Menopause a time for reflection, a time for growth
Posted on May 30, 2008
Filed Under Menopause |
Menopause is the beginning of a new stage in your life. It is also a time when you can improve the way that you live. It is a time when you begin to face new health concerns. As you get closer to menopause, your ovaries produce less estrogen, progesterone and testosterone. Your periods eventually stop. Your body begins to go through many changes, which can increase your risk for certain diseases.
Many of these changes are simply related to aging. Some of them are an interaction between the natural aging process and the lack of estrogen, progesterone and testosterone.
As you age, you may also be at increased risk for:
1. Bladder control problems/pelvic floor dropping
2. Fibroids (for which there are non-surgical treatments)
3. Osteoporosis
4. Insulin resistance/diabetes
5. Heart Problems
6. Depression
7. Certain kinds of cancer (breast, colon, lung)
8. Abnormal uterine bleeding patterns
While these changes are happening in your body, you can make changes to protect your future health. Do you know your risks?
Evaluate your personal and family history. Everyone has a different personal and family medical history that affects their risk for developing certain diseases. Use these checklists to help you assess your risks of these conditions.
#1: Bladder Control Problems/ Pelvic Floor Dropping:
Problems with bladder control occur because of trauma (vaginal deliveries) or simply aging. Women have always been active throughout history but not in organized athletics. With involuntary loss of urine, people often avoid doing an activity, sometimes not even thinking that it’s a problem. When some people lose urine playing tennis or doing high-impact aerobics, they think, “Well I just won’t play tennis or do aerobics.” You don’t have to feel this way. Review this list and see if you are at risk for this problem:
Q How often do you urinate during the day? ____________________
Q How often do you get up at night to urinate? __________________
Q Is the amount of urine you usually pass: Large Average Small
Q Do you usually have a strong sense of urgency to urinate? Yes No
Q Do you have to hurry to empty your bladder when full? Yes No
Q Do you ever not make it in time and leak urine? Yes No
Q Can you overcome the sensation of urgency to urinate? Yes No
Q Does the sight, sound or feel of running water cause you to lose your urine? Yes No
Q Do you ever lose urine when lying down? Yes No
Q Do you have a warning before losing urine? Yes No
Q When urinating, can you usually stop your stream? Yes No
Q Do you accidentally wet the bed when sleeping? Yes No
Q Do you have difficulty starting your urine stream? Yes No
Q Do you feel that you completely empty your bladder? Yes No
Q Do you notice dribbling of urine after voiding? Yes No
Q Have you ever been catheterized because you were unable to void? Yes No
Q Have you ever had your urethra dilated or stretched? Yes No
Q Do you ever pass blood in your urine? Yes No
Q Have you ever passed sand, gravel or stones? Yes No
Q Do you have pain during urination? Yes No
Q Have you been treated for 3 or more urinary infections? Yes No
Q Have you been treated for an infection within 6 months? Yes No
Q Do you lose urine while coughing, sneezing, laughing, lifting, jumping or running? Yes No
Q Do you find it necessary to use some type of protection? Yes No
Q Did your urinary difficulty begin: During a pregnancy? Yes No
Q Following a delivery? Yes No
Q Following an abdominal or vaginal operation? Yes No
Q After the menopause? Yes No
Q List all medications you have taken in the past 6 months. Circle those medications which you are currently taking: ____________________
Also, do you have common symptoms of an overactive bladder:
Q I frequently have a strong, sudden urge to urinate. Yes No
Q I often go to the bathroom more than 8 times in a 24 hour period. Yes No
Q I frequently get up twice or more at night to go to the bathroom Yes No
Q I go to the bathroom so frequently that it interrupts my life . Yes No
Q I’m not always able to hold on until I reach a bathroom. Yes No
Discuss your answers with your caregiver. There is help for you.
# 2: Fibroids
At times, as a woman gets older fibroids will continue to grow, especially in the period before menopause. Although fibroids are benign muscle tumors, their symptoms of pressure, heaviness and bleeding may result in a desire to treat this condition. While surgery has in the past been the major treatment for fibroids, non-surgical therapies are now available as long as an evaluation demonstrates these are appropriate. The evaluation for this condition may include ultrasound, endometrial biopsy, or even hysteroscopy and/or laparoscopy. If you have the symptoms listed below, you may wish to undergo an evaluation at a center which provides all of the options available for the treatment of fibroids, including those which do not require major surgery.
