Sex Education and Wellness


 
Hormone Therapy

What Is Hormone Therapy? Hormone therapy (HT) is a means of replacing the sex hormones estrogen and often progesterone that a woman’s body stops making in sufficient quantities when she reaches natural menopause (or after surgical removal of the ovaries). HT is usually begun at menopause to relieve menopausal symptoms such as hot flashes and night sweats.

Doctors used to recommend that women take HT for the rest of their lives to achieve long-term health benefits such as a reduced risk of osteoporosis, bone fractures, colon cancer, and possibly heart disease and Alzheimer’s disease. But in 2002, a large study called the Women’s Health Initiative, sponsored by the National Institutes of Health, was stopped early because of evidence of an increased risk of heart disease, stroke and breast cancer in women taking a specific estrogen-progestin combination drug regimen.

HT is available by prescription in pills, patches and creams. A woman and her doctor choose the appropriate delivery method based on the woman’s health risks, her preferences, and the risks and benefits to her personally.

Weighing the Risks and Benefits of HT In making the decision to take HT, each woman needs to discuss the risks and benefits with her doctor in the context of her health history and health risks. Women who should not take estrogen are those who have breast cancer or a history of breast cancer, abnormal vaginal bleeding, very high triglyceride (a potentially harmful type of fat in the blood) levels, a history of blood-clotting disorders, active liver disease, or gallstones or gallbladder disease. If you have or had any of these conditions, talk to your doctor. You may be able to use estrogen patches rather than pills.

Benefits

For women who experience debilitating short-term symptoms of menopause that interfere with their quality of life — such as hot flashes, night sweats, sleep disturbances, mood swings, and vaginal dryness, itching and burning — HT is the most effective treatment. Estrogen also reduces thinning of the vaginal walls and pain with intercourse and, in many cases, improves mood, sleep and short-term memory. Low doses of HT can relieve these symptoms. Many newer lower-dose estrogen products are available.

HT protects against osteoporosis by slowing the rate of bone loss and improving bone density throughout the body, including in the hips and spine. Postmenopausal women who take HT have a decreased risk of fractures. However, because of the potential slightly increased risk of heart disease, stroke and breast cancer from HT, unless a woman also has severe menopausal symptoms such as hot flashes, doctors no longer recommend HT solely for preventing or treating osteoporosis. If you have osteoporosis or its precursor condition osteopenia, your doctor can recommend another bone-building medication (see below).

Disadvantages and Health Risks

Taking estrogen alone, the former HT regimen sometimes called estrogen replacement therapy (or ERT), was found to increase the risk of uterine cancer (in women who had not had a hysterectomy). For this reason, progestin (a synthetic form of the female hormone progesterone, which counterbalances estrogen in the body) is now combined with estrogen in HT for women who have a uterus. Women who have had a hysterectomy (and therefore no longer have a uterus) are not at risk for uterine cancer and can take estrogen alone.

Side effects of HT can include vaginal bleeding, breast tenderness, nausea and bloating. In some cases, these side effects can be eliminated by reducing the dose or trying a different drug combination. Various formulas are available that provide different types of estrogens and progestins or a different estrogen-progestin ratio.

The Women’s Health Initiative found a link between taking HT longer than five years and a slightly increased risk of breast cancer. For this reason, most doctors recommend that women who have had breast cancer should not take estrogen. Women who have a family history or other risk factors for breast cancer should talk to their doctor if they are considering taking HT. Whether or not you are taking HT, you need to continue doing month breast self-examinations and, after age 40, have regular mammograms as often as your doctor recommends.

The 2002 Women’s Health Initiative study found that HT slightly increased some women’s risk of heart disease. The precise effect that estrogen has on cholesterol levels and heart disease risk is not clear, but normal levels of estrogen in the body before menopause seem to protect women from heart disease; before menopause, women are much less likely than men to die of heart disease. After menopause, by age 65, women’s death rates from heart disease equal those of men. Doctors no longer recommend that women take HT solely to reduce their risk of heart disease.

Choosing the Right Method for You If you and your doctor determine that HT might be beneficial for you, the next step is to choose the delivery method. You can choose from different pill combinations and doses, patches, and creams.

Estrogen Pills

Estrogen-only pills are usually taken every day. Estrogen-only pills are prescribed only for women who have had a hysterectomy. Women who have not had a hysterectomy should take a combination of an estrogen and a progestin (either in separate pills or in one tablet) to avoid the increased risk of uterine cancer from taking estrogen alone.

