Peri-Menopause, Menopause, Post-Menopause?

Peri-Menopause, Menopause, Post-Menopause…What Does This All Mean??

Wikipedia definitions: (1) Perimenopause: the period of a woman’s life shortly before the occurrence of the menopause. (2) Menopause:  the ceasing of menstruation; the period in a woman’s life (typically between 45 and 50 years of age) when this occurs. (3) Post-Menopause: having undergone menopause or occurring after menopause.

Hmmm? Still uncertain what this all means??

Reality: what you call it, isn’t all that important!! Perimenopause, Menopause, and Post-Menopause are all part of a continuous spectrum.

Perimenopause means ‘around menopause’ and refers to the time when your body makes the natural transition to menopause, marking the end of reproductive years. This time is also called the ‘menopausal transition’.  Women start perimenopause at different ages. You may notice signs, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don’t release an egg (ovulate). This period of time is also marked by decreasing levels of testosterone, another important female hormone. These hormonal changes/fluctuations may cause symptoms, such as hot flashes, sleep problems, vaginal dryness, irritability and mood swings, fatigue, decreased motivation, decreased libido, weight gain or difficult losing mid-section weight, decreased mental focus and decreased concentration.

Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reached ‘menopause’…and perimenopause is over. Essentially, this is one, single day in time.

The time of a woman’s life following menopause is called post-menopause. During this time, many of the symptoms experienced before menopause can decrease. However, a lot of women may have persistent or worsening symptoms. **IMPORTANT** — just because your symptoms may decrease or go away completely, this does NOT mean your body is satisfied with its current hormonal state!!!

Postmenopausal women are at increased risk for a number of health conditions, such as osteoporosis and heart disease. Also, depletion of these hormones can exacerbate chronic pain disorders and mood disorders.  Medications and/or healthy lifestyle changes may reduce the risk of some of these conditions, but there is NO substitute for proper hormone balance!!

Menopause And Ovarian Cancer

Ovarian cancer starts in the ovaries and often spreads to other parts of the body. Although it can happen at any age, it is most common in women over age 50. Half of ovarian cancer cases are found in women age 63 or older, according to the American Cancer Society.  Menopause does not ‘cause’ ovarian cancer. But your chances of developing ovarian cancer increase as you get older. When you go through menopause, your risk increases just because of your age. If you start menopause late — usually after age 52 — your chance of ovarian cancer may be higher (because you’ve had more ovulations). Ovulation is when your menstrual cycle triggers your body to release an egg.

Breast Cancer and Menopause

Menopause itself is not associated with an increased risk of developing cancer. However, the rate of breast cancer increases with age.  Age is the single-most important risk factor for breast cancer. About 95% of women diagnosed with breast cancer each year are over age 40, and about half are age 61 and older. Personal risk is also greater if an immediate family member (mother, sister, or daughter) has had breast cancer, particularly if it was at an early age. Also, women who have had a breast biopsy (removal of breast tissue) that shows certain types of benign disease, such as atypical hyperplasia, are more likely to get breast cancer.

Other risk factors include:

• Having cancer in one breast (may recur or develop in other)
• Having a history of ovarian, uterine, or colon cancer
• Having a genetic abnormality in breast cancer genes BRCA1 or BRCA2
• Late menopause (after age 55)
• Starting menstruation early in life (before age 12)
• Having a first child after age 30
• Never having children

Can I Prevent Breast Cancer?

While there is no definitive way to prevent breast cancer, there are steps you can take to reduce your risk:

• Maintain a healthy weight
• Be physically active and get at least 30 minutes of moderate to vigorous exercise five or more days per week.
• Eat a healthy diet with at least five servings of fruits and vegetables daily; limit the amount of processed meat and red meat eaten.
• Women should drink no more than one alcoholic beverage daily (men should drink no more than two alcoholic beverages daily).

Menopause and Heart Disease

People who have one or more specific risk factors for coronary heart disease may be at much greater risk of heart disease than people with no risk factors.

