Menopause & Osteoporosis
There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. Fortunately, there are steps you can take to prevent osteoporosis, and treatments are available to slow the rate of bone loss if you have osteoporosis.

What is osteoporosis?
Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning "porous bone," it results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain. Generally, osteoporosis is not discovered until weakened bones cause painful fractures (bone breakage), often in the back (causing chronic back pain) or hips. Unfortunately, once you have an osteoporotic fracture, you are at high risk of having another. These fractures can be debilitating. Fortunately, there are steps you can take to prevent osteoporosis from ever occurring. Treatments can also slow the rate of bone loss if you have osteoporosis.

What causes osteoporosis?
Though we do not know the exact cause of osteoporosis, we do know how the disease develops. Your bones are made of living, growing tissue. An outer shell of cortical or dense bone wraps trabecular bone, a sponge-like bone. When a bone is weakened by osteoporosis, the "holes" in the "sponge" grow larger and more numerous, weakening the inside of the bone.

Until about age 30, a person normally builds more bone than he or she loses. After age 35, bone breakdown overtakes bone buildup, which causes a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis.

How is osteoporosis related to menopause?
There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. After menopause, bone resorption (breakdown) overtakes the building of new bone. Early menopause (before age 45) and any long phases in which the woman has low hormone levels and no or infrequent menstrual periods can cause loss of bone mass.

What are the symptoms of osteoporosis?
Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may be first noticed when the person suffers severe back pain, loss of height, or spinal deformities such as stooped posture.

Who gets osteoporosis?
Important risk factors for osteoporosis include:

Age. After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally drop with age.
Gender. Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women’s lighter, thinner bones and longer life spans are some of the reasons why they are at high risk for osteoporosis
Race. Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Additionally, hip fractures are twice as likely to occur in Caucasian women as in black women. However, women of color are more likely to die after a hip fracture
Bone structure and body weight. Petite and thin women have a greater risk of developing osteoporosis because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight
Family history. Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease
How can I know if I have osteoporosis?
A painless and accurate test can provide information about your bone health before problems begin. Bone mineral density (BMD) tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone density. In addition to measuring bone health, the test can determine how severe any osteoporosis is.

Please note that women with no other risk factors whose BMD T-scores are below -2.5 should begin treatment to reduce the risk of fractures. (T-scores compare a person’s BMD to the optimal, or best, density of a healthy 30-year-old woman to determine the risk of fracture.) Women with BMD T-scores below -1.1 and who have other risk factors should also consider beginning treatment to reduce the risk of fractures. Your doctor will talk to you about your own risks for fracture to determine if you need medication.

Who should have a bone mineral density test?
All post-menopausal women who suffer a fracture that is suspicious for osteoporosis.
All post-menopausal women under age 65 who have one or more additional risk factors.
All post-menopausal women age 65 and over, regardless of additional risk factors.

Women never have it easy and when it comes to the matters of health and hormones they have to endure the tortures lifelong. Right from puberty to periods to pregnancy to menopause a woman is constantly struggling to attain a balance with her notorious hormones and her life. Of course, these hormones are not to be blamed as they are only functioning a certain way to ensure that a woman’s physiological and psychological health is balanced and stable. But the fallouts like mood swings, fatigue, lethargy is too much to deal with. While we all speak about how the hormones govern every bit of a woman’s life – puberty, pregnancy, menopause – not much is spoken about a particularly important phase of her life again ruled by the hormones – perimenopause.

In fact, Dr Veena aurangabadwala, Gynecologist, Zen Multispeciality Hospital, Chembur, says, ‘Many people think that this phase is one of the most relaxing phases for a woman but in reality, this is the time when many health issues crop up, especially if the woman is ignorant about her health. In fact, a midlife crisis is not a myth but a reality for women facing perimenopause.’

Dr Veena cautions that during this period a lot of health issues and complaints are seen among women.

Health and you

According to Dr Veena, this is also the time when 30-40 per cent of women develop benign conditions such as fibroids in the uterus/breasts, cysts in the breasts causing some or no symptoms. Some of them also develop menstrual irregularities which can be either stress induced or due to hormonal change. Women do experience extremes of mood swings, hot flashes, phases of depression, loosening of the abdominal skin, bloating, vaginal and at times urinary symptoms too. But they may also be a sign of the most dreaded precancerous or cancerous changes in the reproductive organs. It is important to seek medical attention of a specialist, to rule out possible cancerous changes and treat these conditions by medications, or surgically (if required).

What she can do

In the light of increasing sporadic (not inherited) incidence of breast cancers, and the less aggressive cervical cancer, all women above the age of 40 years, must get their Pap smears and Mammography done at regular intervals of 1-3 yrs (based on familial risk factors). All women must know the technique of Self Breast Examination (SBE). A health check-up once in a year or two (including these screening tests) will help us women stay fit and help identify any new medical conditions requiring attention. A healthy Midlife can make a richer and healthier second innings.

Perimenopause is a tough phase of a woman’s life. While most of us keep talking about the challenges – physiological and psychological — a woman has to face during menopause little is spoken about the perimenopause phase. This phase is the transitional phase for a woman, the phase between pre-menopause and menopause. This particular phase is denoted with a variety of problem that becomes difficult to deal with – abnormal menstrual periods, hormonal fluctuations, insomnia, hot flashes, lack of sexual desire etc. Studies suggest that this is a phase when a woman can go through depression too owing to the hormonal imbalances. This kind of depression is termed as perimenopausal depression and it can make the existing symptoms of depression go worse.

