Health Issues for Women Ages 40 to 55

Some women sail through their mid- to late 40s and 50s without a second thought about menopausal symptoms. For others, hormonal changes can make midlife less than "prime time." Most women can tell if they are approaching menopause because their menstrual periods start to change. This transitional time is often called perimenopause and typically lasts for about five years.

Hormonal fluctuations cause irregular menstrual patterns and other changes associated with menopause, including:

hot flashes
vaginal dryness
urinary tract infections
night sweats
insomnia
headaches
heart palpitations
mood changes
anxiety and irritability
memory lapses and diminished concentration

Most women experience only mild symptoms just prior to and following menopause.

Irregular menstrual periods are common as you get closer to menopause, but they also can be a symptom of gynecologic cancer or other conditions that may need medical attention. Remember, you can still get pregnant during the transition to menopause, even if your menstrual cycle is irregular, so continue to use birth control. Be sure to mention any menstrual problems during regular checkups or schedule an appointment to discuss them. Bleeding after menopause should be reported and evaluated right away.

Menopause itself is one event — 12 consecutive months with no menstrual period and no other biological or physiological cause for the end of your periods.

Postmenopausal Hormone therapy ( commonly referred to as hormone replacement therapy or HRT) has been widely used for short-term management of uncomfortable menopausal symptoms such as vaginal dryness and hot flashes, and as a long-term strategy for preventing diseases common in postmenopausal women (related to estrogen decline) such as osteoporosis. For many years, estrogen had been widely recommended to postmenopausal women as a way to prevent heart disease.

The safety of hormone therapy (often administered as combination of estrogen and progestin hormones) as well as estrogen-alone therapy for short- and long-term use is now under intense scrutiny by the Federal government. Concerns were triggered by major studies of postmenopausal hormone therapy published in 2002 that identified significant risks associated with its use. One of those studies, part of the Women's Health Initiative (WHI) — one of the largest studies of women's health ever undertaken and still underway — investigated the use of combination estrogen-progestin hormone therapy for the prevention of coronary heart disease on healthy women between the ages of 50 to 79 years. The study found that not only did combination hormone therapy NOT prevent heart disease, it could potentially contribute to its development.

In January 2003, the U.S. Food and Drug Administration (FDA) announced that it would require a new, highlighted and boxed warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. The warning highlights the increased risk for heart disease, heart attacks, stroke and breast cancer from supplemental estrogen #151 risks illuminated by a section of the WHI study, which was abruptly halted when the risks were identified.

Also emphasized by the "black-box" warning is that estrogen products are not approved for heart disease prevention. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time. Women taking estrogen products are cautioned to have yearly breast exams, perform monthly breast self-exams and receive periodic mammograms.

Health Issues for Women Ages 40 to 55 (<i>cont'd</i>)

Every Woman is Different

Because every woman's risk profile is different, women who are thinking about taking postmenopausal hormone therapy or are currently taking it for whatever reason, need to review their options and treatment plans with their health care professional in light of the FDA's recent warning. Women who take hormone therapy containing estrogen to prevent osteoporosis should discuss their personal risks for heart disease and breast cancer with their physician. Alternative treatments and preventive medications are available.

Women who are currently taking postmenopausal hormone therapy should consult with their health care professionals before stopping their medication. For women who use hormone therapy to relieve menopausal symptoms, stopping some hormone therapy regimens abruptly may make menopausal symptoms worse. How hormone medication is tapered off will depend on the type of medication being used. A growing number of recent studies suggest that there are other effective options to treat and prevent hot flashes, including lifestyle changes.

Ask your health care professional for more information about the latest research on postmenopausal hormone therapy, how the risks and benefits of using these therapies apply to your personal health needs and what other options are available to you.

New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are currently being developed. The FDA recently approved a low-dose version of the combination estrogen-progestin treatment sold as Prempro, which is expected to be available in the summer of 2003.

Many women turn to "natural hormonal therapies," provided by herbs, supplements and plant-based estrogens to help manage menopausal symptoms as alternatives to synthetic and other forms of estrogen. While research is just beginning to look at how these preparations may affect menopausal symptoms, there is little or no clear evidence that these strategies can help to prevent heart disease or other postmenopausal conditions. Neither is there a clear understanding of how much of these preparations should be used as a prevention strategy.

A slower metabolism

Beginning in your mid-30s, you lose a quarter of a pound of muscle or more every year and gain at least that much in fat. You also lose nearly one percent of bone mass every year, with the most rapid and severe bone loss occurring for many women during the first five to seven years after menopause. These silent changes can catch up with you in your 50s, 60s and 70s. It's not all bad news. The good news is you can prevent complications by acting now. Women who exercise regularly have a better chance of avoiding osteoporosis than women who don't exercise.

Good nutrition is a start

All women should follow these general nutrition guidelines (with advice from your health care professional if you've got a particular health concern):

— get between 1,000 and 1,500 mg of calcium daily

— eat five or more 1/2cup servings of fruits and vegetables

— eat six or more 1/2cup servings of whole grains, complex carbohydrates like pasta, bread, cereal and beans

— eat foods containing omega-3 fatty acids, like mackerel, salmon, albacore tuna and walnuts and avoid foods containing saturated fats (often listed on the label as hydrogenated or partially hydrogenated fats).

— eat soy-rich foods, such as tofu, because they contain chemicals called phytoestrogens (also called isoflavones) that have a weak estrogen-like effect in the body.

Many older women don't eat enough to get the nutrients they need. Vitamin D and the B vitamins are particularly important to women as they age because these vitamins contribute to bone and heart health and may help reduce the risk of osteoporosis and heart disease — health risks for older women.

Vitamin D is essential for calcium absorption by the body. It is found in fortified milk and products made from fortified milk, and is absorbed by the skin from exposure to sunshine. Women need at least 400 IU/day; if your age 70 or older, you need as much as 800 IU/day.
The B vitamins, especially folic acid, have been associated with lowering blood levels of homocystine (an amino acid, which in high levels, is associated with heart disease and stroke). A multivitamin that contains all the B vitamins is good insurance for most women. Green leafy vegetables, lentils and orange juice are also good sources of folic acid.

Add some exercise and you'll be in good shape

For most healthy people, any vigorous activity, such as brisk walking, swimming, running or biking for at least 30 minutes three-to-four times each week provides health benefits to the heart, lungs and circulatory system. Moderate- to low-intensity activity, such as pleasure walking, gardening and housework for 30 minutes on most days provides some benefits. What's most important is to include exercise as part of your regular routine. Before starting any exercise, check with a medical professional.