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Women's Health After Menopause
Menopause is a significant milestone for women and it should mark a change in health care strategies, according to Wulf H.Utian, MD, PhD, professor emeritus of reproductive biology at Case Western University in Cleveland, OH. Utian was speaking to an audience of physicians this week at the annual meeting of the American College of Physicians/American Society for Internal Medicine, in Philadelphia. He said preventative health programs for women in menopause consist of incorporating lifestyle changes and the possible use of pharmaceuticals.
Menopause is a natural event in a woman's life that designates the end of fertility and her childbearing years. Even though it is a naturally occurring event, menopause causes a profound change in a woman's hormonal profile. A decrease in estrogen levels is responsible for causing some symptoms in many women, the most common being sudden intense waves of heat and sweating, better known as hot flashes. Other symptoms may include irregular bleeding, vaginal or urinary tract infections, urinary incontinence and vaginal dryness and inflammation. While these symptoms can be bothersome and uncomfortable, they do not represent a serious risk to health. More significant to health, said Utian, who is also executive director of the North American Menopause Society,
is the increased risk of both heart disease and osteoporosis after a woman enters menopause.
That's why it is a good time to take advantage of preventative screening programs, such as mammography and bone densitometry, said Utian. Even if the disease risk factors are not menopause related, certain conditions become more prevalent as a person grows older, such as colorectal cancer, and menopause begins at an age when such screening is recommended.
While the potential for enhancing the quality of a woman's life after menopause is enormous, close attention must be paid to the selection and utilization of screening procedures, the risks and benefits of pharmaceuticals, cost and a woman's own concerns and attitudes.
A woman's personal demographics need to be considered, such as her earnings, marital status and other support systems. Also important is a woman's own perception of menopause. Doctors should look at the entire menopause transition, such as the potential changes in the hormone profile as well as potential changes in the organs which are most affected by it. Other age related factors, independent of menopause, are important, including awareness of the major causes of death for women over 60, psycho-social cultural factors, and general life expectancy.
Hormone replacement therapy (HRT) is a subject that is constantly evolving, as trends change and new issues arise. HRT is contraindicated for some women, but may be beneficial for others, especially if they are at risk for heart disease or osteoporosis. Utian presented algorithms to the audience, which help assess whether or not a patient is a candidate for HRT. Problems with mood swings, cognitive function and sleep disturbances are considered candidates for HRT, according to the algorithm, as are cardiovascular risks. For women who are not candidates, non-hormonal remedies and lifestyle changes may be able to significantly lessen abnormal feelings and symptoms during this time of physiologic change.