Dr. Susan Love’s Hormone Book, “Medicine is a work in progress, and always will be.” That’s why the only thing that’s certain is the need to be as well informed as possible, with the most up-to-date information on risks and benefits of different approaches.
1
TEST YOUR KNOWLEDGE ABOUT MENOPAUSE
■ Questions:
10. Menopause can result in changes to the tissues located inside the vagina, causing the vaginal walls to become thinner, dryer, and less elastic.
1. Every woman who reaches menopause will experience some unwanted symptoms. ❏ True
❏ True
❏ False
❏ False
2. The average age at which a woman experiences menopause in the Western part of the world is 51. ❏ True
❏ False
■ Answers:
3. Hot flashes are the most common symptom associated with menopause. ❏ True
1. False. About one third of women have no menopausal symptoms.
❏ False
2. True. Menopause often occurs between the ages of 45 and 55, with the average age being 51.
4. Menopause is not the result of declining hormone production. ❏ True
3. True. About 60 percent of women approaching menopause will experience hot flashes.
❏ False
4. False. Menopause is when your periods stop and your ovaries stop producing estrogen.
5. The single most effective way to determine if you have experienced menopause is if you have not had a period for 12 consecutive months. ❏ True
5. True. Natural menopause has occurred when a women has not had a menstrual period for a full year.
❏ False
6. Perimenopause, which is sometimes described as “being in menopause,” is the phase around the onset of menopause that is often marked by various physical signs, such as hot flashes, night sweats, mood swings and difficulty sleeping. On average, perimenopause lasts for one year. ❏ True
6. False. This transition can take between one and 10 years, but averages about three years. 7. True. Hormone Replacement Therapy can be used for a short time to reduce the symptoms of menopause. However, due to associated risks, women taking HRT for hot flashes should take it for the shortest time possible, at the lowest effective dose.
❏ False
7. Hormone replacement therapy can provide effective relief from menopausal symptoms, such as hot flashes and mood swings. ❏ True
8. False. Postmenopausal bleeding is abnormal and should be reported to your doctor.
❏ False
9. False. After three consecutive exams having “normal” results, it is recommended that women 50-64 years of age and women over the age of 65 undergo a gynecological examination every one to three years.
8. Intermittent vaginal bleeding following menopause is normal. ❏ True
❏ False
10. True. With decreased estrogen levels, the vagina becomes drier and its walls become thinner.
9. Once a woman reaches menopause, she can stop getting yearly gynecological examinations. ❏ True
❏ False
2
STAGES OF MENOPAUSE
What Perimenopause Means
Menopause often occurs between the ages 45 and 55, with the average age being 51. Typically, the age when a woman will reach menopause is the same as when a woman’s mother and sisters experienced menopause. If a woman smokes or is a former smoker, menopause may occur up to two years earlier than might have been expected.
Years before the end of a woman’s periods, she will go through a transitional time that is called perimenopause. The transition occurs as a woman’s hormones are gearing down from the high levels needed to reproduce. This transition can take between one and 10 years, but averages about three years.
■ Symptoms
may come and go, and more symptoms may develop, as the process of menopause progresses. Symptoms of menopause that generally improve with time include: – Menstrual changes – Hot flashes – Changes in appearance (thinning hair, dry skin, brittleness of nails, weight gain, bloating) – Emotional changes (mood swings, change in sexual interest) – Sleep disturbances (insomnia) – Rapid, irregular heartbeat (palpitations) – Headaches
Hormone changes are responsible for the onset of perimenopause. As a woman reaches the end of her childbearing years, production of her ovarian hormones (estrogen and progesterone) begins to fluctuate. During perimenopause, many menstrual cycles are annovulatory (do not include ovulation), and estrogen levels can sharply rise and then quickly drop. This elevation causes menstrual periods to become shorter, then more and more irregular until they stop. Variations in hormone levels that occur during perimenopause are responsible for many of the symptoms. About a third of women have no symptoms, while a third have mild ones and another third have severe ones. Here are some of the commonly mentioned symptoms: – Fatigue – Insomnia – Irregular menstrual periods – Heavy bleeding – Irritability – Hot flashes and night sweats – Memory difficulties – Mood swings
■ Symptoms
of menopause that can be long-term and get worse with time include: – Vaginal changes (dryness, itching, pain during sexual intercourse) – Urinary tract changes (incontinence, increase in infections)
■ The
decline in the amount of the hormone estrogen can cause long-term health risks. Women who have gone through menopause may have a higher risk of: – Loss of bone mass and density (osteoporosis) – Vaginal changes (dryness, itching, pain during sexual intercourse) – Urinary tract changes (incontinence, increase in infections) – Increased cholesterol levels – High blood pressure – Stroke – Weight gain
What Menopause Means Menopause is a normal part of the natural aging process. It marks the end of a woman’s menstrual period and her ability to become pregnant. Natural menopause has occurred when a woman has not had a menstrual period for a full year. When menstruation has permanently ended without any kind of medical intervention, natural menopause has been reached. Menopause is a change that is a natural and normal occurrence.