Estrogen/Progestin Pill Regimens

There are two methods for taking estrogen and progestin: the continuous method and the cyclic method.

In the continuous method, you take a pill that contains both estrogen and progestin or separate estrogen and progestin pills every day. Like other HT regimens, the continuous method can cause irregular bleeding (especially during the first three months), but the bleeding usually stops after a few months.

In the cyclic method, you take estrogen and progestin in separate pills, as prescribed, or a combination formula that packages the proper dose in a pill-pack. You take estrogen either every day or for 25 days of the month and progestin for 10 to 14 days each month. The cyclic method can cause monthly bleeding that can last up to a year or longer.

Hormone Patches

To use the estrogen patch or the estrogen-progestin patch, a woman applies the patch to the skin of her abdomen or buttock for three and a half or seven days, and then applies a new one. A patch is worn every day and can be left on all the time, including while bathing and swimming. The hormones are delivered through the skin into the bloodstream. Progestin can be taken in pill form with the estrogen patch. Both patches may cause monthly bleeding. Estrogen patches relieve menopausal symptoms and protect against bone loss

Estrogen Cream

Estrogen cream is inserted into the vagina or around the vulva to ease vaginal dryness and urinary problems. Women who are not bothered by hot flashes may choose this method to decrease vaginal or urinary symptoms such as painful intercourse or urinary frequency. However, if a woman still has a uterus and she uses the vaginal cream more often than once a month, she needs to take progestin for at least 10 days every other month to counteract the increased risk of uterine cancer from the estrogen. Talk to your doctor about whether you need to take progestin while you are using the vaginal estrogen cream.

Raloxifene

Raloxifene is an estrogen-like drug that is part of a class of drugs called selective estrogen receptor modulators (SERMs). Raloxifene can be prescribed to prevent or treat osteoporosis. The drug does not seem to increase the risk of uterine cancer as estrogen does, and it may actually protect against some invasive forms of breast cancer. Raloxifene does not cause monthly bleeding, but it also does not relieve hot flashes or other menopausal symptoms.

HT can usually be customized to provide maximum benefits with minimum side effects. If you have irregular bleeding or other side effects while taking HT, talk with your doctor about switching regimens or lowering the dose. Such adjustments can often decrease or eliminate the symptoms. Women who start HT usually have a three-month checkup, followed by six-month or annual checkups that include pelvic and breast examinations. These checkups may also include blood tests to measure cholesterol levels, especially if you have risk factors for heart disease. In addition, remember that after menopause you should have a mammogram every year.

Questions to Ask Your Doctor Your doctor is familiar with your health history and can help you make decisions about HT. Here are some questions you might want to ask your doctor:

If I decide to take HT, when should I begin?

Which form of HT is most appropriate for me?

What side effects are possible from the form of HT I’m taking?

What tests or procedures might I have during my regular checkups?

How long should I wait for any side effects to stop before considering a change in dosage or regimen?

For how long should I take HT?

________________

Additional Resources American College of Obstetricians and Gynecologists

409 12th St, SW

P. O. Box 96920

Washington, DC 20024-2188

(202) 638-5577

www.acog.org

North American Menopause Society (NAMS)

PO Box 94527

Cleveland, OH 44101

1-800-774-5342

www.menopause.org

Related Articles

Hormones & You: Osteoporosis and Women’s Health (English/Spanish Patient Information Page)

JAMA Patient Page: Heart Disease and Women

Last update: March 2005 by Ramona I. Slupik, M.D.

© Copyright 2005 American Medical Association All rights reserved.

Osteoporosis

Bones go through a constant state of loss and regrowth. As a person ages, more loss than growth can occur. This can lead to a condition called osteoporosis. The bones then become thin and fragile and can break easily.

What Is Osteoporosis? 

Bone is made up of calcium and protein. There are two types of bone — compact bone and spongy bone. Each bone in the body contains some of each type. The first signs of osteoporosis are seen in bones that have a lot of spongy bone, such as the spine, hip and wrist.

Once made, bone is always changing. Old bone is removed in a process called resorption, and new bone is formed in a process called formation. From childhood until age 30 years, bone is formed faster than it is broken down. After age 30 years, the process begins to reverse: bone is broken down faster than it is made. Too much bone loss can result in osteoporosis.

With osteoporosis, bones become thin and brittle because more bone is lost than formed.

Osteoporosis can pose a special threat to women. Estrogen — a female hormone — protects against bone loss. As a woman nears menopause, her body produces less estrogen.

