domingo, 21 de abril de 2013

Menopause: Time for a Change | National Institute on Aging

Menopause: Time for a Change | National Institute on Aging


Postmenopausal Health Concerns

How will you feel when you are several years past your last period? Most of your menopausal symptoms are likely to have disappeared. Some, like vaginal dryness, may be an ongoing problem. And for a few women, hot flashes and night sweats continue.
Some other health problems important for women to know about are:
  • Osteoporosis
  • Cardiovascular disease
  • Urinary incontinence


'Normal Bone' shows a dense network of fibers; 'Bone with Osteoporosis' shows very sparse, disconnected fibers
Normal Bone and Bone with Osteoporosis
(click to view)
Osteoporosis is a condition in which bones become very weak and can break easily. Often, the first sign of osteoporosis is a bone that cracks, sometimes after just straining or twisting. Bone is constantly changing, removing old bone and adding new bone. Because estrogen plays an important part in building new bone, the decline in estrogen starting with menopause leaves many older women at risk for developing osteoporosis.
In fact, half of American women over the age of 50 will probably have a bone break or fracture later in life because of osteoporosis. For too many, the broken bone, especially if it is a hip fracture, will mean they can no longer live independently. Broken bones because of osteoporosis are also common in the wrist and spine. Breaks in bones of the spine (vertebrae) are especially serious as this can lead to curvature of the spine, loss of height, and pain. A broken hip or wrist is often the result of a fall, but for a woman with osteoporosis in her spine, bending over or coughing strongly can be enough to cause a broken vertebra.
Some women are more at risk of developing osteoporosis than others. Risk factors, things that increase your chance of developing a health problem, include:
  • a family history of osteoporosis
  • a broken bone while an adult
  • surgery to remove both ovaries before natural menopause
  • early menopause
  • insufficient calcium throughout life
  • extended bed rest
  • smoking
  • long-term heavy drinking
  • using certain medicines, such as glucocorticoids or some anticonvulsants, for long periods of time
  • being thin or having a small body frame
If you have any of these risk factors or are concerned about the health of your bones, talk to your doctor about what you can do to protect them.
Recommendations for Women from the National
Academy of Sciences, 2010*
Calcium: 1,200 mg (milligrams)
  not more than 2,000 mg
Vitamin D: Age 51-70, 600 IU**
  not more than 2,000 IU
Age 70 and older, 800 IU
  not more than 4,000 IU
* Total recommendation—from food, drinks, and, if needed, supplements—each day.
**International units
There are steps you can take to prevent osteoporosis after menopause. The first step in preventing osteoporosis is to build as much bone density as possible by age thirty. After that age, some people may begin to lose bone strength. In women, bone loss picks up speed around the time of menopause and slows again a few years later. But bone loss continues into old age. So, if you have daughters or granddaughters, encourage them to exercise and get plenty of calcium and vitamin D while they are younger.
Keeping the bone strength you have at menopause is the next step in preventing osteoporosis. Exercise and a proper diet helped build bone early in life. Those same actions can help maintain its strength or slow its loss now. Regular weight-bearing exercise (such as walking, running, stair climbing, or using weights to exercise) at least three or four times a week can help keep your bones strong. Strengthening and balance exercises can help you avoid falls which could cause a broken bone.
You can also preserve bone density by eating foods rich in calcium and vitamin D or, if needed, taking calcium and vitamin D supplements. Foods high in calcium include milk and milk products (low-fat ones are probably best), canned fish with soft bones such as salmon, dark-green leafy vegetables, and foods with calcium added, like orange juice, bread, and cereals.
If you think you may not be getting enough calcium in your diet, talk with your doctor before trying a calcium supplement. But be careful. Too much calcium can also cause health problems.
Your body uses vitamin D to absorb calcium. Getting between 5 and 30 minutes of sunlight outdoors twice a week will help your body make the vitamin D it needs. But people over the age of 50, especially those who live in northern urban areas, may not be exposed to enough sunlight year round to make enough vitamin D. Cereals and milk fortified with vitamin D, as well as eggs and fatty fish, are good sources of this vitamin.
Lifestyle changes can also help protect your bones. If you smoke, preventing bone loss is yet another reason to stop. Women who smoke also seem to go through menopause about 1 1/2 to 2 years earlier than those who don’t smoke. And, if you drink alcoholic beverages, be careful how much you drink. Having too much alcohol might cause you to fall and break a bone in addition to other serious health problems.
person pitchforking hayHow will you know if exercise, diet, and lifestyle changes are protecting your bones? If you are over age 65 or if you are 60 to 64 and have any of the risk factors described earlier, don’t wait for a broken bone to find out if you have osteoporosis. Talk to your doctor about a bone density test, perhaps a DEXA-scan (dual-energy x-ray absorptiometry), to find out how solid your bones are. Two spots at high risk for fracture will probably be checked—hips and spine.
Sometimes exercise, diet, and lifestyle changes are not enough, and medicines are needed. Medications include bisphosphonates, raloxifene, estrogen, calcitonin, and parathyroid hormone. Some of these build up bone density. Others prevent further bone loss. Talk to your doctor to find out which would be best for you. Contact the National Institute of Arthritis and Musculoskeletal and Skin Diseases, listed in For More Information, to learn more.