3
HORMONE REPLACEMENT THERAPY
Menopause Treatment – A Major Turning Point In the summer of 2002, the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health announced that it was calling an early halt to the estrogen plus progestin component of the WHI study. The WHI is a 15-year study sponsored by the NHLBI to evaluate heart disease, breast and colorectal cancer, and fractures in postmenopausal women. The reason for the halt (5.2 years into the study, with a planned duration of 8.5 years) was that the overall risks – particularly as they related to breast cancer, heart disease and stroke – exceeded the benefits to the study participants taking the hormone replacement therapy (HRT).
You might be a woman who is already taking hormones or thinking about taking hormones for uncomfortable symptoms caused by menopause or for its benefits on bones. The choice to use hormones is a difficult and complex health decision facing women. Recently, the results from a large government sponsored study, the Women’s
As a result, the recommendation by the NHLBI was against the long-term use of HRT for menopausal women, and that HRT for post-menopausal women should not be initiated or continued for either primary or secondary prevention of heart disease. The WHI study was not designed to investigate the effects of HRT on the common symptoms women experience after menopause, such as hot flashes, vaginal dryness, night sweats and sleeplessness. In the past, short-term HRT use was defined as five years or less. There are no data from the WHI study to clearly establish what constitutes safe, short-term use. However, the recommendation by the American College of Gynecologists was that women should be counseled to take HRT for the shortest duration possible, at the lowest effective dose. Menopause: Understanding Your Options can help. If you are considering HRT – or want to know what other options you have – read on.
Health Initiative (WHI), have brought new information to consider when making a decision about hormones.
4
HORMONE REPLACEMENT THERAPY
Why Are Hormones Used After Menopause?
The study found that if 10,000 women take the combination estrogen plus progestin therapy for one year, as compared to 10,000 women not taking the combination:
During menopause, which means end of menstruation, hormones produced by the ovaries (mainly estrogen) decreases. Estrogen given alone or with progestin partially replaces decreased amounts of estrogen in the body. Women who have had their uterus removed use estrogen alone, called “estrogen replacement therapy (ERT),” whereas women with a uterus take a combination of estrogen plus progestin, called “hormone replacement therapy (HRT).” Hormones are often prescribed to relieve common symptoms of menopause such as hot flashes, night sweats, difficulty sleeping and vaginal dryness. They have also been used traditionally to prevent other health problems associated with menopause such as osteoporosis (thin bones) and heart disease.
■ Eight
more will develop invasive breast cancer
■ Seven
more will have a heart attack
■ Eight
more will have a stroke
■ Eight
more will have blood clots in the lungs
■ Six
fewer will have colorectal cancers
■ Five
fewer will have hip fractures
The study found that out of the estimated six million women in the United States using estrogen plus progestin:
The Women’s Health Initiative (WHI) Study The purpose of the WHI study is to learn about ways to prevent heart disease, breast and colon cancer and osteoporosis in women. One of the studies examined the long-term effects of the most commonly used HRT (Prempro™) in the United States on these health conditions and other risks. Prempro™ is a combination of 0.625 mg conjugated equine estrogens (estrogen) and 2.5 mg medroxyprogesterone acetate (progestin). The HRT study was stopped early because the risks were greater than the benefits of therapy. Another portion of the study that is evaluating taking estrogen alone in women who have had a hysterectomy has not been stopped.
5
■ 4,800
more will develop invasive breast cancer
■ 4,200
more will have a heart attack
■ 4,800
more will have a stroke
■ 4,800
more will have blood clots in the lungs
■ 3,600
fewer will have colorectal cancers
■ 3,000
fewer will have hip fractures
HORMONE REPLACEMENT THERAPY
Questions and Answers about the WHI Study
■ Heart
disease: Studies now show that estrogen plus progestin doesn’t prevent heart disease. Women should not use HRT for preventing heart disease.
