Tag Archives: Osteoporosis

The Benefits of Daily Exercise after Menopause

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Women experience menopause with lost ovarian function due to aging or surgical removal. Loss of estrogen in the postmenopausal state affects the body in both obvious and subtle ways. Obvious effects are hot flushes, thinning hair and skin wrinkling, but there are many more silent harmful effects.

Early menopause contributes to osteoporosis. Gradual weakening of bones occurs without the estrogen stimulus to calcium metabolism and bone strength. Further bone loss may evolve to fractures and disability.

We also know the effectiveness of high-density-lipoprotein (HDL), the “good” blood fat, is reduced without estrogen effect. This transporter molecule is responsible for removing cholesterol buildup in arteries. HDL particles without the effect of estrogen are less efficient and the risk for heart attacks increases in women following menopause. Postmenopausal women can offset some of this effect by eating healthy and staying active. Statin medication to modify abnormal blood lipids may also be needed.

A study reported at the North American Menopause Society stated women after menopausal tend to weigh more, have larger waist lines, and a higher percentage of body fat than younger more active premenopausal women. Sedentary behavior correlated with a larger waist size – no surprise. But their findings showed regular exercise brought benefit to both pre- and post-menopausal women. When women increased their daily exercise – energy, mobility, and bone density all improved, along with reduction in waist size. Increased activity and weight control can also reduce the risk of developing Type 2 diabetes.

Last year, a journal of the American Association for Cancer Research reported a four year study examining women who walked the equivalent of thirty minutes per day had a lower risk of invasive breast cancer. The exact mechanism is unknown, but we do know exercise carries many positive benefits. Researchers stressed the benefit of lowered risk of invasive breast cancer was lost when exercise stopped — so daily exercise is key.

Walking daily can become a positive routine and is as important to overall health as brushing your teeth. Dogs love to walk. Our dogs provide encouragement to take a hike even in the rain. If you don’t have a dog, find a friend to join you. Exercise and social relationships correlate with happiness and longer life. Find a route that makes you smile and take a daily walk.

Some good advice from Dr. Seuss:
You have brains in your head.
You have feet in your shoes.
You can steer yourself in any direction you choose.

20151018_142608Betty and Bev

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POST-MENOPAUSAL HORMONE THERAPY IS BACK!

Low Dose Estradiol (bioidentical estrogen) and Dermal Patches Show Benefit

For those who have not experienced hot flashes or flushes, as they are sometimes called, they don’t sound like much of a problem. For most women, they aren’t. For me, someone who is often cold and wears wool socks to bed the year-round, it was a comfortable experience. I was warm enough for the first time in my life, except for experiencing the 108 degree temperatures on a Nevada desert.

The actual cause of vasomotor instability resulting from low estrogen is not fully understood and the problem is highly variable between women. Some are afflicted with numerous episodes each day associated with marked flushing, drenching sweats requiring clothing changes and faintness, while others barely notice the transition of waning hormones.

Women often seek medical care for hot flashes but it is the silent problems evolving without estrogen stimulation become important over time. Hot flashes tend to disappear while related heart disease and osteoporosis evolve causing problems in years to come.

Until about ten years ago, most women with menopausal symptoms were prescribed some form of hormone replacement. But results from the 2002 Women’s Health Initiative (WHI) and the Million Women Study (MWS) changed this practice. There was controversy and confusion among the experts, but in the end, the women lost when the consensus was that hormone replacement carried too much risk. The risks primarily included increased breast cancer, uterine cancer, strokes and blood clots.

Experts decided risks outweighed the benefits and recommended discontinuing hormone therapy. — Suddenly, hot flashes around the world contributed to global warming.

Breaking from the refusal to order hormone replacement for women, in June 2013 the British Menopause Society and Women’s Health Concern updated their guidelines. New recommendations are based on findings from a panel of experts that reanalyzed data from the WHI and MWS studies related to the specific hormones used. This time, when tracking the hormone options, they found low dose bioidentical estrogen, both oral and skin patch, carried less risk.

 Supporting Information

Another article just published in the Journal of the American Medical Association, JAMA, agrees with the use of bioidentical estrogen in hormonal replacement.  A joint University of Washington/Group Health study revealed women taking the generic estradiol had fewer vascular problems than those taking the equine estrogen preparation (Premarin). This difference may be related to clotting factors levels making blood clots more likely in women taking Premarin. Also the risk of having a heart attack was slightly higher in women using Premarin. No difference in stroke risk was seen.

Which Estrogen is Preferred?

There are many forms of estrogen and progesterone, both in oral, patch and cream forms. But estradiol is the same as that produced by the human ovaries. Premarin and other preparations are similar in effect but differ in chemical structure from estradiol. This new evaluation of the 2002 data showed the skin patch delivery of hormones appears most favorable.

 What About Other Risks?

Science evolves. Study outcomes change how we treat diseases. Hormone replacement surged from high utilization to stopping its use all together. Now the transition is back toward favorable aspects of low dose preparations. This is not to say, it is safe in all cases.

  • If you have had breast cancer, even the cell type without estrogen or progesterone receptors, you are probably not a candidate for hormones.
  • If you have had a stroke or venous blood clots in your legs or elsewhere, you would not likely be prescribed either estrogen or progesterone.

 The hormone progesterone is known to increase the risk of heart disease in women. Its use is to induce hormonal withdrawal bleeding and reduce the risk of uterine cancer in association with estrogen replacement in women who have a uterus. Estrogen can be used alone, without progesterone, following hysterectomy.

 If you are troubled with disabling hot flashes or marked bone loss (osteoporosis) you may be a candidate for estrogen replacement. You should discuss taking an FDA–approved bioidentical form of estrogen via skin patch with your physician.

 In my book, Your Heart – Prevent & Reverse Heart Disease, there is a chapter on women’s heart disease and the impact of menopause.  Additional favorable studies are noted reporting similar findings using low dose estrogen after menopause. One such study showed a significant reduction in heart disease with bone density improvements in women who took low dose estrogen.

 Note: “Bioidentical” is not the same as pharmacy-compounded estrogen products that are not standardized and may have variable potency.

 For more information on menopause check out: http://www.womenshealth.gov and my book at http://www.yourheartbook.com.

Betty Kuffel, MD

References:

SAGE Publications. Hormone replacement therapy: British Menopause Society and Women’s Health Concern release updated guidelines. ScienceDaily, 24 May 2013. Web. 2 Oct. 2013.

Nicholas L. Smith. Lower Risk of Cardiovascular Events in Postmenopausal Women Taking Oral Estradiol Compared With Oral Conjugated Equine Estrogens. JAMA Internal Medicine, 2013