Statement
I feel a heaviness in the pelvic area… Yes No
I have been experiencing bleeding that is not normal, such as very heavy periods or bleeding between periods… Yes No
I have been told that I have a fibroid and that it is growing slowly.. Yes No
I have a fibroid and I am also experiencing problems with bladder capacity, going more frequently and having less volume and more urgency. Yes No
I have been told that I need surgery for my fibroid. Yes No
Before surgery is entertained, including hysterectomy, be aware of the options which include embolization (treatment of the fibroid through a radiologic procedure), myolysis (treatment of the fibroid laparoscopically by vaporizing some of the tissue causing it to shrink), laparoscopic myomectomy, laparoscopic supercervical hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy. These are alternatives to the frequently recommended approach to the abdominal hysterectomy with its relatively large scar and long recovery time.
# 3: Osteoporosis
The bones of most women begin to weaken after age 35. After menopause, this weakening process becomes accelerated. This can lead to a disease called osteoporosis. The bones become weak and brittle and are more likely to break. It is important to determine your risk for osteoporosis and to take steps to prevent it. However, because it is impossible to predict the presence of osteoporosis and because it can occur without any of these risk factors, some health care providers urge all women over the age of 50 to have a bone density evaluation to determine their bone status. In fact, it may be advisable for you to have your bone density checked prior to the beginning of the loss of bone density to determine the current status. Do not confuse a decision by an insurance company to cover or not cover a certain evaluation with good medical care. Your body is the only body that you have. Unfortunately, you are not born with a gauge that tells you the status and density of your bones (like an oil gauge would tell you how much oil is in your car). Even if your insurance company does not reimburse you for such an evaluation, it makes good sense for you to know whether you have extremely strong and thick bones or thinner, less dense bones, which are more at risk for future bone loss. However, certain conditions do give an indication that you are more at risk for developing osteoporosis. Answer the questions below and if your answers are yes to any of these you may wish to consider having an evaluation of your bone density performed.
Statement
I went through menopause before age 40. Yes No
I stopped having periods for at least 6 months because I exercised. Yes No
I had my ovaries removed by surgery. Yes No
I have small bones or I am very thin. Yes No
I have family relatives who developed osteoporosis, who developed a stooped posture or who broke bones after menopause. Yes No
I have not eaten many foods high in calcium (milk, cheese, yogurt, tofu etc.) and I have not been taking calcium supplements. Yes No
I have lost height. Yes No
I am of Northern European extraction. Yes No
I am on thyroid medication or have had problems with my thyroid. Yes No
I am on steroid medications or have had to use steroid medications in the past. Yes No
Discuss your answers with your caregiver. Protect yourself from bone loss.
# 4: Diabetes and Glucose Intolerance
Diabetes is a powerful coronary heart disease risk factor for women, more so than for men. Having diabetes negates the general protective effect of estrogen. In addition, women older than 45 years are twice as likely as men to develop diabetes. Women with Type II diabetes have a 3 to 7 time increase risk of cardiovascular events and the risk increases with other risk factors.
Insulin resistance (also known as glucose intolerance) is now recognized as a pre-Type II diabetes state. Insulin resistance can be difficult to recognize and difficult for many healthcare providers to diagnose. Insulin resistance is associated with weight gain, hypertension, cardiovascular disease, stroke, polycystic ovary disease and development of frank Type II diabetes. Diet, exercise and certain medications can blunt the effects of glucose intolerance/insulin resistance, but first the condition must be recognized. Review this list to determine if you are at risk and should be evaluated for this condition:
Statement
I am gaining weight every year without changes in my diet or exercise pattern.. Yes No
I have relatives with Type II diabetes.. Yes No
I get very fatigued after a meal with sugar concentrate. Yes No
I have been heavy all of my life. Yes No
My periods have been irregular all of my life. Yes No
I have abnormal hair growth. Yes No
I have been told that I have polycystic ovary disease. Yes No
Discuss your answers with your caregiver. Protect yourself from the effects of insulin resistance.