■ Are other estrogens and progestins safer than those
in Prempro™? How about lower doses or patches?
The WHI study used only Prempro™ (0.625mg conjugated equine estrogen/2.5 mg medroxyprogesterone acetate) in its study. It is unknown at this time if other estrogens and progestins, lower doses of conjugated equine estrogens and medroxyprogesterone acetate, or HRT patches have the same effects as Prempro™. It should not be assumed that others are safer.
■ Osteoporosis:
HRT is helpful in preventing bone fractures. Each woman needs to talk to her doctor about her benefits and risks of using HRT to prevent osteoporosis. There are other medications that can be used to decrease a woman’s risk for osteoporosis.
■
■ Do the WHI study results apply to oral contraceptives?
No. The WHI study did not study the long-term effects of oral contraceptives. ■ What if I have had a hysterectomy and am taking
Hot flashes: Women taking HRT for hot flashes should take it for the shortest time as possible at the lowest effective dose. Even though the results of the WHI study revealed that the diagnosis of breast cancer increased after four years, it is unknown when the cancer started to develop. Your need for HRT should be examined regularly with your doctor.
However, every woman is different. Ask your doctor about benefits, risks, and alternatives to HRT. Also, talk to your doctor about your family and personal medical history, including your risk for heart disease, osteoporosis, and breast cancer.
only estrogen?
The WHI has not stopped its study in women who have had a hysterectomy and are only taking estrogen. To date, women taking estrogen only have not had the same problems as those women taking Prempro™. If you are unsure about your therapy, talk to your doctor so he can help you choose the most appropriate treatment option for you.
Ask your doctor the following questions at the next visit: ■ Why am I taking HRT?
However, for women with an intact uterus, switching from combined estrogen plus progestin to estrogen only therapy is not recommended because of the increase in the risk for endometrial cancer.
■ What are my benefits and risks with taking HRT? ■ What are the alternatives to HRT? ■ How
do I prevent heart disease?
You should not panic, but discuss your individual situation with your doctor.
■ How
do I prevent osteoporosis?
Here is what the American College of Obstetricians and Gynecologists and other experts are recommending on the use of HRT for treating heart disease, osteoporosis, and hot flashes.
■ Do
■ What should I do if I am currently taking HRT?
I need a bone mineral density or BMD test?
Research on HRT and other therapies is continuing, and medical recommendations may change. It is important to stay informed and take an active role in managing your own health care. Together with your doctor and health plan’s information and programs, we can ensure the best possible care and outcomes for you.
6
HORMONE REPLACEMENT THERAPY
Should You Try Hormone Replacement Therapy?
Alternatives to Hormone Replacement Therapy
The decision to start, continue or stop HRT is one that each woman needs to make after discussing personal benefits, risks and other treatment choices with her doctor. Here is what the American College of Obstetricians and Gynecologists and other experts are recommending on using HRT for treating heart disease, osteoporosis and hot flashes.
■ Heart disease: Having a healthy lifestyle such as eating
■
food low in fat or cholesterol, exercising, not smoking, and maintaining a healthy weight can improve heart health for all women. There are also other well-proven medications (e.g., lipid-lowering drugs) that can decrease a woman’s risk of heart attack or stroke.
■ Osteoporosis:
Regular weight-bearing exercise such as walking and taking enough calcium and vitamin D can help make bones strong. In addition to HRT, there are other prescription medications that can help to prevent osteoporosis, such as bisphosphonates (Actonel®, Fosamax®) and selective estrogen receptor modulators (Evista®). These medications, like most drugs, also have side effects, and you should consult your doctor to learn the most appropriate therapy for you.
Heart disease: Studies now show that estrogen plus progestin doesn’t prevent heart disease. Women should not use HRT for preventing heart disease.
■ Osteoporosis:
HRT is helpful in preventing bone fractures. Each woman needs to talk to her doctor about her benefits and risks of using HRT to prevent osteoporosis. There are other medications that can be used to decrease a woman’s risk for osteoporosis.
■ Hot
flashes: Avoid getting too warm by dressing in layers and avoid drinking hot drinks or eating hot soup. Drinking alcohol and eating spicy food can also trigger hot flashes. Some patients have found that mild hot flashes can be relieved by eating a serving of soy foods daily or taking a supplement of black cohosh. Remember, before starting any herbal remedies, talk to your health care provider. The safety and effectiveness of black cohosh for more than six months is unknown. Other prescription medications that are approved for other use have also been found to help some women with hot flashes.