Common cardiovascular diseases include a narrowing and hardening of the arteries (atherosclerosis), chest pain that happens when not enough blood is getting to the heart (angina), heart attack, and stroke. High blood pressure (hypertension) is a strong risk factor for cardiovascular disease and stroke.
Many women think, wrongly, that only men need to worry about cardiovascular disease. Heart disease and stroke affect women too. Women seem to be protected from these diseases until after menopause when this protection fades. While many women fear breast cancer, in fact heart disease kills 11 times more women every year. That is why it is so important for women to take steps to reduce their risk.
Make sure your blood cholesterol (a fatty substance in the blood), blood pressure, and blood sugar are at normal levels. Regular medical checkups will show whether your results are at normal levels (see chart below). If your blood pressure or blood sugar is too high, follow your doctor’s advice to control it. Uncontrolled blood pressure or blood sugar can also lead to heart disease, including a heart attack. Blood sugar that is too high also puts you at risk for diabetes, another strong risk factor for cardiovascular disease.
KNOW YOUR NUMBERS: The First Step to Heart Health
Factor Goal
Total Cholesterol Less than 200 mg/dL
LDL (“Bad”) Cholesterol Goals vary:
Less than 100 mg/dL, optimal
100 to 129 mg/dL, near optimal/ above optimal
130 to 159 mg/dL, borderline high
160 to 189 mg/dL, high
190 mg/dL and above, very high
HDL (“Good”) Cholesterol 50 mg/dL or higher for a woman
Triglycerides Less than 150 mg/dL
Blood Pressure Less than 120/80 mmHg
Fasting Glucose (Blood Sugar) Less than 100 mg/dL
Waist Measurement Less than 35” for women
Body Mass Index Less than 25 Kg/m2
Exercise Minimum of 30 minutes most, if not all days of the week
Reprinted with permission,, ©2007, American Heart Association, Inc.
person wearing scarf and mittens standing in the snowAround the time of menopause, total cholesterol, LDL (low-density lipoprotein) cholesterol, and triglyceride levels may go up, and your HDL (high-density lipoprotein —the so-called “good” cholesterol) level may go down. High levels of LDLs can, in time, lead to blocked arteries. In turn, blocked arteries can result in a heart attack or stroke. High triglycerides can be another sign that you are at risk for heart disease or diabetes. HDLs (think of H as in healthy) help keep your arteries clear, so that blood can flow freely. Get treatment for high LDL, cholesterol, and triglyceride levels to lower your risk of having a stroke or heart attack.
High triglycerides can also be a sign of metabolic syndrome, a group of conditions that put people at risk for heart disease and diabetes. These include obesity, low HDL level, high blood sugar, insulin resistance (a condition in which the muscle, fat, and liver cells do not properly use the insulin produced by the pancreas), and high blood pressure. Metabolic syndrome is also sometimes called syndrome X. If your doctor says you have metabolic syndrome or if he or she is worried that you might be at risk for it, consider changing your lifestyle.
At a regular checkup your doctor will look for five signs of metabolic syndrome:
  • Waist size greater than 35” in women
  • Blood pressure reading of 130/85 or higher
  • Fasting blood sugar of 100 mg/dL (milligrams/deciliter) or higher
  • High triglycerides (over 150 mg/dL)
  • Low HDLs (less than 50 mg/dL in women)
Having only one of these signs can put you at risk for heart disease or for diabetes. If you have at least three of these, you have metabolic syndrome. People with metabolic syndrome are now known to be at much greater risk of heart disease, stroke, and type 2 diabetes.