# 5: Heart Problems
The risk for women of heart disease rises rapidly after menopause. Before menopause, the estrogen produced by the ovaries protects you from heart disease. As you reach menopause, your body produces much less estrogen. Without this protection, your risk of heart disease begins to rise. Although it is difficult to predict an individual’s risk for heart disease, there are certain risk factors which have been identified. Remember that cardiovascular disease is the leading cause of death in women. It represents 2 x the number of deaths from all cancers. Coronary heart disease is 49% of cardiovascular disease mortality and stroke is 40% of cardiovascular disease mortality. Cardiovascular disease is the leading cause of death in women. Coronary heart disease affects 1 in 15 women age 45 to 64 and 1 in 7 women greater than 65. If you answer yes to any of these statements, your risk of coronary heart disease is increased:
Statement
I smoke. Yes No
I have diabetes or insulin resistance. Yes No
I have high blood pressure.. Yes No
I have high cholesterol. Yes No
I have a low HDL cholesterol. Yes No
I am overweight/obese. Yes No
I do not exercise/am sedentary. Yes No
I have one or more relatives with a history of heart disease.. Yes No
Many of these factors can be modified to protect you from heart disease. Menopause is a time of reflection and evaluation and allows you to make choices that can affect how you live the rest of your life.
# 6: Risks of Depression
Depression affects twice as many women as men. Depression can be successfully treated in 70% of cases. Answer these questions and discuss them thoroughly with your caregiver:
Statement
I am experiencing a loss of interest in the things that I used to enjoy. Yes No
I am feeling sad, blue or “down in the dumps”… Yes No
# 7: Risks of Cancer:
All women face an increased risk of different types of cancer as they age. When cancer is detected in the early stages, it can often be treated successfully. Major concerns exist for cancers of the lung, breast, colon and pelvic organs. Answer these questions and discuss them thoroughly with your caregiver.
Statement
I went through menopause after the age of 55. Yes No
I started my periods before the age of 12…. Yes No
I more than 1 close relative who has had colon, breast or ovarian cancer. Yes No
I have not given birth or I did not have my first baby until after the age 30. Yes No
I do not check my breasts for lumps every month. Yes No
I do not protect my skin from the sun with sunscreen, clothing or hats. Yes No
I smoke cigarettes or breathe in second-hand smoke at home or at work. Yes No
Regular Screening Tests:
Regular screening tests can help protect your health after menopause. Which of the following statements apply to you?
Statement
I am over age 50 and my last mammogram was more than a year ago. Yes No
I do not have a Pap test as often as my healthcare professional recommends. Yes No
I do not have my cholesterol level tested regularly. Yes No
I do not get my stool checked for blood every year and do not have a bowel exam (colonoscopy) every three to five years. Yes No
Lifestyle habits:
Remember that your every day habits and activities can play a big part in staying healthy. Answer these questions and discuss them thoroughly with your healthcare professional.
Statement
I drink too much alcohol. Yes No
I exercise less than an average of 30 minutes a day. Yes No
I use tobacco products. Yes No
The more statements answered with a “yes”, the more you may be at risk for certain health problems. Use this checklist as a guide and talk to your healthcare professional about your responses.
# 8: Abnormal Uterine Bleeding:
Abnormal uterine bleeding (to heavy, to frequent, irregular) can be a sign of hormone changes. However, it can be a sign of cancer, pre-cancer, fibroids or polyps. An evaluation by pelvic ultrasound and if indicated, by endometrial biopsy, hysteroscopy or “D&C” may be indicated. Hormone levels may be tested. Treatment of benign conditions can frequently be performed as an outpatient using hysteroscopy. Decisions about hormonal replacement therapy during and after menopause are critical issues for all women. The role of hormone replacement, whether natural hormones, selected estrogen-receptor modulators, or synthetic hormones is a subject, which will be discussed, in future articles. If you have any questions call for an appointment. Dr. Carter can discuss your concerns by appointment only.
Leave a Reply