■ Hot
flashes: Women taking HRT for hot flashes should take it for the shortest time possible at the lowest effective dose. Even though the results of the WHI study revealed that the diagnosis of breast cancer increased after four years, it is unknown when the cancer started to develop. Your need for HRT should be examined regularly with your doctor.
■ Vaginal dryness: Vaginal lubricants and moisturizers
that are available over-the-counter can help with vaginal dryness. For severe cases, prescription estrogen creams, tablets, or plastic rings that are given inside the vagina are also available. When estrogen is given this way, only a small amount of estrogen gets absorbed in the blood.
Please consult your doctor to discuss the alternatives mentioned above.
7
HORMONE REPLACEMENT THERAPY
Discontinuing Hormone Replacement Therapy The decision to start, continue or stop HRT requires evaluation of the risks and benefits for each woman on an individual basis. For women currently using HRT, it’s important to assess the reason for its use and evaluate potential risks, benefits and alternatives. No definitive data exists to guide women planning to discontinue HRT. While many women have no difficulty stopping HRT, others may develop symptoms soon after discontinuation. In many women, these symptoms are mild and resolve over a few months. However, in a small subset of women, recurrent symptoms are severe and persistent. Most clinicians use the following methods: ■ “Dose
taper”: Progressively decrease the dose of estrogen.
■ “Day
taper”: Decrease the number of days per week of HRT use, effectively decreasing the weekly dose.
■ Combined
“dose taper” and “day taper”: First cut the dose in half, then decrease the days of use.
If you are considering discontinuing HRT, talk to your doctor to determine the most appropriate way to approach tapering off the medication. Also, be sure to discuss how your treatment will be handled if, when tapering off, you experience symptoms – mild or severe.
8
DIFFERENT WOMEN, DIFFERENT EXPERIENCES
■ Donna,
■ Bernie,
44
48
“Two years ago, I noticed some strange things going on with my period. I’d get it, then I wouldn’t get it. I remember skipping a month, then having a slight period, and then I never got my period again. I had some hot flashes, but at the time I didn’t know what they were! Then in the spring, after not having my period for four to five straight months, I started feeling very depressed and just different. I had night sweats, and at 4:00 a.m. every morning, I would wake up and want to take the blankets off. I also had a lot of anxiety.
“I started going into perimenopause the year after my son was born. I had just turned 40. Heart palpitations were a very common symptom. The attacks twice landed me in the emergency room, where a male doctor told me I had ‘holiday heart’ from playing, eating, and having one glass of wine at a Memorial Day Picnic. “When he left the room, the nurse, who was 43, came back in and said, ‘Let me really tell you what’s happening.’ She described my symptoms and the reasons. Her last words were, ‘Women just get these at our age.’
“Finally, I went to the doctor, and he put me on Prozac®. He didn’t want me to be on hormone replacement therapy (HRT), because my mother had breast cancer. He also put me on an osteoporosis drug, Fosamax®. About six months later, I noticed that I was much more relaxed and wasn’t having night sweats any longer. Since I felt as I was getting better and I didn’t like the feeling I had on Prozac – it gave me dry mouth – I decided to stop taking Prozac myself after being on it for about eight months. I just quit cold turkey. I didn’t know I should have gone off it gradually.
“I am not a candidate for hormone replacement therapy because of family histories of heart and ovarian cancer. Since I spoke to that nurse, I have found some neat methods to help with my growing number of hot flashes, night sweats, and irritability. Exercise, rest, not sweating the small stuff, and nutrition have helped. My doctor didn’t really touch on any of these alternative methods, but I found them on my own. I have increased soy and found a great soy and flax cereal that has really helped, too. I get hot flashes much less frequently since upping soy in my diet. Why it works, who knows? But it does. Also, I have begun to see a counselor every other week. It helps to vent!”
“Then last year I had a bad summer. I cried. I had so much anxiety built up, but I didn’t know if it was my new job or if I was still going through menopause. I probably should have gone back to the doctor and asked him to put me back on the Prozac, but I didn’t. I just stayed nuts all summer. My family didn’t know what to do with me. I just went back for my annual checkup a month ago, and I told the doctor how crazy I felt last summer, that I had gone off the Prozac on my own, and that I felt better now. The depression and anxiety just wound up going away on its own. But going through menopause was the pits. I felt lost throughout the process.”