Some symptoms of osteoporosis are back pain or tenderness. Signs include a loss of height, and a slight curving of the upper back.

Osteoporosis affects at least 10 million Americans — most of whom are women. Each year, more than 1.5 million fractures related to osteoporosis occur in the United States. As many as 24 percent of patients older than 50 years with a hip fracture die in the year following their fracture from problems caused by lack of activity, such as blood clots and pneumonia.

Risk Factors 

Compared with men, women are more at risk of osteoporosis because their bones are smaller and lighter than men’s.

Prevention 

It is hard to grow new bone after it is lost, so prevention is important. To prevent osteoporosis, focus on building and keeping as much bone as you can.

Exercise

Exercise increases bone mass before menopause and slows bone loss after menopause. Active women have higher bone density than women who do not exercise.

Diet

Bone loss can increase if your diet is low in calcium. Calcium slows the rate of bone loss.

Good sources of calcium are dairy products, such as milk and yogurt. Other sources are leafy green vegetables, nuts, seafood, and juices and cereals that are fortified with calcium. A well-balanced diet is very healthy for bones.

Detection 

You should have a physical exam once a year. During this exam, you can be given special tests that show the density of bone.

Bone mineral density tests measure bone mass in the heel, spine, hip, hand or wrist. Measuring one area can give your doctor a sense of your bone density in other parts of your skeleton.

Dual-Energy X-ray Absorptiometry

Dual-energy X-ray absorptiometry (DXA) is used most often to measure the bone density of your spine or hip. It is currently the most accurate test available.

Quantitative Computed Tomography

Quantitative computed tomography (QCT) uses both computed tomography scanning and computer software to test the bone density of the spine.

Quantitative Ultrasonography

This test, which often takes less than one minute, uses sound waves instead of radiation to measure bone density.

Treatment 

There are many treatment options available to help reduce the risk of fracture.

Hormone Therapy

Hormone therapy slows bone loss after menopause. Estrogen has been shown to decrease the risk of hip fractures and spinal deformities. Estrogen also can relieve symptoms that occur around menopause, such as hot flushes (hot flashes).

Selective Estrogen Receptor Modulators

Women also can take a type of drug known as selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause.

SERMs may be a good choice for women who need protection from osteoporosis, but can’t or don’t want to take HT.

Bisphosphonates

If a woman does not take estrogen or SERMs, there is another option for preventing osteoporosis — bisphosphonates. These medications are used to slow bone breakdown.

Other Options

Another medication used to slow the breaking down of bone is called calcitonin. It can be given by injection or nasal spray.

Finally … To increase your chances of staying healthy, you have an important goal — to prevent bone loss. Exercise every day, even if you walk only a few blocks, and get enough calcium.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 2003 The American College of Obstetricians and Gynecologists

Menopause and Bladder Control

Does Menopause Affect Bladder Control?

Yes. Some women have bladder control problems after they stop having periods (menopause or change of life). If you are going through menopause, talk to your health care team.

After your periods end, your body stops making the female hormone estrogen. Estrogen controls how your body matures, your monthly periods, and body changes during pregnancy and breastfeeding.

Some scientists believe estrogen may help keep the lining of the bladder and urethra plump and healthy. They think that lack of estrogen could contribute to weakness of the bladder control muscles.

Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence. It is one of the most common kinds of bladder control problems in older women.

Recent studies have raised doubts about the benefits of taking estrogen after menopause. The studies also point to added risks from taking estrogen for many years. No studies have shown that taking estrogen improves bladder control in women who have gone through menopause. Your doctor can suggest many other possible treatments to improve bladder control.

What Else Causes Bladder Control Problems in Older Women?

Sometimes bladder control problems are caused by other medical conditions. These problems include:

Infections

Nerve damage from diabetes or stroke

Heart problems

Medicines

Feeling depressed

Difficulty walking or moving

A very common kind of bladder control problem for older women is urge incontinence. This means the bladder muscles squeeze at the wrong time — or all the time — and cause leaks.

If you have this problem, your health care team can help you retrain yourself to go to the toilet on a schedule.

What Should You Do About Bladder Control After Menopause?

Talk to your health care team. You may have stress or urge incontinence, but other things also could be happening.

Medicines and exercises can restore bladder control in many cases. Your doctor will give you a checkup first.

What Treatments Can Help You Regain Bladder Control?

