Your Change. Your Life. Take Charge. A public health forum brought to you by

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1 Menopause And You: Your Change. Your Life. Take Charge. A public health forum brought to you by

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3 Menopause And You: Your Change. Your Life. Take Charge. About the Society of Obstetricians and Gynecologists 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 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. 1

4 Tonight s Agenda What happens at menopause? How can we manage our symptoms? 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 2

5 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 3

6 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? 4

7 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 5

8 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 Research shows little positive impact: Mean number of VMS per day 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 6

9 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) 7

10 Why The Interest In Custom Compounded 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 HAVE NO standard manufacturing or quality 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 8

11 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 HAVE HAVE HAVE adequately studied in research proof of safety and efficacy standard manufacturing or quality control regulation of advertising claims 9

12 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? 10

13 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? 11

14 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 12

15 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 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 13

16 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: ½the risk of women in their 60s and ¼the risk of women in their 70s Menopause And Aging: How Can We Maximize Our Health As We Get Older? 14

17 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 15

18 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 Preventing Fractures Exercise and balance training Improved coordination Better balance Greater strength Less chances of falling Less fractures 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 16

19 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 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 17

20 Vulvovaginal Atrophy Symptoms Urge to go Frequent urination Vagina dryness Painful sex Recurrent urinary infection The Vagina: Time Does Not Heal ½of 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 18

21 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 19

22 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 About ½of women aged are overweight Risk to your health: Diabetes Hypertension Cancer Stroke 20

23 Nutrition Recommendations Balanced diet Reduce total fat intake / cholesterol intake Control weight Calcium mg / day Vitamin D at least IU / day Limit alcohol intake Limit caffeine intake 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!!! Need Help With Your Diet? Canada s Food Guide 21

24 Question Period For more information, consult: sogc.org menopauseandu.ca menopause.org sexualityandu.ca HPVinfo.ca Thank You! 22

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28 Menopause And You: Your Change. Your Life. Take Charge.