9
DIFFERENT WOMEN, DIFFERENT EXPERIENCES
■ Rebecca,
50
“This particular doctor started me on estrogen patch Climara®. That helped. I immediately slept seven hours that night. But I’m a runner and found patches peeled up on me. With some fine-tuning over the next few months, I was ultimately put on a regimen of Estrace® (micronized estradiol, which is from plant sources), and low-dose testosterone. My symptoms totally disappeared. Here I am almost four years later, and I feel fabulous. I sleep like a baby every night, and I have no more anxiety or depression.”
“I am a CEO of a large public relations firm. I’m very active. I run 25 to 30 miles per week and have for 20 years. The onset of my perimenopausal symptoms was at 45, and they came on fairly sudden. I had severe insomnia and anxiety, heart palpitations, minor depression, and inner trembling sensations. The anxiety was so bad I couldn’t even get on airplanes. I was still having regular cycles, though. I bounced from doctor to doctor. My OB/GYN, whom I love, and my family physician, kept saying, ‘Becky, it’s nerves. You’re under a lot of stress.’ I’ve heard this story so many times. I was prescribed Xanax® (an anti-anxiety medication). My symptoms were somewhat reduced, but the problem was still there. My anxiety returned with a vengeance when I went off Xanax. “I went through a gambit of tests and had insomnia real bad, and horrible panic and anxiety attacks. And I’m trying to run a company, and I have children. I bounced around to several doctors over the next year and a half. My mother kept telling me, ‘Becky, it’s your hormones.’ Every doctor dismissed my suggestion that it might be hormonal, because my FSH (follicle stimulating hormone) test was normal. I started going to a psychiatrist, and after three sessions she said she thought it was a physical problem. “I tried things on my own, like soy-based products, but they didn’t do anything. Finally, I discovered a doctor, who had done an online interview about menopause. I couldn’t believe what I was reading on the computer screen. She described my symptoms perfectly. I ran out and bought her book. I made an appointment with her and saw her 3 months later in Dallas. She ran a full battery of tests of my hormonal levels. At the clinic, they talk to you about lifestyle, eating, and exercise. They look at everything you’re doing. All that plays into how you feel and your symptoms.
10
DIFFERENT WOMEN, DIFFERENT EXPERIENCES
■ Margaret,
58
“Finally, I went back to the doctor. By now, my regular gynecologist had retired. His partner tested my hormone level and said it was low. He put me on hormone replacement therapy (Prempro®) and that helped. It leveled out my emotions, irritability, and some of the physical symptoms went away. I felt 99 percent better. I had been on Prempro for about three years, and I started having more cystic breasts to a point where every time I went for a mammogram, I had to go for a follow-up ultrasound. My doctor and I discussed this, and he took me off Prempro and put me on Premarin® (an estrogen) and Prometrium® (an oral progesterone). But that made me feel breathless. Once again, it was back to the doctor.
“I was 45 when I started having heavy bleeding. Basically, that’s all I recognized as a symptom that I was heading into menopause. I later realized, though, that I was having anxiety and depression. When I went to my gynecologist, he said it was too soon for me to be going through menopause. (My mother didn’t go through it until her early 50s.) He sent me for a sonogram because of the bleeding and said I had fibroids that would probably shrink as I went into menopause. I had to separate what was going on in my life with what was happening physically. I had a lot of anxiety and a lot of depression, and I kept gaining weight. I went on like this for another five years. At 52, I started having hot flashes, and things started getting worse. I had lots of depression, lots of mood swings and sleepless nights. It was really awful.
“This time, I talked with my doctor about trying something natural to see how that worked. I really didn’t want to take HRT if I didn’t have to. So, I started eating soy, taking fish oils, and Promensil® (a plant estrogen made from red clover) which is supposed to be very good for your breasts and helps with cysts. The trouble was, it didn’t work hardly as well as HRT. All the symptoms I had in my early 50s came back with a vengeance. I still had night sweats and hot flashes, and the depression was unbelievable. “Again, I went back to the doctor. He wanted to put me on an antidepressant, but I didn’t want to take one, so he put me back on HRT – Premarin and Provera®, but at half the dose. He wants to keep me on it for another year and see how I feel. If things are better, he’ll take me off. It’s working, and I’m back on track. Sometimes I’ll get a very mild flash, but I can deal with it.”