It depends on what kind of bladder control problem you have. Your health care team also may recommend some of the following:

Limiting caffeine

Exercising pelvic muscles

Training the bladder to hold more urine

If these simple treatments do not work, your health care team may have you try something different. These treatments might include:

Biofeedback

Electrical stimulation of pelvic muscles

A device inserted in the vagina to hold up the bladder

A device inserted directly into the urethra to block leakage

Surgery to lift a sagging bladder into a better position

What Professionals Can Help You With Bladder Control?

Professionals who can help you with bladder control include:

Your primary care doctor

A gynecologist: a women’s doctor

A urogynecologist: an expert in women’s bladder problems

A urologist: an expert in bladder problems

A nurse or nurse practitioner

A physical therapist

________________

Additional Resource National Kidney and Urologic Diseases Information Clearinghouse

National Institute of Diabetes and Digestive and Kidney Diseases

3 Information Way

Bethesda, MD 20892-3580

E-mail: nkudic@info.niddk.nih.gov

Updated: April 2004

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

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The Menopause Years

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or “around menopause.” Menopause marks the end of the reproductive years that began in puberty.

The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward.

What Is Menopause?

Estrogen and Menstrual Changes

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier.

At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when the menstrual periods stop.

What to Expect Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body.

Hot Flushes

The most common symptom of menopause is hot flushes (hot flashes). As many as 75 percent of menopausal women in the United States will have them. A hot flush is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat.

Sleep Problems

Hot flushes can cause a lack of sleep, often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause.

Vaginal and Urinary Tract Changes

Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.

Bone and Other Body Changes

Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Osteoporosis, a result of this bone loss, increases the risk of breaking bones in older women. The bones of the hip, wrist and spine are affected most often.

Emotional Changes

Menopause does not cause sudden mood swings or depression. However, the change in hormone levels may make you feel nervous, irritable, or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep.

Sexuality 

Menopause does not have to affect your ability to enjoy sex. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable.

Regular sex may help the vagina keep its natural elasticity.

Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive.

You are not completely free of the risk of pregnancy until one year after your last period.

The Gynecologic Visit 

Routine visits to your doctor for breast, pelvic, and rectal exams are recommended for all women. Your doctor will do a Pap test to check for cancer of the cervix. Between visits you should perform a breast self-exam once a month.

Depending on your age, your doctor may recommend that you have a mammogram. (Women older than 40 years should have a mammogram every one to two years, and then every year beginning at age 50 years.)

Hormone Therapy Hormone therapy (HT) can help relieve the symptoms of menopause. It replaces female hormones no longer made by the ovaries. Depending on your situation, you may begin HT before menopause. If you are taking birth control pills, they will be stopped when you begin treatment.

Benefits

Many of the symptoms of menopause can be eased by taking estrogen.

Risks

Like any treatment, hormone therapy is not free of risk. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking a progestin will help reduce the risk of uterine problems. The drawback of using a progestin is that menopausal women may start bleeding again.

There is an increased risk of breast cancer in women who use combined hormone therapy.

Other Therapies 

Women also can take selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause. SERMs are a type of medication that strengthen tissues of the bones.

If a woman does not take hormone therapy or SERMs, there are some other options for preventing bone loss. A medication called calcitonin slows the breaking down of bone. Other medications used to slow bone breakdown are bisphosphonates.

Staying Healthy

Good Nutrition

Eating a balanced diet will help you stay healthy before, during, and after menopause. It’s important to eat a variety of foods to make sure you get all the essential nutrients. Choose a low-fat, low-cholesterol diet. Also, be sure to include enough calcium in your diet to help maintain strong bones.

Exercise

Exercise is very important, especially as you get older. Regular exercise slows down bone loss and improves your overall health. Follow a program of regular weight-bearing exercise, such as walking and aerobics.

Finally … Menopause is a natural event. Today, women can expect to live one third of their lives after menopause. The physical changes that occur around menopause should not prevent you from enjoying this time of your life.

_________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 2003 The American College of Obstetricians and Gynecologists

Midlife Transitions: A Guide to Approaching Menopause

Midlife often is called “the prime of life,” and research suggests it really is. At midlife, middle age abound.

What is true is that midlife is a busy time, full of changes.

Your body changes at midlife, too. Around your mid-40s, you enter a transition phase called perimenopause. It is a time of gradual change leading up to and following menopause. In general, perimenopause extends from age 45 years to age 55 years, although the timing varies among women. During this time, the ovaries produce less estrogen.

Menopause is sometimes called “the change of life.” It marks the end of menstrual periods and of your childbearing years. On average, the age at which American women have their last menstrual period is 51 years.

Perimenopause and menopause are natural events.