Common Risk Factors:

1) High blood pressure:  High blood pressure can strain the heart and increase wear and tear on the blood vessels, making blockage more likely.

2) African-American Race:  African-Americans are more likely than Caucasians to develop severe high blood pressure as well a heart disease. Heart disease risk is also higher among Mexican-Americans, American Indians, native Hawaiians, and some Asian-Americans. This may be partly due to higher rates obesity and diabetes.

3) Post-Menopausal Female:  Men have a higher risk of heart disease than women. However, the risk of heart disease in postmenopausal women increases and becomes similar to that of men.

4) Family History of Heart Disease:  The genetic make-up of some individuals increases their chances of developing heart disease.

5) Over Age 40:  The older you get, the more likely you are to develop heart disease.

6) High cholesterol:  High cholesterol can contribute to the build-up of plaques that can clog blood vessels leading to the heart, narrowing them and potentially blocking blood flow to the heart.

7) Smoker:  Cigarette smoking is a major cause of heart disease. It causes plaque to build up in the arteries and can greatly increase your risk for heart attack.

8) Diabetes:  About three-quarters of people with diabetes die of some form of heart or blood vessel disease. Even when blood sugar levels are under control, diabetes increases the risk of heart disease, but the risks are even greater if blood sugar is not well controlled.

9) Physically inactive, Overweight, or Obese:  An inactive lifestyle is a risk factor for heart disease. Regular physical activity helps prevent heart and blood vessel disease. And people who have excess body fat — especially around the waist — are more likely to develop heart disease even if they have no other risk factors.  Exercise can help control cholesterol, diabetes, and obesity, as well as help lower blood pressure.

10:  Other:  Other factors may also contribute to an increased risk of heart disease. These may include an individual’s stress level and consumption of alcohol. Talk to your doctor about your specific situation, taking all factors into consideration.

Osteoporosis and Menopause

Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning “porous bone,” osteoporosis results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain. Many times, osteoporosis is not discovered until weakened bones cause fractures usually in the back or hips. Unfortunately, once you have a broken bone due to osteoporosis, you are at high risk of having another. And these fractures can be debilitating. Fortunately, there are steps you can take to prevent osteoporosis from ever occurring. And treatments can slow the rate of bone loss if you already have osteoporosis.

What Causes Osteoporosis?

Though we do not know the exact cause of osteoporosis, we do know how the disease develops. Your bones are made of living, growing tissue. An outer shell of dense bone encases a sponge-like bone. When a bone is weakened by osteoporosis, the “holes” in the “sponge” grow larger and more numerous, weakening the internal structure of the bone. Until about age 30, a person normally builds more bone than he/she loses. During the aging process, bone breakdown begins to outpace bone buildup, resulting in a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis.

How Is Osteoporosis Related to Menopause?

There is a direct relationship between lack of estrogen and development of osteoporosis. Early menopause (before age 40) and any prolonged periods in which hormone levels are low and menstrual periods are absent/infrequent can cause loss of bone mass.

What Are the Symptoms of Osteoporosis?

Osteoporosis is often called the “silent disease” because initially bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as stooped posture.

Who Gets Osteoporosis?

Important risk factors for osteoporosis include:

• Age: After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally decline with age.
• Gender: Women over the age of 50 are at the greatest risk. Women are four times more likely than men to develop osteoporosis. Women’s lighter, thinner bones and longer life spans account for some of the reasons why they are at a higher risk for osteoporosis.
• Ethnicity: Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Hip fractures are twice as likely to occur in Caucasian women as in African-American women. However, women of color who fracture their hips have a higher mortality.
• Bone structure and body weight: Petite, thin women have a greater risk of developing osteoporosis because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight.
• Family history: Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease.
• Prior history of fracture/bone breakage.
• Certain medications: The use of some medications, such as the long-term use of steroids (like prednisone) can increase risk of osteoporosis.

