June 20--For women in their 50s, lower estrogen levels lead to menopause and a
whole set of health concerns.
"This is the beginning of the aging process," says Kate Beadle, a Kaiser
Permanente nurse practitioner who specializes in menopause.
Dr. Audrey Curtis, who's helping start a women's health clinic at Legacy
Meridian Park, says: "A lot of women feel like they're on a roller coaster.
Their hormone levels are doing what they did in the teenage years, really up and
For some women, the answer is hormone replacement therapy to deal with symptoms
of menopause. But the 50-year history of HRT has been as wild as the mood swings
it is supposed to prevent. And the changing recommendations for women, as well
as cancer fears, have led to confusion and stress.
Introduced in the 1960s, long-term estrogen treatment was marketed as a wonder
therapy to combat aging, disease and depression. Two 1975 studies indicating
increased cancer risk made a temporary dent in sales, but it didn't last as
other hormones like progestin were added to the therapy, supposedly eliminating
the added cancer risk.
In 2002, a major study by the federal Women's Health Initiative made a much
bigger impression, linking estrogen-based treatment and elevated cancer risk.
And estrogen was not a miracle drug that prevented certain chronic diseases,
contrary to an earlier study.
Since then, the Women's Health Initiative has been criticized for design flaws
by medical researchers and other experts, and even its authors have backtracked
on some of their warnings of elevated risk of heart disease.
In 2012, the U.S. Preventive Services Task Force issued a review of published
research, including the Women's Health Initiative, and did not address the use
of HRT to treat symptoms of menopause. However, it recommended against the use
of HRT by post-menopausal women to prevent chronic disease.
The task force concluded:
Estrogen plus progestin and estrogen alone decreased risk for bone fractures.
Estrogen plus progestin and estrogen alone increased risk for stroke,
thromboembolic events, gallbladder disease and urinary incontinence.
Estrogen plus progestin increased risk for breast cancer and dementia
Taking estrogen alone decreased risk for breast cancer.
The federal task force tries to be the last word on science. But then came a
newer study late last year out of Denmark. It found that timing the short-term
use of hormone replacement therapy close to the advent of menopause led to a
clear improvement in cardiovascular health, and no increase in cancer rates --
and the younger when HRT began, the better.
So many health care providers have warmed back up to hormone replacement
therapy, even as patients remain understandably skeptical. The Women's Health
Initiative "perpetuated some bizarre concepts that have really infiltrated into
the medical world," says Duncan Neilson, chief of women's services for Legacy
Gary Hoffman, head of women's services at Providence St. Vincent, is more
measured. "The studies of HRT end up all over the map," he says, adding that the
use of HRT is not for everyone and "is more of a temporary treatment to deal
with the symptoms of menopause."
Other issues to track
Of course, women in their 50s are not just concerned about menopause. Tracking
their memory and bone health becomes more important.
Half of post-menopausal women will have osteoporosis-related bone fractures,
according to the U.S. Preventive Services Task Force. About a quarter of those
will suffer a vertebral deformity and a sixth of them face hip fractures.
When it comes to bone density and osteoporosis, moderate exercise in your 50s is
still a good idea. But one possible little-known help: a daily alcoholic drink
While the research is not conclusive, an Oregon State University study last year
found striking evidence that very moderate intake of alcohol after menopause can
help prevent the deterioration of bones. The study focused on women consuming an
average 1.4 drinks per day.
That doesn't mean everyone should start drinking. After all, alcohol is
associated with a higher risk of breast cancer, particularly those having two
drinks a day or more. And heavy drinking is associated with bone loss.
Regardless, the OSU researchers found that a blood marker associated with bone
decay appears to drop dramatically in women who drank moderately. In an
interview last year, Oregon Health & Science University bone researcher Eric
Orwoll said the OSU results aren't airtight, but are consistent with previous
research that found the greatest bone fracture risk in those who drink heavily
or not at all.
"The changes that they saw make sense," he said.
Stay on top of screenings
Health screening schedules become more important with age.
There's a higher risk of colon and skin cancer and heart disease, changes of
metabolism, and a stepped-up need for cholesterol, thyroid and diabetes
screening, bone-density testing and more.
Despite debate over mammograms, false positives and unintended harms, every year
or two remains the recommendation for women in their 50s. And -- good advice at
any age -- exercise remains key for mental and physical health, especially as
arthritis might be creeping in.
-- Nick Budnick
(c)2013 The Oregonian (Portland, Ore.)
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