11
DIFFERENT WOMEN, DIFFERENT EXPERIENCES
■ Wanda,
49
“I used to laugh at this woman I worked with. She was always complaining about how hot it was in the office. She was about eight years younger than me, and I used to kid her. I’d say, ‘Girl, you’re gonna go through the change before me.’ Then one day, I noticed that I felt hot too. Also, I didn’t feel like myself. I couldn’t concentrate. I was depressed and anxious. I had a feeling I knew what was going on, because right about the time, my periods started getting strange – really heavy one month, light the next, then I’d skip a period. I also had trouble sleeping, and mood swings would go along with that. I was a mess, and it started to affect my work. “I talked to my doctor about what I could take. She suggested I try something natural first and see if that worked. If not, she said she’d talk to me about certain drugs that might help. But I’m not a big drug taker. She mentioned taking Remifemin®, which is made from some herb (black cohosh). I didn’t really like the sound of that, but she said it was safe and doesn’t have any side effects. So, I started taking it. At first, nothing happened. It took a few weeks to really kick in. Finally, a little over a month later I started noticing that I was able to sleep again, and I wasn’t as moody. My husband even noticed the difference. He jokes about me taking my happy pills. “I still have hot flashes, now and then, but I just sneak over and push the thermostat in the office so I can cool off. The other thing I do is keep a secret supply of chocolate in my desk. It improves my mood, too. My friend, who’s always complaining of being hot, laughs at me now, but I tell her I’ll see if she’s laughing when she goes through menopause.”
12
SELF-CARE KIT
Having a positive and healthy lifestyle is important throughout a womanʼs life, and at no time is it more essential than when a woman is going through menopause. Adopting the following behaviors may help relieve the discomforts and symptoms associated with menopause.
Hot Flashes and Night Sweats Hot flashes are a sudden feeling of heat in the body due to fluctuations in your hormone level. The feeling may last one to five minutes. Then you may feel very cold and even clammy as your sweat dries and you return to a normal temperature.
■ Participate
in moderate physical activity or exercise for at least 30 minutes three times per week. Weight-bearing exercises, such as jogging, stair climbing or walking are especially good for strengthening bones.
Here are some things to try without seeing a doctor:
■ Make sure your diet is nutritious and well balanced.
Eat a variety of foods with high fiber and low cholesterol (examples: vegetables, fruits, whole grain foods, fish, poultry and lean meats).
■
■ Avoid
hot places and wear lighter clothes
■ Dress
in layers
■ Donʼt
eat spicy foods
■ Avoid
caffeine and alcohol
■ Exercise
(it reduces hot flashes in some women)
■ Try
to avoid stress in your life, which can bring on hot flashes
Get plenty of calcium (examples: low-fat milk, yogurt and/or 1200 mg of calcium supplements each day). Vitamin D (5 to 10 micrograms a day) helps the body to better absorb calcium. Two good sources are milk fortified with vitamin D and getting about 15 minutes of sunlight each day.
■ Increase
your intake of foods containing soy.
If you are still having hot flashes, you may want to visit your doctor and discuss other treatment options, such as alternative therapies or prescription therapies.
■ Eliminate
or reduce alcohol consumption to one drink a day.
■ Do
not smoke cigarettes. If you currently smoke and need help quitting, call PacifiCare Customer Service for more information on smoking cessation programs. Call toll-free 1-800-531-3341 Monday through Friday between 7 a.m. and 8 p.m.
For more information, visit the Menopause: Understanding Your Options program area at www.pacificare.com.
Even if you maintain a healthy lifestyle by eating right and exercising regularly, you may still experience some of the symptoms of menopause such as hot flashes, night sweats or mood swings. If you have any of these discomforts, try following some of these helpful tips.
13
SELF-CARE KIT
Osteoporosis Osteoporosis is the condition in which bones become more porous, fragile and highly prone to fractures. Osteoporosis can pose a special threat to women. Estrogen protects against bone loss. As a woman nears menopause, her body produces less estrogen, hence increasing bone loss. Bones affected by osteoporosis can potentially become thinner, weaker and sometimes unable to support normal daily activities. Some suggestions for minimizing your risk of osteoporosis include: ■ Avoid alcohol and tobacco ■
Participate in weight-bearing exercise such as walking, jogging, or climbing stairs for at least 30 minutes three times per week
■
Get the recommended daily intake of calcium (1,200 to 1,500 mg) in your diet by drinking low-fat milk or taking calcium supplements
■ Get enough vitamin D (5 to 10 micrograms per day) from
enriched milk or about 15 minutes of sunlight daily. Vitamin D helps the body better absorb calcium.
You should discuss your individual risks for osteoporosis and therapies with your doctor.