How Do I Know If I Have Osteoporosis?

Bone mineral density (BMD) tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone strength. A bone density test is indicated for:

• Women age 65 and older.
• Women with numerous risk factors.
• Menopausal women who have had fractures.

How Can I Prevent Osteoporosis?

There are many ways you can protect yourself against osteoporosis, including:

• Exercise: Establish a regular exercise program. Exercise makes bones and muscles stronger and helps prevent bone loss. It also helps you stay active and mobile. Weight-bearing exercises, done at least 3-4 times a week, are best. Walking, jogging, playing tennis, and dancing are all good weight-bearing exercises. In addition, strength and balance exercises may help you avoid falls, decreasing your chance of breaking a bone.
• Eat foods high in calcium. Getting enough calcium throughout your life helps to build and keep strong bones. The U.S. recommended daily allowance (RDA) of calcium for adults with a low-to-average risk of developing osteoporosis is 1000 mg (milligrams) daily. For those at high risk of osteoporosis, the RDA is 1,500 mg daily. Excellent sources of calcium are milk and dairy products, canned fish with bones like salmon and sardines, dark green leafy vegetables, and breads made with calcium-fortified flour.
• Supplements: Calcium carbonate and calcium citrate are good forms of calcium supplements. Be careful not to get more than 2,000 mg of calcium a day. That amount can increase the chance of kidney stones.
• Vitamin D: Your body uses vitamin D to absorb calcium.  You can get vitamin D from eggs, fatty fish like salmon, cereal and milk fortified with vitamin D, as well as from supplements. People aged 51-70 may need a higher amount of Vitamin D daily.
• Medications: Actonel, Evista, Fosamax, and Boniva are some of the drugs available to help treat and/or prevent osteoporosis.
• Estrogen and Testosterone: Estrogen helps protect against bone loss. It is used as treatment for the prevention of osteoporosis. Replacing estrogen lost after menopause slows bone loss and improves the body’s absorption and retention of calcium. Testosterone actually builds bone.
• Avoid certain medications: Steroids, some breast cancer treatments (such as aromatase inhibitors), drugs used to treat seizures (anticonvulsants) and blood thinners (anticoagulants) increase the rate of bone loss if not used as directed. If you are taking any of these drugs, speak with your doctor about how to reduce your risk of bone loss through diet, lifestyle changes and, possibly, additional medication.
• Other preventive steps: Limit alcohol consumption and do not smoke.  Smoking causes your body to make less estrogen, which protects the bones. Too much alcohol can damage bones and increase the risk of falling and breaking a bone.

How To Get Calcium If You Are Lactose Intolerant

If you are lactose intolerant or have difficulty digesting milk, you may not be getting enough calcium in your diet. Although most dairy products may be intolerable, some yogurt and hard cheeses might be digestible. You can also eat lactose-containing food by first treating it with commercial preparations of lactase (which can be added as drops or taken as pills). There are also lactose-free dairy products you can buy. You can also eat lactose-free foods high in calcium, such as leafy green vegetables, salmon (with bones), and broccoli.

Weight-Bearing Exercises and How They Help Strengthen Bone

Weight-bearing exercises are activities that make your muscles work against gravity. Walking, hiking, stair-climbing, or jogging are all weight-bearing exercises that help build strong bones. Thirty minutes of regular exercise (at least 3 to 4 days a week) along with a healthy diet may increase peak bone mass in younger people. Older women and men who engage in regular exercise may experience decreased bone loss or even increased bone mass.

Protecting Yourself From Fractures If You Have Osteoporosis

If you have osteoporosis, it is important to protect yourself against accidental falls, which may result in fractures. Take the following precautions to make your home safe:

• Remove loose household items, keeping your home free of clutter.
• Install grab bars on tub and shower walls and beside toilets.
• Install proper lighting.
• Apply treads to floors and remove throw rugs.

‍