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September is Menopause Awareness Month

September is Menopause Awareness Month! Menopause is an issue of great importance to the 5,000 women per day who enter menopause in the United States and Canada. It's also important to the families of all of these women. Menopause is simply the cessation of menses (menstruation) as a result of the body's decreased estrogen production.  This can be due to aging or any number of other reasons including some we don't fully understand.  The average age of menopause in the US is 51, but it can occur as early as the 20s or as late as the 60s. 

Why is it important to have menopause awareness?  Because the same thing that causes periods to stop also causes menopausal symptoms in two out of three menopausal women. The ovaries stop producing estrogen, potentially causing hot flashes, night sweats, sleep disturbances, mood swings, vaginal dryness, and decreased libido. Regardless of whether or not a woman has menopausal symptoms, the decrease in natural estrogen production increases a woman's risk for several conditions including heart disease, osteoporosis, and Alzheimer's disease. 

This connection between the cessation of menstruation and the increase in risks for heart disease, osteoporosis, and Alzheimer's, among others, led to the theories (correct in some cases, recently proven incorrect in others) that estrogen replacement therapy (ERT) would be an effective treatment for these diseases. We know that estrogen alone can significantly increase the risk of cancer of the lining of the uterus (endometrial cancer).  To prevent this, we have given concomitant progesterone therapy to all women taking estrogen, UNLESS they have already had a hysterectomy.

The results of the Women's Health Initiative (WHI) and other studies in the past year have clarified that ERT with or without progesterone does in fact reduce the risk of osteoporotic fractures and reduces the risk of colon cancer.  However, we have also learned that combined estrogen plus progesterone (HRT) can actually increase the risk of coronary artery disease, heart attacks, stroke, and breast cancer, as well as breast cancer deaths.  Other studies have also suggested an increased risk of dementia, the mental changes similar to those in Alzheimer's disease.  The biggest outstanding question now is whether these studies also apply to women taking estrogen alone and whether there's a differential effect in results based upon a woman's individual genetic make-up and/or the age at which she begins therapy.  In the next few days we will summarize some of the recent, and slightly confusing, studies in this area that have been featured in the media over the past two months. 

Many doctors believe these studies raise more questions than they answer.  What is newly agreed upon is that HRT has no benefit in preventing cardiovascular disease.  What is still generally agreed is that if healthy menopausal women need short-term HRT to treat menopausal symptoms, that's probably fine.  What is also agreed upon is that there is no one right answer for all women.  This makes preparation, education, and information all the more important.  You don't go into menopause overnight, so don't prepare for it overnight. Your friends and family are good sources of information and support, but your doctor is the best source of medical information about menopause for you.  Ask questions now to help form a good treatment plan later.  And now, more than ever before, an ounce of prevention is worth a pound of cure.

Created: 9/2/2003  -  Donnica Moore, M.D.

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