A New Perspective of Women at Midlife
Vanessa Barnabei, MD, PhD
Medical College of Wisconsin Obstetrician and Gynecologist;
Director, Total Health for Midlife Women Program
Currently, about 43 million women are between the ages of 40 and 60. This middle phase of life is often a time when women begin seriously considering their own health concerns. Dr. Vanessa Barnabei discusses these issues and what women can do to live longer, healthier lives.
Q. What are the main health concerns for women as they get older?
After women go through menopause, their ovaries stop producing estrogen. This lack of estrogen often leads to a decrease in bone density and sometimes to osteoporosis. Bones becomes less dense and weaker, making fractures more likely. Osteoporosis can also be life-threatening. Many people don't realize that something like a hip fracture can significantly impact quantity and quality of life. The rate of death following a hip fracture for an elderly woman is 50 percent. A third to a half of all women will have a clinically significant fracture of some type in their lifetime, which can lead to chronic disability.
Premenopausal levels of estrogen may help protect women against coronary artery disease. But after menopause, changes such as an increase in cholesterol levels increase the risk for cardiovascular disease. Women often think their greatest health concern is breast cancer, but they are more likely to die of heart disease. In fact, heart disease will kill more women than any other disease. After menopause, the risk rises dramatically and will continue to rise as a woman gets older. Men are at a higher risk beginning in their 50s. Women don't hit that same risk level until their 60s. But by age 70, the risk is similar for men and women.
Q. What can women do to avoid these diseases?
Not smoking, increasing exercise – especially weight-bearing exercise – and eating a healthy diet are things women can do to not only help them avoid osteoporosis and heart disease, but just about every other health risk.
Women should work with their doctors to screen for signs of early bone loss and pursue methods to prevent further bone loss. Lifestyle changes can help, and there are medications that can slow down or even reverse bone loss. Additionally, all women need an adequate calcium intake - about 1,200 to 1,500 milligrams a day – and that may require them to take supplements.
Women can lower their risk of developing cardiovascular disease by getting high blood pressure under control and losing excessive weight. Overweight is a strong risk factor for developing diabetes, and diabetes is a huge factor for developing heart disease. Managing elevated cholesterol levels is also important. Current medications are very effective in lowering cholesterol levels and may decrease the risk of heart attack and stroke.
Q. Until recently, it was believed that hormone therapy protected women against heart disease and osteoporosis, but now the therapy has become controversial. Under what circumstances would a woman consider hormone therapy?
Issues about hormone therapy result from the Women’s Health Initiative study that found estrogen-plus-progestin therapy increased the risk of heart attack, stroke, blood clots and breast cancer. The study’s examination of estrogen alone showed no difference in risk for heart attack and breast cancer, although there was an increased risk for stroke and blood clots. Both studies, however, found a reduced risk of fractures and both focused only on postmenopausal women. This tells us additional studies are needed. There are many unanswered questions, such as what effect hormone therapy has on women in the earlier stages of menopause.
A woman must make a decision concerning the use of hormone therapy on her own with her doctor’s advice and current prescribing guidelines. Risks and benefits must be weighed, but the symptoms of menopause – hot flashes, mood changes, sleep quality, fuzzy-headedness – can make a lot of women absolutely miserable. If a woman is having significant quality of life issues, hormone therapy is something she might want to consider.
Q. What about alternative methods for treating the symptoms of menopause?
There are not many alternatives and they don't work all that well. The most effective alternative is the selective serotonin reuptake inhibitor (or SSRI) group of antidepressants. These are taken at much lower doses than what is prescribed to treat depression. Women respond to SSRIs because it appears that the same chemical in the brain that is responsible for depression also plays a role in causing menopausal symptoms. But many women feel there is a stigma attached to taking an antidepressant and, although fewer than with hormones, there may be side effects.
Studies have found that most over-the-counter herbal supplements are of little value. But lifestyle changes can help. Increasing exercise, watching diet, dressing appropriately, minimizing stress and avoiding hot and spicy foods, alcohol and caffeine can all help women better deal with the symptoms of menopause.
One-on-One Support for Women at Midlife
The Total Health for Midlife Women Program at Froedtert & Medical College of Wisconsin helps women deal with the physical and emotional changes that can occur during their middle years. In the program's one-on-one sessions with knowledgeable health care professionals, a woman can discuss issues from controlling weight to handling stress or managing symptoms of menopause. "We want the program to be an enhancement to care provided by the woman's own doctor," according to Marlys Swanson, RN, BSN.
Swanson says a typical session includes a thorough health assessment. She'll go through the woman's medical history and discuss a range of subjects including diet, exercise, stress and anxiety, and personal habits, such as smoking and alcohol use.
Although geared toward women between the ages of 40 - 60, women of all ages are welcome to participate. To make an appointment, call 414-805-3666 or 800-272-3666 and ask for the Total Health for Midlife Women Program.