Health risks in menopause
Challenges some women face during "the change of life."
Every woman knows that changing hormones are a fact of life, but it's only when our hormones are dwindling that we discover how important they really are. In addition to hot flashes, night sweats and mood swings, some menopausal women face increased risks for serious health conditions. Find out how women of a certain age can protect their health for the decades to come.
Around 2 million women a year reach menopause at about age 51. Since American women live about 84 years, that's more than 30 years without reproductive hormones. Reproductive hormones (estrogen, progesterone and testosterone) are interconnected with other hormones, like thyroid, cortisol and insulin.
Together, these hormone combinations help control our bodies. When hormone levels change, many body systems are affected. That's why menopause affects women's hearts and their reproductive and endocrine systems, as well as skin, bones, hair, mental sharpness, emotional well-being and sleep.
Most women remain healthy after menopause. Some, however, develop health problems when changing hormones combine with the effects of aging, genetics, lifestyle issues and stress. Dr. Janet Gibbens, obstetrician/gynecologist with Women's Health Today in Portland, Oregon, says, "The biggest health issues are osteoporosis, cardiac disease and weight gain."
Osteoporosis (bone loss) causes bones to become porous and brittle. The National Osteoporosis Foundation says the disease causes half of women over age 50 to break bones. According to Dr. Gibbens, "Osteoporosis is thought to be caused by estrogen loss plus inadequate calcium and vitamin D. The most rapid decline in bone density happens during the first five years of menopause. If a woman uses estrogen replacement therapy, bone loss doesn't happen as quickly. Even without estrogen, she can help maintain bone density with vitamin D3 and calcium supplements. Vitamin D is more important than calcium. Women should have a baseline bone density test within a year or two of menopause."
Other influences that are connected to bone loss are:
- History of broken bones
- Height loss
- Being small and thin
- Poor nutrition
- Alcohol consumption
- Lack of exercise
Ask your gynecologist if you should take hormone replacement therapy (HRT). Also ask if you should take calcium and vitamin D3 supplements, and if so, what dosage. Then, hit the gym. Exercises like running and weight lifting help maintain and build bone strength. If you already have bone loss, ask your doctor about medications to improve your bone strength.
Before they hit menopause, women are less likely to get a heart attack than men. After menopause, they catch up. Researchers think that estrogen protects women's cardiovascular systems. When estrogen drops, that protection goes away. In addition, menopause changes the levels of cholesterol, lipids and triglycerides in your blood and causes weight gain. That's why heart disease is the biggest killer of women over 50.
According to Dr. Gibbens, whether or not hormone replacement therapy helps or hurts heart heath is a hot topic of debate. "Before the Women's Health Initiative study was halted in 2002, we thought HRT provided strong cardiac benefits" she says. "That study was halted when evidence showed HRT created increased cardiovascular risk."
Later research analysts discovered that the study that was halted was flawed. It only looked at one type of HRT. Newer studies indicate that when women begin HRT within a few years of menopause, it appears to provide protection to the heart. Getting started early is key, Dr. Gibbens points out. "Started later, it doesn't seem to provide the same benefits."
The American Heart Association says that, as a woman, to keep your heart healthy you should:
- Eat a heart-healthy diet rich in fruits and veggies, whole grains and high-fiber foods.
- Eat fish at least twice a week or take omega-3 fatty acid supplements. (Flax seeds are also an excellent source of omega-3s.)
- Eat a diet low in salt, saturated and trans fat, and cholesterol.
- Drink no more than one alcoholic drink per day.
- Don't smoke.
- Maintain a healthy body weight.
- Exercise at least two-and-a-half hours per week.
In addition, keep your heart health numbers within these guidelines:
- Blood pressure: Less than 120/80 mm HG
- Total cholesterol: Less than 200 mg/dL
- LDL ("bad") cholesterol: Less than 100 mg/dL
- HDL ("good") cholesterol: Greater than 50 mg/dL
- Triglycerides: Less than 150 mg/dL
- Glucose (HbA1c): Less than 7%
- Body mass index: 18.5 to 24.9
- Waist circumference: Less than 35 inches
Weight gain, really?
Most menopausal women face frustrating weight gain. Hormonal changes cause women's metabolism to slow down, which causes weight gain around their waists. Post-menopausal women are also often less physically active, so they lose muscle. Genetic factors and unhealthy eating habits can add to the mix. Soon, many women gain the "apple shape" linked to increased risks for diabetes and heart disease.
"Menopausal women have to eat less and exercise more just to maintain the same weight," says Dr. Gibbens. "To lose weight, they have to work even harder. Women who use HRT might not gain as much weight, but it won't provide complete protection."
What about cancer?
More women develop cancer after menopause, but research indicates that's probably related to aging, lifestyle and genetic factors, not menopause. The best ways to avoid developing cancer are the same diet, lifestyle and exercise tips that help reduce risks for bone loss, heart disease, weight gain and diabetes.
Should you use HRT?
HRT has many benefits, but it also has risks. It can increase your risk of breast cancer, heart disease and stroke. "It's not appropriate for every woman," says Dr. Gibbens, "but many can take it safely to improve a long list of menopausal symptoms."
If you're approaching the age of "the change," talk to your doctor about your options. Getting an early start can give you the best chance for good health and well-being for life.
- What Women Need to Know (National Osteoporosis Foundation)
- Menopause and Heart Disease (American Heart Association)
- North American Menopause Society
Published on Jan. 19, 2012; updated on May 9, 2014.
Jeanne Faulkner is a freelance writer and registered nurse in Portland, Oregon. Her work appears regularly in Pregnancy and Fit Pregnancy, and she has contributed articles to the Oregonian, Better Homes & Gardens, Shape and other publications.