Symptoms and Effects Some women compare perimenopause to puberty — another time when you have to adjust to big changes. These changes may make you feel unlike your usual self. Many changes of perimenopause are related to a decrease in estrogen levels. Some are related to aging.

Menstruation

In your 40s, increasing and decreasing hormone levels can cause changes in your menstrual cycle. These changes can be erratic.

Although changes in bleeding are normal as you near menopause, they still should be reported to your doctor. Abnormal bleeding can sometimes be a sign of other problems.

Hot Flushes

As you approach menopause, you may start having hot flushes (also known as hot flashes). About 75 percent to 85 percent of perimenopausal women get them. These flushes are the most common symptom of perimenopause.

A hot flush is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You may break out in a sweat. A hot flush may last from a few seconds to several minutes or longer.

Hot flushes can happen anytime — day or night. Those occurring during sleep, called night sweats, may wake you up and leave you tired and sluggish the next day. Even though hot flushes are a nuisance, are sometimes embarrassing, and may interfere with daily life, they are not harmful.

Sleep Problems

Perimenopausal women may have to deal with sleep problems. Night sweats may disrupt your rest. You may have insomnia (trouble falling asleep), or you may be awake long before your usual time.

Vaginal and Urinary Changes

As your estrogen levels decrease, changes take place in the vagina. Over time, the vaginal lining gets thin, dryer and less flexible. Some women have vaginal burning and itching. The vagina also takes longer to become moist during sex. This may cause pain during sex. Vaginal infections also may occur more often.

Bones

Once made, bone is always changing. Old bone is removed in a process called resorption, and new bone is formed in a process called formation. From childhood until age 30 years, bone is formed faster than it is broken down. After age 30 years, the process begins to reverse: bone is broken down faster than it is made. However, bone loss that happens too fast can result in osteoporosis. Osteoporosis causes bones to become too thin and weak.

To prevent osteoporosis, you should focus on building and keeping as much bone as you can before menopause. You can do that by getting plenty of calcium and exercise.

Cardiovascular Disease

Heart disease kills more women than any other cause of death. After menopause, a woman’s risk of heart disease and stroke increases. Women who have not reached menopause have a far lower risk of cardiovascular disease than men. The estrogen produced by women’s ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.

Sexuality 

Sexuality is an important part of life. Sex can give you a feeling of well-being and bring you closer to your partner.

Sexual Changes in Women

Your sex drive and sexual response may change in the perimenopausal years or beyond. As you age, sexual arousal takes longer. It’s important to talk with your partner about what you’re feeling and what excites you. You may need to spend more time on foreplay or try new positions.

When estrogen levels are low, vaginal tissue gets thinner and dryer. This may cause discomfort during intercourse. Water-soluble lubricants sold over-the-counter can help moisten the vagina.

Some postmenopausal women enjoy sex less than they used to because they feel self-conscious about wrinkles and other signs of aging. However, many women say their sex lives are better after menopause.

Sexual Changes in Men

Men take longer to get aroused as they age, just as women do. Their erections may become less rigid, as well. This is normal and should not affect sexual satisfaction.

Emotional Concerns 

The constant change of hormone levels during perimenopause can effect a woman’s emotions. Some women have mood swings, memory lapses and poor concentration. Some may feel irritable or are depressed.

Lifestyle Changes 

Losses, new demands and changes in routines are common at midlife. Your children may be entering their teen years — a time of challenges.

Today, many women wait to start a family until they are around 40 years of age. Becoming a new mother at midlife — no matter how joyful an event — is a big adjustment.

Women who have not had children or never married also face changes of midlife.

Despite these challenges, midlife often is still a rewarding phase of life.

How to Cope 

The best thing you can do to get through midlife’s rough spots is reach out for help. Talking with others is reassuring. If you open up to a friend, you may find she is facing the same fears and stresses.

If you are bothered by unsteady emotions or mental lapses, talk to your doctor.

Hormone Therapy 

A major decision facing you as you enter menopause is whether to take HT. For many women it is a confusing issue.

What Is Hormone Therapy?

With HT, you are given estrogen to replace the estrogen your body is no longer making. If you have never had a hysterectomy and, therefore, still have a uterus, you normally are given progestin, as well. This helps reduce the risk of cancer of the lining of the uterus that occurs when estrogen is used alone.

Estrogen often is prescribed as a pill you take daily or a patch you wear on your skin. Estrogen also is available as a vaginal ring.

