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
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.
Osteoporosis
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.
Cancer
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.
Conditions that suggest Postmenopausal Status / Issues
Being postmenopausal
Counter Indicators
Being/being pre/being peri menopausal
Risk factors for Postmenopausal Status / Issues
Total/radical/partial hysterectomy or hysterectomy with one ovary or hysterectomy with both ovaries
When the uterus has been removed, you should experience no more periods. When both ovaries are removed, the levels of estrogen in the body drop dramatically and women usually experience symptoms of “surgical menopause” within a few days of surgery.
Postmenopausal Status / Issues suggests the following may be present
Recommendations for Postmenopausal Status / Issues
Reading List
Suzanne Somers has brought bioidentical hormones onto center stage. In her book, The Sexy Years, she describes how bioidentical hormones relieved her menopause symptoms. She also makes it clear that she intends to stay on them for the rest of her life.
Essential Fatty Acids
Researchers have found postmenopausal women who supplement their diets with flaxseed, as opposed to soy, have a greater chance of reducing their risk of osteoporosis and hormone-sensitive cancers. [American Journal of Clinical Nutrition February, 2004;79(2): pp.318-325]
Key
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| Likely to help |
Glossary
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Postmenopause
The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cardiovascular
Pertaining to the heart and blood vessels.
Estrogen
One of the female sex hormones produced by the ovaries.
Stroke
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Virus
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Pap Test
Papanicolaou test. Microscopic examination of cells collected from the vagina and cervix to test for uterine cancer or dysplasia.
Colon
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Colorectal Cancer
A cancerous tumor of the large intestine. It is marked by dark, sticky stools containing blood and a change in bowel habits.