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Blog: MenoPause ~ take time to think about it

  • Experts do agree: hormone therapy for treatment of symptoms at menopause gets thumbs up

    by Margery Gass | Sep 04, 2012
    It’s been 10 years since research put the brakes on the combination hormone therapy segment of the Women’s Health Initiative (WHI) study because the risks looked worse than the benefits. After that, many women and clinicians abandoned hormone therapy completely. NAMS and 14 other top medical organizations came together to cut through the confusion and tell women and their clinicians that hormone therapy is still an acceptable treatment—and a relatively safe one—for menopause symptoms at the time of menopause. It just should not be used indefinitely for the purpose of preventing chronic diseases.

    These are the major points the experts do agree on:

    • Hormone therapy is okay for relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopause symptoms. You and your clinician need to weigh your individual risks and benefits.
    • If you still have a uterus, you need to take progesterone or a similar product along with estrogen to prevent cancer of the uterus. If you no longer have a uterus, you can take estrogen alone. If you are taking a low-dose vaginal form of estrogen, you will probably not need to take progesterone, but be sure to report any bleeding.
    • Both estrogen alone and combination therapy increase the risk of blood clots and stroke, but the risk is rare in women ages 50-59.
    • The risk of breast cancer goes up a small amount with 3-5 years of combination estrogen/progesterone therapy and decreases after hormone therapy is stopped.
    • If vaginal dryness or discomfort with intercourse is your only symptom and lubricants do not solve the problem, then the best treatment for you may be low-dose vaginal estrogen, but check with your provider.
    Go comment!
  • The jury is still out on calcium supplements

    by Margery Gass | Aug 16, 2012

    Recently, women trying to keep their bones healthy by taking calcium supplements got what seemed like bad news. Last May, a widely reported study linked calcium supplements with an increased risk of heart attack. Then in June, the US Preventive Services Task Force (USPSTF) put out a draft recommendation on calcium and vitamin D supplements that did not send a positive message. Women started calling their menopause practitioners asking if they should stop taking their supplements. But only days later, another widely publicized study concluded that calcium and vitamin D supplementation cut the risk of death.

    So who’s right? Well, maybe that’s the wrong question because, even though these events made big news, we can’t draw firm conclusions yet. So don’t stop taking your calcium supplement just yet. Perhaps take a cue from the conclusion that the National Osteoporosis Foundation drew from this and much more research—that you try to meet your daily calcium needs through diet first and take a calcium supplement if you aren’t getting enough.

    1 Comment
  • Chalk up another aspirin benefit?

    by Margery Gass | Aug 13, 2012
    Taking a daily aspirin helps reduce your risk of dying from cancer, especially from cancers of the gastrointestinal tract, shows a new study from the American Cancer Society. But the 15% reduction this study found is a much more modest figure than the 37% in a study that made a big news splash last March. Still, it’s good news for women who are 65 and older who have been advised to take an aspirin a day for their cardiovascular health. Some younger women who already have cardiovascular disease or who are at high risk also fall into this category.

    Does this good news mean everybody should start taking an aspirin a day? No, aspirin is a medication that also has side effects that need to be considered. It can cause stomach irritation, bleeding from the stomach that can lead to anemia, ringing in the ears, stroke, and other undesirable effects.  So if you’re younger than 65 and are interested in using aspirin for cancer prevention, talk first with your clinician to weigh the benefits and the risks.
    Go comment!
  • A toast to your bone health?

    by Margery Gass | Aug 08, 2012
    Do you enjoy an occasional glass of wine with dinner or a nightcap? Your moderate drinking may benefit your bones. Recent research in Menopause shows that moderate drinking (1-2 drinks/day) increases bone mineral density by slowing bone loss a bit in menopausal women.

    But do alcohol and menopause really mix? You’ve probably heard that moderate drinking is good for your heart. But you’ve probably also heard that it’s a danger for breast cancer and that it might trigger hot flashes. There is a balance of risks and benefits that you will have to consider before ordering that drink.

    The most important thing is how much you drink. The benefits come with moderate—big emphasis on moderate—drinking. Heavy drinking can actually lead to osteoporosis that cannot be reversed. It’s also a risk for fractures.

    If you drink alcohol, enjoy yourself, but make sure your drinking is light to moderate.

    Go comment!
  • Your midlife health care just got more affordable

    by Margery Gass | Aug 07, 2012
    On August 2, 2012, portions of the Affordable Care Act kicked in that mean most women will not have to pay out of pocket for services such as:

    • Annual well-women visits, including routine breast and pelvic exams and Pap tests
    • Birth control and prenatal care – don’t dismiss it too quickly – it is still possible for women to get pregnant around the time of menopause. That is why you should not consider yourself protected from pregnancy until you are one year past your last menstrual period with no bleeding since that last period.
    • Interpersonal and domestic violence screening and counseling
    • HIV screening and counseling 
    • Counseling for sexually active women about sexually transmitted infections – yes, even after menopause it is possible to become infected by a partner who is carrying an infection. Some couples in a new relationship agree that both will be tested for sexual infections before becoming intimate.
    Other important benefits for you are in effect already, including no out-of-pocket costs for mammograms if you’re over 40 and screenings for osteoporosis if you are over age 60 (most guidelines suggest screening after age 65). Midlife is a great time to talk with your provider about how to stay healthy for the rest of your life.

    Go comment!
  • It’s your appointment. How can you get the most out of it?

    by Margery Gass | Jul 30, 2012
    According to a 2012 survey, 77 percent of women having menopausal symptoms have not had a conversation with their healthcare provider about their symptoms. So be your own best advocate and bring up your concerns at your next visit. It’s your appointment, and this is your opportunity to have your issues addressed one-on-one with your healthcare provider. Here are some tips to help you get the most out of your appointment:

    • Make a list. Take a list of questions to your appointment with the most important item at the top. 
    • Don’t be shy. If you’re concerned about a sexual topic, don’t hesitate to bring it up. Sexual concerns are common at menopause. Your healthcare provider is there to help.
    • Take notes. Or ask for printed material or other resources that could help you at home. 
    • Inform your provider. Be sure to tell your provider if you are taking over-the-countermedications, supplements, herbs, or other products so that drug interactions can be avoided.
    • State your preferences. Some women prefer prescription medications, others prefer lifestyle and behavior changes to reduce symptoms. It helps your provider to know what your healthcare priorities are.
    • Ask questions. Query your provider about what you should be doing to be your healthiest.
    Go comment!
  • Low-risk women can skip the treadmill stress test

    by Margery Gass | Jul 30, 2012
    Thinking about starting an exercise program? You don’t have to have an electrocardiogram (ECG) or a treadmill stress test if you’re not at risk of heart disease and you don’t have symptoms, such as shortness of breath or chest pains, according to an expert US government panel. Late in July, the US Preventive Services Task Force (USPSTF) issued a recommendation against routine ECG testing. 

    “At risk” is the key. If you have high blood pressure or diabetes, for example, the American College of Cardiology and the American Heart Association say that an ECG may be reasonable, even if you don’t have symptoms. They also say it may be appropriate for women with intermediate heart disease risk and no symptoms who want to start a vigorous, high-impact exercise program.

    If you are unsure about your risk for heart disease, check with your provider.

    Go comment!

MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

Margery L.S. Gass, MD, NCMP
NAMS Executive Director

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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