Oral contraceptives (birth control pills) also contain estrogen and progestin, but in higher doses. During perimenopause, oral contraceptives offer birth control and help regulate the menstrual cycle. They may be used during perimenopause before HT.

Benefits of Hormone Therapy

One benefit of HT that women are likely to notice right away is the relief from symptoms. For about 98 percent of women who take estrogen, hot flushes are relieved. Estrogen also treats vaginal dryness and irritation. Women who take estrogen have fewer urinary problems, such as infection and incontinence.

Hormone therapy also has been shown to help keep bones strong, which helps prevent osteoporosis. However, it only protects bones for as long as you use it.

Risks and Side Effects

As with any treatment, HT is not risk free. Estrogen therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer. However, adding progestin lowers the risk of uterine cancer to less than that in women who do not take HT.

In women who take HT, spotty bleeding may occur. Some women even get heavier bleeding like that of a menstrual period.

There is an increased risk of breast cancer in women who use combined hormone therapy. The increase appears to be small, but increases depending on how long a women takes hormone therapy. Hormone therapy also modestly increases the risk of heart attack, stroke and blood clots.

A Healthy Lifestyle Women in their 30s and 40s can make key lifestyle changes to lower their risk of health problems when they get older. Perimenopause is a good time to pay attention to your health if you haven’t been doing so all along.

Eat a Healthy Diet

Eating a healthy diet will help you look and feel better. It also will lower your risk of osteoporosis and heart disease.

Exercise

Making exercise a part of your life can pay off in many ways. Exercise can help you lose weight and keep it off. Aerobic exercises help protect against heart disease and diabetes, and weight-bearing exercises help prevent osteoporosis.

In short, exercise makes you look and feel better.

To get a good cardiovascular workout, you need to exercise at your target heart rate for 30 minutes or more most days of the week.

Maintain a Healthy Weight

Weight gain is not so much a result of meno-pause as of middle age. About one in four women aged 35 to 64 years is overweight. Metabolism slows as you age, so your body takes longer to burn up the food you eat. Women have about 25 percent body fat, compared with 15 percent for men. This extra fat makes it easier for women to gain weight and harder to lose it.

In general, it’s best not to exceed weight guidelines for your height.

Don’t Smoke

Women who smoke shorten their lives by five to eight years. They also increase their risk of osteoporosis. Smoking doubles the risk of heart disease and cancer of the cervix and vulva in women, and multiplies the risk of lung cancer 12 times. Even the children of smokers can be affected by being exposed to secondhand smoke.

Limit Alcohol Intake

Drinking alcohol poses special concerns for women. A woman who drinks the same amount as a man is affected more. This is because her body contains less water to dilute the alcohol and her stomach has less of the key enzyme that digests it. When you drink, the alcohol slows your reflexes and affects your judgment and memory. One important reason why perimenopausal women should watch their drinking is that alcohol interferes with bone growth and calcium absorption.

Get Regular Health Care

Routine health care, even if you’re not sick, can help detect problems early. It also gives you and your doctor a chance to talk about ways to avoid problems later in life.

Do Self-Exams

Throughout the year, there are exams you can do yourself to find possible problems early. One of these is the breast self-exam. Being familiar with the usual ridges and bumps in your breasts may make it easier for you to notice any changes.

Checking your entire body for skin changes also is a good idea.

Use Birth Control

Although your menstrual periods may become erratic as you get closer to menopause, pregnancy is still possible. Even having other signs of perimenopause, such as hot flushes, does not mean you can’t get pregnant. About 75 percent of pregnancies in women older than 40 years are unplanned.

Get Preconceptional Counseling

If you are planning a pregnancy late in your childbearing years, be aware that the risk of problems increases with the woman’s age. A woman younger than age 50 years should take 0.4 mg of folic acid daily if she is planning a pregnancy. It’s also important to receive preconceptional counseling.

Having a first child near or after age 40 years is not rare. Women who get pregnant in their 40s can have safe pregnancies and healthy babies.

Practice Safer Sex

Everyone who is sexually active is at risk of getting an STD. Some STDs, such as syphilis or chlamydia, usually can be cured. Others have no known cure. Among these is acquired immunodeficiency syndrome (AIDS), a life-threatening disease caused by human immunodeficiency virus (HIV).

The best protection from STDs is for a couple to have sex only with each other.

Finally … There was a time when no one talked about menopause; it was a mystery to most women. Today, you can find a wealth of information on the topic. Talk with your doctor and learn as much as you can. That way, you can look ahead to the next stage of life with confidence.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © October 2003 The American College of Obstetricians and Gynecologists

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