Lifestyle changes—not smoking, avoiding second-hand smoke, exercising, and following a healthy diet—can also help prevent heart disease. Not smoking or quitting, if you do, will also protect your bones and greatly lower your risk for cancer, especially lung cancer. Work with your doctor to set up a plan to lower your risk of heart disease.
Being physically active at least 30 minutes almost every day will help lower your risk of heart disease. You don’t have to be active all at one time. For example, try ten-minute intervals three times a day. Exercise should include endurance, also known as aerobic, activities—the kind that gets your heart pumping, like walking, running, swimming, tennis, or bike-riding.
If you are just beginning to exercise, start slowly. Maybe begin by taking the stairs whenever possible. First walk up one flight of stairs and then add more when you can. When shopping, don’t look for the closest parking space—choose one farther away from the stores to add more walking to your day. Or, don’t use the bus or subway to go one stop—walk instead. Almost anyone, at any age, can start being more physically active. You might check with your doctor if you aren’t used to energetic activity or you have a chronic health problem or a family history of early heart disease.
two ice skaters skating a figure eightHeart-healthy nutrition starts with less fat in your diet and more fruits, vegetables, and whole-grain foods. By using nonfat or lowfat dairy products, you can still get the calcium you need for your bones while taking care of your heart. Fruits and vegetables are generally low in unhealthy fats, unless fat is added during cooking.
Keeping a healthy weight will also help prevent heart disease. Exercise and a heart-healthy diet should help you do that. More than 30 minutes of moderate physical activity on most days are needed if you want to lose weight—experts recommend 60 minutes daily. Watching portion sizes when you eat is important. So is limiting added sugars, including drinks like sodas, juices, fruit drinks, and alcohol. And get enough sleep. Some studies show that women who get the least sleep gain the most weight.
These lifestyle changes—exercise, a heart-healthy diet, and weight control—will also help prevent or reverse metabolic syndrome. This, in turn, will lower your risk for heart disease, stroke, or type 2 diabetes—major causes of illness and death in older women.


Urinary problems such as frequent infections and urine leakage sometimes also develop at this time. While these changes are not unusual, they are not necessarily related to menopause. You should still see your doctor, who may be able to help you control any of these problems.
When women have problems controlling their bladder, especially as they grow older, that’s called urinary incontinence, and there are several types. If you have stress incontinence, you might leak urine when you sneeze, laugh, cough, or step off a curb. Overflow incontinence means there is a problem emptying the bladder, so you might leak urine because your bladder is always full. Urge incontinence means you can’t hold the urine until you get to the toilet. Somewhat similar is functional incontinence, in which you can’t get to the toilet in time because physical problems keep you from moving quickly.
Urinary incontinence is treatable—don’t try to ignore it or to just live with it. Many things cause urinary incontinence, including muscle weakness, nerve damage, or infection. Your doctor can decide on the cause and suggest the most effective treatment. This might include bladder control training, medicines, implants, or surgery. Contact the National Institute of Diabetes and Digestive and Kidney Diseases, listed in For More Information, to learn more.

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