In fact, a study published in Archives of General Psychiatry noted that perimenopausal women were twice as likely to be diagnosed with the major depressive disorder (MDD) as those who hadn’t yet entered this hormonal transition. They are also four times as likely to develop depressive symptoms as women who hadn’t gone through perimenopause. In fact, in this phase women who had the highest frequency of hot flashes reported having the most significant symptoms of depression.

Women who were at the high risk of developing depression were

Women without children

Women who took antidepressant

Here are some signs and symptoms of perimenopausal depression

There isn’t much of a difference between depression symptoms and that of perimenopausal depression, however, women who face perimenopausal depression experience a severity of these following symptoms

lack of energy and fatigue

slow cognitive function

inattentiveness and inability to concentrate

general lack of interest

feel of worthless, hopeless or helpless

extreme mood swings

irritability

crying for no reason or tearfulness

heightened anxiety

profound despair

insomnia along with hot flashes or night sweats

Why does it happen?

Perimenopausal depression is a trigger of hormonal fluctuations. When estrogen levels fluctuate, the mood-boosting hormones serotonin and norepinephrine levels in the brain are affected.
Serotonin, norepinephrine along with dopamine helps to keep your mood upbeat and make you feel happy. They also help to lower anxiety levels. But when estrogen levels fluctuate these neurotransmitters don’t work effectively this result in mood swings and depression. It is better to speak to an expert and seek help if the symptoms are getting the better of you. Many women are capable of overcoming these symptoms on their own but if you need help don’t hesitate to look around.

Late onset of puberty as well as a late arrival of menopause is likely to increase the chances of women surviving upto 90 years, says a study. The findings showed that women whose puberty began at the age of 12 or later as well as experienced menopause, either naturally or surgically at age of 50 or later may survive nine decades.In addition, women with more than 40 reproductive years were also significantly associated with increased odds of longevity. "Our team found that women who started menstruation at a later age were less likely to have certain health issues, like coronary heart disease, and those who experienced menopause later in life were more likely to be in excellent health overall," said Aladdin Shadyab, postdoctoral student at the University of California, San Diego. Women who started menstruation and experienced menopause at a later age were also less likely to be smokers or have a history of diabetes. Factors, such as smoking, can damage the cardiovascular system and ovaries, which can result in earlier menopause, the researchers said. "Women with later menopause and a longer reproductive lifespan may have decreased risk of cardiovascular diseases," Shadyab added in the paper published online in Menopause.
In the study, which is the first to evaluate the association of reproductive factors with survival to a specific advanced age, such as 90 years old, approximately 16,000 participants were followed for 21 years.Out of these 55 per cent survived to age 90.

Women may be at greater risk for developing diabetes, heart disease and stroke in the years before menopause, rather than afterward, a U.S. study suggests. This may mean that the higher cardiovascular risk seen among post-menopausal women could be related to changes in that time before menopause and less so to the changes after menopause has occurred," said lead study author Dr. Mark DeBoer, a researcher at University of Virginia School of Medicine in Charlottesville. While the reasons for this are unclear, the findings suggest that women may need to pay especially close attention to cardiovascular risk factors in the years leading up to menopause and consider lifestyle changes like improved diet and exercise habits that can make problems like diabetes and heart disease less likely, DeBoer added by email.
Menopause typically happens between ages 45 and 55. As the ovaries curb production of estrogen and progesterone, menstruation stops, and women can experience symptoms such as hot flashes, night sweats and vaginal dryness. Certain treatments for menopause symptoms that contain man-made versions of the hormones estrogen and progestin have also been linked to an increase risk of heart attack and stroke.Previous research has also linked menopause to an increased risk of what's known as metabolic syndrome, a constellation of conditions that increase the risk of heart disease, diabetes and stroke. Obesity, inactivity and a history of smoking appear to make these problems more likely.
For the current study, researchers examined data on 1,470 white and African-American women participating in a national study of the causes and health effects of hardening of the arteries.All of the women went through menopause during the ten-year study period.Researchers focused on five things that contribute to metabolic syndrome: expanding waist circumference, elevated fats in the flood, declines in so-called "good" HDL cholesterol, spikes in blood pressure and increased levels of sugar in the blood. After taking into account whether women used hormone-replacement therapy, researchers still found bigger changes in triglycerides (fats in the blood), cholesterol and glucose (blood sugar) before menopause than afterwards.For white women, waist size spiked more after menopause, however.African-American women experienced larger increases in blood pressure after menopause than before, the researchers report in the Journal of the American Heart Association.
One limitation of the study is that researchers defined the timing of menopause based on whether women said they had a menstrual period in the previous two years, the authors note. Menopause is commonly diagnosed after women cease menstruation for one year, which means the study may have categorized some women as going through this transition who had already completed it. Researchers also lacked data on hormone levels for individual women, even though these can fluctuate and influence the risk for metabolic problems, said Dr. Robert Eckel, of the University of Colorado Anschutz Medical Campus in Aurora.
Not all types of hormone-replacement therapy carry the same risks, and the study also didn't account for the way hormones were administered, Eckel, who wasn't involved in the study, said by email. "Cardiovascular disease screening remains important for all adults including men and women," Eckel said. "Perhaps the frequency of evaluation should be more emphasized in this important peri-menopausal interval (between ages 45-55) in women - more science needed here."