Tip sheet: What to know about health risks after menopause

Despite the health risks affecting half of the world’s population for a third of their lives or longer, many health care providers are unprepared and/or lack the knowledge to fully treat postmenopausal women.

This is a problem not only in the US, but in many societies around the world. And, while it’s encouraging to see more doctors starting to specialize in menopause, they’re still few and far between. The Menopause Society (formerly the North American Menopause Society) certifies menopause practitioners who have received advanced training. There are still only about 1,300 NAMS-certified practitioners in the world.

This lack of education and training means older women often don’t get the information or treatment they need, from the availability of vaginal creams to bone density scans. It also perpetuates misconceptions about menopausal hormone therapy (MHT), supplements, and other nonhormonal therapies.

Why? Journalists should be asking medical schools, hospitals, clinics and professional organizations that question.

A challenging time of life

Menopause is defined as the time in a woman’s life when menstruation has stopped for 12 consecutive months. The average age at which women reach menopause in the US is 51, although the time can vary widely.

The effects of changes in estrogen, progesterone and other hormone levels go beyond the stereotypical hot flashes and night sweats. When a woman is in the postmenopausal phase of life, the risks of serious health problems increase, sometimes significantly.

Studies show that many doctors, including OB/GYNs, are not well versed in many aspects of postmenopausal women’s health. Few medical schools have courses that focus on these issues, and residents don’t get much hands-on training either, according to Joanne Naidorf, DO, an osteopathic physician in Alexandria, Va. There was no emphasis or education regarding menopause or perimenopause, Naidorf wrote in Medium.

This lack of training can mean providers are unprepared when it comes to older women’s health, according to the federal Office on Women’s Health. However, as women transition, changes in estrogen levels increase women’s risk for many serious conditions:

• Heart disease: Before age 55, women have a lower risk of heart disease than men. Estrogen helps keep blood vessels relaxed and open and helps the body maintain a healthy balance of good and bad cholesterol. Without estrogen, cholesterol can begin to build up on the walls of the arteries leading to the heart. By age 70, women have about the same risk of heart disease as men of the same age.
• Impact: The risk of stroke in women doubles every decade after 55. Lower levels of estrogen in a woman’s body may play a role in the buildup of cholesterol on the walls of the arteries leading to the brain.
• Osteoporosis: Loss of estrogen causes faster bone loss, increasing the risk of osteoporosis. Women lose bone mass at a much faster rate than before menopause, putting them at risk for osteoporosis, a bone disease characterized by progressive loss of bone density and thinning of the bone tissue, which makes bones break easily. Women who experience severe hot flashes and night sweats during the years around menopause tend to have greater bone loss and have a higher risk of hip fracture than women who do not have severe symptoms, research shows.
• Incontinence: About half of postmenopausal women have problems with incontinence and other urinary tract problems. Although these problems can significantly affect quality of life and mental health, many women do not seek treatment.
• Oral health problems: There is an increased likelihood of dental problems after menopause. Lower estrogen levels reduce the amount of saliva, leading to sore and sensitive gums, cavities, ulcers, infections and tooth decay.
• Gaining weight: Many women gain an average of 1.5 pounds each year as they move through their 50s. Lower estrogen levels may play a role, but weight gain can also be caused by an age-related slowing of metabolism. Weight gain increases the risk of high blood pressure, cholesterol, diabetes, heart attack and stroke. The risk is higher in women who are already obese, inactive, or who don’t already eat a healthy diet. Women also lose muscle mass as they age, and calorie burning slows down.
• Changes in sexual health: Many women experience changes in their sex life as they go through menopause. Not only can menopause affect sexual desire, but women can also experience physical problems during sex due to vaginal dryness and loss of elasticity. This can lead to pain or bleeding, as well as more urinary tract infections and genitourinary menopausal syndrome (GSM), also known as atrophic vaginitis or vaginal atrophy, according to University of Utah Health.

Resources

Experts

• Jen Gunter, MD, OB/GYN and author of The Vagina Bible.
• Rebecca Levi-Gantt, MD, private practice, Napa, CA.
• Susan Reed, MD, University of Washington.
• Monica Bozic, MD, University of Chicago.
• Stephanie Faubion, MDMBA, Mayo Clinic and Medical Director, The Menopause Society.