Moods In some women, menopause is associated with mood changes or deep feelings of sadness (depression). If your mood changes seem to be mild, then discussing any sad or stressful life events with your doctor may help. If your mood changes are becoming a big problem, however, then you could try other methods: ■ Learn
ways to avoid stress, practice relaxation techniques such as yoga
■ Get more
exercise
■ Get
enough sleep
■ Go
for counseling or join a support group
■ Take
up a hobby
■ Meet
with friends
14
TALKING TO YOUR DOCTOR ABOUT MENOPAUSE
If your doctor knows your medical history and menopausal symptoms, then he/she can help you choose the best treatment plan for you.
Ask Your Doctor About: ■ The
■ Your
own body changes and how to get relief from those changes
Tell Your Doctor About:
■ How
■ Drugs
you take every day, including herbal medicines
■ Reactions ■ Chest
■ Medicines ■ Whether
pain
during sex
■ Pain
or trouble urinating
changes
■ The
to urinate more often or a sudden unexpected loss of urine from hot to cold in your body
■ Sudden
changes in your moods or deep sadness
■ Family
history of osteoporosis
■ Any
form of cancer you have had
■ Family ■ Liver
history of cancer
problems you have
■ Problems ■ Vaginal
with blood clots
bleeding that is not normal
For some women, talking about the issues around menopause can be difficult. But it is essential that you keep the lines of communication open between you and your doctor.
For more information, visit the Menopause: Understanding Your Options program area at www.pacificare.com.
15
treatments for your body changes
made from herbs
you need medical treatment for your
risks of replacing hormones
■ Bone
■ A need
■ Swings
long your changes may last
■ Nonhormonal
you have to drugs
■ Pain
usual signs of menopause
density study/DEXA scan
TALKING TO YOUR DOCTOR ABOUT MENOPAUSE FILL THIS OUT AND BRING IT TO YOUR DOCTOR WHEN DISCUSSING YOUR HEALTH AND MENOPAUSE. Symptoms I Am Having:
List of Drugs, Herbs and Vitamins I Am Taking:
❏ Hot flashes ❏ Swings from hot to cold ❏ Pain or trouble urinating ❏ Sudden changes in moods or deep sadness ❏ Need to urinate more often or sudden unexpected loss of urine ❏ Abnormal vaginal bleeding ❏ Pain or trouble during sex ❏ Chest pain ❏ Vaginal dryness ❏ Other symptoms/health problems:
My Health History:
If I’m Currently Taking Hormone Replacement Therapy, Ask My Doctor:
❏ I have/had a form of cancer
❏ Why am I taking HRT?
❏ Family history of breast or uterine cancer ❏ Family history of osteoporosis
❏ What are my benefits and risks with taking HRT?
❏ I have/had liver problems ❏ I have/had problems with blood clots
❏ How do I prevent heart disease?
❏ I have allergies ❏ Other:
❏ How do I prevent osteoporosis? ❏ Do I need a bone mineral density or BMD test?
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ANNOTATED BIBLIOGRAPHY
We encourage you to review these publications; however, science is rapidly changing in this field. As a result, some of the information in these materials may not represent the most current information. To stay informed, visit the online Menopause: Understanding Your Options program area at www.pacificare.com. Hormone Replacement Therapy: Conventional Medicine and Natural Alternatives, Your Guide to Menopausal Health-Care Choices. Linda Laucella. McGraw Hill. 1999.
The Hormone Solution: Naturally Alleviate Symptoms of Hormone Imbalance from Adolescence Through Menopause. Erika Schwartz. Warner Books. 2002. Dr. Schwartz promotes natural and safe forms of hormone replacement for women through all stages of their lives. She advocates the use of natural hormones not only for menopausal symptoms but also for acne, migraines, fibroid tumors, and PMS.
In a question and answer format, this book examines bone density, breast cancer, and heart disease. It also gives advice on how women in menopause can maintain emotional and physical well-being. Dr. Susan Love’s Hormone Book: Making Informed Choices About Menopause. Susan M. Love, Karen Lindsey. Random House. 1998. Next edition coming in February 2003.
The Silent Passage: Menopause. Gail Sheehy. Pocket Books. 1998. In this revised and updated version of her bestselling book, Ms. Sheehy recalls her own personal experience with menopause. Interviews with other women (including some celebrities) give personal and multifaceted points of view.
Dr. Love, a breast surgeon, presents straightforward information about taking hormones. She offers a middle ground. Readers learn the pros and cons of HRT as well as serious side effects.
