Menopause-Debunking Myths Speaker Chery

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Published on December 17, 2008

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Debunking Menopause Myths : Debunking Menopause Myths Cheryl L Bowles EdD, RN Professor, School of Nursing University of Nevada, Las Vegas “The hardest years in life are those between ten and seventy.” Helen Hayes : “The hardest years in life are those between ten and seventy.” Helen Hayes Introduction : Introduction Perimenopause median age – 47.5 yrs 41.75 million women over age 50 in US Women spend 1/3-1/2 life in post menopause Spontaneous menopause average age is 51.4 yrs Menopause transition average 4 years but highly variable In 2000, 45.6 million postmenopausal women Definition of Terms : Definition of Terms Menopause – permanent cessation of menstrual cycle. Greek “meno” (month) and “pausis” (a pause). Really a process. Postmenopause - time in woman’s life after last period (12 full months) Premature Menopause – last period before 40 years Menopause is a Hormone Deficiency Disease : Menopause is a Hormone Deficiency Disease “The reason some men fear older women is they fear their own mortality.” – Frances Lear Menopause is a Hormone Deficiency Disease : Menopause is a Hormone Deficiency Disease Significance of “men” in both “men”opause and “men”struation. Male dominated western medical model Focused on deficiency disease approach Did not study as normal process Response has been to intervene Menopause is a Developmental Stage of Life : Menopause is a Developmental Stage of Life When I was 40, I used to wonder what people thought of me. Now I wonder what I think of them.” Brooke Astor at 92 Developmental Stage : Developmental Stage Lack of studies on psychosocial research of menopause as a developmental stage Meaning of menopause of women experiencing it : self-concept, identity, sexuality, relationships Unique experience and meaning of menopausal events to women HRT has been used on Women for over 75 Years : HRT has been used on Women for over 75 Years HRT has been used on women for over 75 years : HRT has been used on women for over 75 years “Menopause” coined by French physician in 1800’s Disease caused by certain organs Reproductive organs central for women Psychoanalytic movement in 1900’s By 1930 estrogen used for menopausal symptoms. Menopausal Women should not have HRT : Menopausal Women should not have HRT HRT or no HRT, that is the Question : HRT or no HRT, that is the Question Women’s Health Initiative (WHI) Heart and Estrogen/progestin Replacement Study (HERS) North American Menopause Society (NAMS) 2007 Position Statement Treatment of moderate to severe hot flashes and night sweats HRT or no HRT, that is the Question : HRT or no HRT, that is the Question Vaginal symptoms Progestogen is used for endometrial protection from unopposed ET Evidence of efficacy of ET/EPT in reducing the risk of postmenopausal osteoporotic fracture HRT or no HRT - Recommendations : HRT or no HRT - Recommendations Lowest doses, shortest period of time Not as treatment for long term, chronic condition Always consider Risk-benefit ratio Use lower doses, non-oral routes Effects of long term therapy on perimenopausal women not known Menopause makes you Crazy and Forgetful : Menopause makes you Crazy and Forgetful Menopause makes you Crazy and Forgetful : Menopause makes you Crazy and Forgetful No substantial data saying menopause makes women at greater risk for depression. Greater risk if there is previous depression in childbearing, PPD and severe PMS Psychosocial factors that appear to be more predictive of depression Menopause makes you Crazy and Forgetful : Menopause makes you Crazy and Forgetful 2003 Study of Women's Health Across the Nation (SWAN) 3,300 women age 42-52 from five ethnic groups tracked over 6 years No evidence of decline in brain function occurs as women progress through the menopausal transition Taking Calcium Supplements doesn’t help : Taking Calcium Supplements doesn’t help Taking Calcium Supplements doesn’t help : Taking Calcium Supplements doesn’t help Postmenopausal women in US and Canada have low calcium intake Probability of calcium adequacy in the American diet is 46% for women NIH Daily elemental calcium requirements: 31-50 yrs = 1000 mg; Postmenopausal not using ET = 1,500 mg; All women aged 65 and older = 1,500 mg Calcium Supplements : Calcium Supplements During menopause bone resorption rate increase due to Lower estrogen levels 5 -7 years around menopause, women lose 2% of bone annually The amount of calcium needed is also affected by the decrease in intestinal absorption that occurs with age Vitamin D is essential for the efficient intestinal absorption of calcium Calcium Supplements : Calcium Supplements Recommended calcium levels refer to amount of elemental calcium. Supplements list the elemental calcium content Calcium carbonate provides the highest percentage which is 40% To maximize absorption, calcium should be taken in doses of 500 mg elemental calcium or less throughout the day and usually with meals. Osteoporosis has Warning Signs : Osteoporosis has Warning Signs Osteoporosis has no warning signs; often the first sign is a fracture Prevalence of osteoporosis increases from 4% of women 50-59 to 52% in women 80 and older Osteoporosis and fracture vary with ethnicity Important Factors: age, bone density, Lifestyle, diet, genetics, activity, smoking, thinness, menopause status, alcohol Osteoporosis and Bisphosphonates : Osteoporosis and Bisphosphonates Bisphosphonates - Fosamax, Actonel, Boniva Reduces risk of vertebral & nonvertebral fractures Poorly absorbed and must be taken first thing in the morning when the stomach is empty Effects of stopping on young postmenopausal women (mean age 50-51) Things go better with Cola : Things go better with Cola Regular Cola Consumption Linked to Lower Bone Density in Women Farmingham study of 1,672 women and 1,148 (age 30-87) men from 1996 to 2001. Cola intake was associated with significantly lower BMD at each hip site, but not the spine, in women but not in men. Increased levels of phosphoric acid (found in dark colas) which can interfere with bone absorption After Menopause your Sex Life is over : After Menopause your Sex Life is over “I want to be a grandmother. Oh yes – but I want to be the sexiest grandmother in the world.” Sophia Loren in her 60”s Sex after Menopause : Sex after Menopause One of the best predictors of a women’s post-menopausal sexual interest is her activity and sexual satisfaction prior to reaching menopause Research shows that when surveyed most women report no drop in sexual desire. AARP survey found that two-thirds of men and women ages 45 and older say they are satisfied with their sex life's. Most women have Problems in the Menopausal Transition : Most women have Problems in the Menopausal Transition “I believe the second half of ones life is meant to be better than the first half. The first half is finding out how you do it and the second half is enjoying it” Frances Lear Menopausal Transition : Menopausal Transition Every woman is different. Each makes the transition through menopause in a unique way. Approximately 20% of menopausal women have moderate to severe symptoms Attitudes toward menopause – under 35 more negative, over 45 more positive, men more negative than women and male physicians the most negative Web sites with good information : Web sites with good information North American Menopause Society (NAMS) http://www.menopause.org International Menopause Society http://www.imsociety.org National Women’s Health Network http://www.nwhn.org Society for Menstrual Cycle Research http://menstruationresearch.org

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