When midlife women move beyond menopause into postmenopause, they may experience changes due to aging that may - or may not - be related to declining hormone levels. These changes include serious health conditions such as heart disease, osteoporosis and cancer. Risks for developing these are best determined as early as possible, so that preventive strategies can be employed. As long as any menopausal symptoms persist, a woman is still technically "in menopause" until they subside. This may require the use of hormones.
Heart disease is the number-one killer of women in North America. After age 50, nearly half of all deaths in women are caused by some form of cardiovascular disease. Nearly twice as many women die from heart disease as die from breast cancer; it is speculated that estrogen protects women from heart disease. While a man's risk of heart disease starts to increase significantly after age 45, women begin to be more at risk after menopause, when estrogen levels fall.
The higher the risk of heart disease, the more aggressive the prevention strategy should be. Outside the heart, diseased blood vessels can cause adverse conditions such as stroke, high blood pressure or poor circulation, which in turn can lead to difficulty walking and even to loss of limbs. While some risk factors cannot be changed, others can be controlled or modified to create a more heart-healthy lifestyle.
Postmenopausal osteoporosis is a disease in which the bone mineral content of the skeleton gradually decreases with age until the bone has become fragile and susceptible to fractures. In most women, bone loss accelerates during the first few years after menopause, which is related to the decline in estrogen levels that occurs at that time. Adequate estrogen reduces bone breakdown while adequate progesterone encourages new bone growth. The overall effect of both is to reduce bone loss. Other therapies exist to actually increase bone density after menopause, not just slow the rate of loss.
Since osteoporosis has no early warning signs, it is not usually detected until it has become advanced. Prolonged and severe pain in the middle of the back and tooth loss are two possible indicators of underlying bone loss. Other signs are changes in the shape of the spine and loss of height. While it is normal to lose some height while aging, most experts agree that a loss of two inches or more is cause for concern. Standard X-rays are not sensitive enough to reveal osteoporosis until a considerable amount of bone has already been lost.
Menopause is not associated with an increased risk of cancer. However, since cancer rates typically increase with age, women should be aware of the most common cancers that affect women. In addition, some of the therapies used for menopause are associated with an increase or a decrease in the incidence of certain types of cancer.
Breast Cancer. This is perhaps the cancer that women fear most, with nearly half of all cases occurring in women aged 65 years and older. This fear comes not only from the possibility of dying from the disease, but also from the rigorous demands of treatment and the probability of cancer recurrence. Progesterone use should reduce the risk of breast cancer. The use of naturally-occurring estrogens along with progesterone should pose little risk; most natural doctors advise against the use of synthetic hormones. Early detection of breast cancer is important in ensuring a better outcome.
Endometrial (Uterine) Cancer. Using synthetic estrogens without a progesterone, also called "unopposed ERT", over a period of three or more years has been associated with a marked increase in endometrial cancer.
Cervical Cancer. The death rate from cervical cancer has dropped sharply in the United States and Canada, but it remains a serious concern. Today, 25% of all new cases and more than 40% of all deaths from cervical cancer occur in US women over age 60. If diagnosed early, cervical cancer is highly treatable with a five-year survival rate of 91%. Cervical cancer is now understood to be caused by the human papilloma virus (HPV).
Having a regular Pap smear test will usually allow for the early discovery of abnormal changes. Despite the importance of the Pap test, about 50% of US women diagnosed with cervical cancer have never had one. While A Pap test reliably detects cervical cancer, it cannot be relied on to detect cancer of the uterus.
Ovarian Cancer. Representing only about 4% of all cancers, ovarian cancer causes more deaths than any other cancer of the reproductive system, mainly because it is usually only detected at an advanced and less curable stage. When ovarian cancer is detected early, 95% of women survive at least five years.
Lung Cancer. Today, lung cancer is the leading cause of cancer death in North American women, surpassing the long-time leader, breast cancer. The number of newly diagnosed cases continues to rise. These alarming statistics parallel the increasing numbers of women who smoke cigarettes, by far the most important risk factor in developing this disease. Nonsmokers' exposure to second-hand tobacco smoke also poses health risks. One study reports that the risk of lung cancer is approximately 30% higher for wives of smokers than for wives of nonsmokers.
Colon & Rectal Cancer. After lung and breast cancer, colorectal cancer is the next most common cause of cancer death in US women. Colorectal cancer is not associated with menopause but with age; its incidence is six times higher in women aged 65 years and older compared with women aged 40-64 years.