Menopause Core Curriculum Study Guide. The North American Menopause Society. 2000.
What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone. John R. Lee, MD, Virginia Hopkins. Warner Books. 1996.
This guide advises women on how to manage the phases of menopause, peri- and postmenopause, and induced menopause, as well. The reader is provided with workable strategies for coping with present symptoms and long-term effects, such as osteoporosis. Traditional and alternative medications for treatment are also covered.
The authors make a case for taking natural progesterone to control symptoms of menopause, instead of conventional hormone replacement therapy. Hysterectomy: New Options and Advances. Lorraine Dennerstein, Carl Wood, Ann Westmore. Oxford University Press. 1995. This book is written for any woman facing hysterectomy who wants the decision to be her own. The different types of surgical procedures are explained in detail. Alternatives to surgery are also presented.
17
ANNOTATED BIBLIOGRAPHY
The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change. Christiane Northrup. Bantam Doubleday Dell Publishers. 2001. Dr. Northrup presents the positives involved in the menopausal stage of a woman’s life. She contends that menopause can spark a new time for some women – leading to more satisfaction in a loving relationship and more creativity in a woman’s professional life. The author stresses the importance of diet, attitude, and the mind-body connection. The Premature Menopause Book: When the “Change of Life” Comes Too Early. Kathryn Petras, Michelle Warren. Wholecare Publishers. 1999. Ms. Petras relates her own story of early menopause at the age of 38. She advises that all women know the symptoms of early menopause to avoid the confusion and missed diagnoses. She also gives crucial information on the kinds of tests women should request from their doctors if they suspect they are in early menopause. Treatments and reproductive issues are discussed. Readers are given a multitude of resources, including helpful Internet sites and support groups. “No, It’s Not Hot in Here”– A Husband’s Guide to Understanding Menopause. Dick Roth. Northstar Publications, Inc. 1999. Any man reading this book would gain valuable insight into the emotional, physiological, and psychological effects of menopause on the women they love. By making the subject easy to understand and presenting menopause as a “natural” part of a woman’s life, the author demystifies the topic.
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NOTES
For additional information on the WHI or womenʼs health in general, the following resources are available (not affiliated with PacifiCare):
6. National Institutes of Health. New facts about: estrogen/progestin hormone therapy. Available at: http://www.nhlbi.nih.gov/whi/hrtupd/ep_facts. htm. Accessed August 13, 2002.
National Institutes of Health (NIH) – www.nih.gov
7. National Institutes of Health. NIH News Release: NHLBI stops trial of estrogen plus progestin due to increased breast cancer risk, lack of overall benefit. Available at: http://www.nih.gov/news/pr/ jul2002/nhlbi-09.htm. Accessed July 9, 2002.
The North American Menopause Society (NAMS) – www.menopause.org The American College of Obstetricians and Gynecologists (ACOG) – www.acog.org The Hormone Foundation – www.hormone.org
8. National Cancer Institute. Questions and answers: Use of Hormones after menopause. Available at: http://newscenter.cancer.gov/pressreleases/ estrogenplus.html. Accessed July 12, 2002.
National Center for Complementary and Alternative Medicine – www.nccam.nih.gov
9. Writing Group for the Womenʼs Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA;228:321-333.
References 1. Pharmacists Letter. Letter for patients, “What should I do now about my hormone replacement therapy?” Available at: http://www. pharmacistsletter.com. Accessed August 13, 2002.
10. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001;285:2496-2497.
2. The American College of Obstetricians and Gynecologists. Statement on the Estrogen plus Progestin Trial of the Womenʼs Health Initiative. July 9, 2002. Available at: http://www.acog.org/ from_home/publications/press_releases/nr07-0902.cfm. Accessed July 12, 2002.
11. A 60-Year-Old Woman Trying to Discontinue Hormone Replacement Therapy. JAMA 2002; 287: 2130-2137.
3. Response to Womenʼs Health Initiative study results by the American College of Obstetricians and Gynecologists (ACOG). A letter sent to ACOG members on August 9, 2002. 4. Use of botanicals for management of menopausal symptoms. ACOG Practice Bulletin. June 2001 (number 28). Available at: http://www.acog. org/from_home/publications/misc/pb028.htm. Accessed August 13, 2002. 5. The North American Menopause Society. Alternatives to hormone replacement therapy: Suggestions from The North American Menopause Society (July 11, 2002). Available at: http://www. menopause.org/alternatives_hrt.html. Accessed July 17, 2002. 19
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