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Menopause And You:

Menopause And You:. Your Change. Your Life. Take Charge. About the Society of Obstetricians and Gynaecologists of Canada (SOGC). One of North America’s oldest organizations devoted to the specialty of obstetrics and gynaecology

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Menopause And You:

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

  2. About the Society of Obstetricians and Gynaecologists 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 • www.sogc.org

  3. 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. Gatheraccurate, complete information to help decide on how to navigate your transition.

  4. Tonight’s Agenda What happens at “menopause”? How can we manage our symptoms? What can we do to maximize our health during menopause? 1 2 3

  5. What Is Menopause? • A period of change: • Hormonal • Physical • Emotional • End of menstruation and child-bearing years

  6. 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

  7. 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

  8. Brain Breasts Heart Liver Bones Vagina Skin Uterus Ovaries Estrogen And Progesterone Have Many Effects In The Body

  9. 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 What Happens With Hormonal Changes? No two women experience menopause in the same way

  10. 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

  11. Why Do Hot Flashes Happen? Body becomes more sensitive to small changes in core body temperature

  12. AUDIENCE COMMENTARY… What Have You Done To Manage Hot Flashes?

  13. How Are Women Trying To Manage Hot Flashes? • Lifestyle changes • Alternative & complementary therapies • Traditional hormonal therapy • Non-hormonal prescription therapies

  14. 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

  15. Herbal Remedies, Soy & Botanicals • Soy • Black cohosh • Alfalfa • Dong quai • Ginseng • Evening primrose oil • Multi-botanical products

  16. 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

  17. 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

  18. 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

  19. 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

  20. Custom-Compounded Bioidenticals

  21. 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)

  22. 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

  23. These products… Problems With “Custom-Compounded” Bioidenticals

  24. “Custom-Compounded” Bioidenticals & Safety • 29 products from 12 compounding pharmacies were tested: • ⅓ failed quality control tests • ¼ failed potency standards

  25. 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

  26. 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

  27. What Is Traditional HT? These hormone preparations…

  28. 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

  29. 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

  30. AUDIENCE COMMENTARY… For those of you who are taking hormone therapy: How much? How long?

  31. 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

  32. 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)

  33. Menopause And HT: What’s The Controversy?

  34. Breast Cancer: How does taking HT affect your risk of developing breast cancer?

  35. 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

  36. ↑ 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 Risk Factors For Breast Cancer

  37. 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

  38. AUDIENCE COMMENTARY… How many of you are aware of the “Women’s Health Initiative Study” (WHI)? What does it mean to you?

  39. The Women’s Health Initiative 2002 (WHI) NOT a study looking at effects of HT on menopausesymptoms

  40. 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

  41. Women in their 50s have: ½ the risk of women in their 60s and ¼ the risk of women in their 70s Heart Disease: Does Age Matter?

  42. Menopause And Aging: How Can We Maximize Our Health As We Get Older?

  43. 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

  44. Treating Heart Disease And HT SOGC Position • HT is not recommended for preventing heart disease • HT does not increaserisk of cardiovascular disease when used by women within 10 years of menopause

  45. 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

  46. 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 • www.osteoporosis.ca

  47. Preventing Fractures Exercise and balance training Improved coordination Betterbalance Greaterstrength Less chances of falling Less fractures Less damage from fall

  48. 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

  49. 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

  50. Prevention Of Osteoporosis • SOGC encourages • Healthy diet • Adequate calcium and vitamin D • Regular exercise • www.sogc.org • www.menopauseandu.ca • www.osteoporosis.ca

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