health after menopause

Many of my patients who have gone through menopause have asked if they might benefit from Hormone Replacement Therapy (HRT). Like menopause itself, treatment for its symptoms is highly individualized. Most women go through menopause over the course of four years, typically beginning between the ages of 45 and 55.

Menopause is similar to puberty in that hormone levels change rapidly in a short period of time. As the ovaries stop producing estrogen, progesterone and testosterone, it can take a while for your body and brain to adjust to these changes. However, even on the other side of menopause, symptoms can persist, including hot flashes, vaginal dryness and other quality-of-life issues.

Initially, it was believed that when used long-term, HRT was safe for addressing nearly all of the negative effects of menopause: from cardiovascular disease risk to bone health to mood swings. One of the most well-known studies of HRT was conducted more than 20 years ago. The study, known as the Women’s Health Initiative, sponsored by the National Institutes of Health, published its findings in the Journal of the American Medical Association in the summer of 2002. The results were shocking: women in the study taking HRT showed an increased risk of developing heart disease and breast cancer. The media frenzy at the time led many women to discontinue their HRT regimens. However, a key blind spot in the study was the age group of the participants: the average age was 63 years, which is, on average, 12 years past menopause.

Recommendations regarding the use of HRT have shifted over the past decade. Based on current guidelines, HRT is deemed safe for women in early menopause who don’t have a history of heart disease, blood clots, stroke or cancer. The U.S. Food and Drug Administration has approved HRT to treat hot flashes, prevent bone loss, treat vaginal dryness and vaginal atrophy, and treat premature low estrogen levels. It is generally not recommended for women over 60; in November 2022, the U.S. Preventive Services Task Force recommended against the use of hormone therapy to prevent chronic health problems, such as cardiovascular disease, osteoporosis and cancer in postmenopausal women.

Based on your medical and family history and other risk factors, your physician can help you determine what treatment options are best for you. Outside of specific treatments, there are a few ways women can protect their health after menopause:

• Bone density screenings: All women 65 and over should undergo this screening to assess their risk for osteoporosis and bone fractures. Your primary care provider, OB-GYN or endocrinologist can order this test for you.
• Cardiovascular exercise and strength training: As we age, our bodies gradually lose muscle mass, which can cause injury and eventual disability. While aerobic exercise, such as jogging or swimming, is important for heart disease and weight management, adding resistance training to your routine helps maintain lean muscle mass and bone density. Even 10 minutes a day of body weight exercises, such as yoga, can yield benefits.
• Improve your insulin sensitivity: After menopause, women tend to develop insulin resistance. The body has to work harder to digest carbohydrates. A good rule of thumb is to keep your breakfast below 20 grams of carbs to prevent a significant insulin spike in the morning and keep your body in fat-burning mode. Intermittent fasting, or eating your meals within a limited, typically eight-hour window, then fasting for 16 hours, can also help keep insulin levels in check.

Finally, one of the most important pieces of advice I can offer to women is to give yourself grace. As women, we tend to be very hard on ourselves. It can be helpful to speak to a mental health professional if you are experiencing emotional challenges on top of physical discomfort.

{White Plains Hospital}

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