By REBecca B. Singson, MD
Tuesday, June 12, 2007
Menopause is the absence of menses for at least six months or a Follicle Stimulating Hormone (FSH) level of 35 IU/ml or above. The average age of menopause for Filipinos is 49, though perimenopause starts as early as 10 years before the actual menopause. Approaching this golden period, here are a dozen tips from a gynecologist’s point of view on how to maintain your health and sanity:
• Visit a gynecologist annually on your birthday. Get tested for CBC, urinalysis, blood chemistry panel 23, chest x-ray, treadmill test, transvaginal ultrasound, and Pap smear, if not hysterectomized; bilateral mammography and fecal occult blood for colon cancer screening.
• If you started sex by 18 years old and have had five sexual partners or have had any partner who was promiscuous, have an HPV (human papillomavirus) test aside from a Pap smear. The HPV test is far more accurate than a Pap Smear, which can miss cervical cancer up to 50 percent of cases. This is a more direct test as it detects presence or absence of virus that causes cervical cancer. If HPV test is negative, do a Pap Smear test once in three years. However, if test is positive, the risk of acquiring cervical cancer increases by a hundredfold.
• Have a bone densitometry once in three years to detect osteoporosis. Couple that with bone turnover markers such as a 2,3. Dpd-Pyrilinks or Urinary Collagen Ntx test. This is done by submitting your first or second urine in the morning to detect how much bone is lost every day. Should you be given drugs for osteoporosis, these bone turnover tests will also be your basis to tell if the drug taken works or not within eight weeks from start of therapy.
• Go for hormone replacement therapy. If you are having hot flashes, mood swings, irritability, anxiety, depression, sleeplessness, fatigue, memory loss, low libido, and skin or vaginal dryness, you may need hormone replacement therapy (HRT).
• You may opt to take either synthetic or natural hormone replacement therapy. Some women are afraid to use HRT because of results of WHI trial showing increased risk for breast cancer, coronary heart disease (CHD), stroke, venous thromboembolism, and pulmonary embolism (you must realize that this study is extremely flawed). The average age of women included in this study is 65 years old, at which period they are more prone to breast cancer and their arteries are riddled with arteriosclerosis, making them more prone to strokes and heart attacks. However, these results are not necessarily true for women who recently went into menopause.
The natural bioidentical hormones are plant-based which don’t necessarily carry the same risk. You can be as energetic and as vibrant as you were in your teens with hormone replacement therapy.
If you have osteopenia or osteoporosis, with all symptoms stated in an aforementioned tip, your best bet for correction is hormone replacement therapy. However, if you just have osteopenia or osteoporosis without all the symptoms stated, take an anti-bone resorption drug. For osteopenia, the only FDA-approved drug is Raloxifene. For osteoporosis, Raloxifene is the ideal drug for women younger than 65 years old. If over 65 years old, you may use Fosamax daily, Fosavance once weekly, Actonel once weekly or Bonviva once monthly. These medicines must be prescribed by your doctor before taken.
The advantage of Raloxifene is that it decreases breast cancer risk by 44 percent, equivalent to the effect of Tamoxifen but at the same time may increase the risk of fatal strokes. It is, therefore, the drug recommended to women who need to be treated for osteoporosis with a family history of breast cancer or are strongly fearful of acquiring breast cancer.
• Be sure you are taking 1,500 mgs. of calcium every day. You normally obtain about 300-400 mgs. from your diet so a tablet of calcium twice a day should do the trick. Your calcium should have half the amount of magnesium as your calcium to make a 2:1 ratio as well as some vitamin D. Your calcium absorption depends on what it is chelated to. You absorb 20 percent calcium from calcium carbonate, a little more with calcium gluconate, and about 60 percent absorption with calcium citrate, so look for a calcium citrate supplement.
• Exercise. No matter how much calcium you ingest, if you don’t exercise against gravity, you can’t force your bones to deposit calcium. So, at least do brisk walking two to three times your normal pace at a minimum of 40 minutes a day. Biking and swimming don’t count in helping your bones deposit calcium. Ballroom dancing and tai-chi help in balance training, such that if you drop, you can catch your fall and prevent a fracture.
• See a doctor. Remember, any vaginal bleeding after menopause is abnormal. So be sure to see a doctor to check out the cause of the problem.
• Live life. Menopause is a liberating point in life, free from pregnancy, and many times released from raising kids, who by now have grown independent. It is a period to fulfill yourself, reassess what you have accomplished. Deepen your relationship with God, spouse and/or significant other. Have a great moment enriching your life!
source: The Philippine Star
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