Animal Research Suggests Perimenopause Is A Critical Time For Women's Health

ScienceDaily

Research in monkeys suggests that the perimenopause -- the five to 10 years before a woman's menopause -- is a critical time for preventing heart disease and osteoporosis.

"Research in animals suggests that the five years before menopause are when bone is lost and when heart vessel disease begins to accelerate," according to Jay Kaplan, Ph.D., from Wake Forest University Baptist Medical Center, who spoke today at the annual meeting of the American College of Veterinary Pathologists in Boston. "Waiting until menopause is not the time to start thinking about prevention."

Kaplan, a professor of comparative medicine, was invited to summarize his extensive research on how hormone levels affect health. His work has focused primarily on how stress during the younger years can interfere with ovulation and reduce estrogen levels, which can set the stage for heart disease later in life.

"But, this isn't just a problem in younger women," he said. "At perimenopause, all women are affected by variably changing and ultimately declining estrogen levels. Perimenopause is a time of increased vulnerability to chronic disease."

Women have traditionally been considered immune from heart disease until after menopause, when their estrogen levels dramatically drop. However, Kaplan's research has shown that in monkeys, the process starts much earlier. He found that stress in the younger years can reduce estrogen levels and lead to the buildup of fatty deposits in the blood vessels (atherosclerosis) that can lead to heart attacks and strokes.

"Our research adds to the growing body of evidence that cardiovascular health after menopause is influenced by hormone levels many years earlier," said Kaplan. "Our monkey studies showed that a deficiency of estrogen before menopause places these females on a high-risk trajectory, even if they got estrogen treatment after menopause."

For women in perimenopause who intend to take hormone therapy, Kaplan said the research suggests that perimenopause may be the best time to start.

"The results emphasize that primary prevention of heart disease should start pre-menopausally," he said.

Kaplan's animal studies found that treating the estrogen-deficient monkeys with estrogen before menopause markedly slowed the growth of atherosclerosis. Kaplan said the findings were consistent with the hypothesis that estrogen inhibits the development of vessel disease, but may be ineffective if the disease already exists.

"Applied to women, this lifetime study suggests that having an estrogen deficiency in the pre-menopausal years predicts a higher rate of heart disease after menopause, even when treated with hormone replacement therapy after menopause," said Kaplan.

Kaplan said that some physicians advocate women taking oral contraceptives right up until menopause, and then beginning hormone therapy. He said animal research suggests that oral contraceptives can be effective in heart disease protection.

However, the Women's Health Initiative, the largest study to date to test the effectiveness of hormone therapy in women, found that treatment with combination therapy (estrogen and progestin) increased risk of breast cancer, heart attacks and stroke. As a result of the study, many doctors advise that women not take hormone therapy to prevent heart disease.

But critics of that study say it didn't involve enough younger women to see if taking the drugs earlier can be effective for prevention. A theory that there is a "window of opportunity" for hormone therapy to be effective for prevention is being tested in a five-year study of peri-menopausal women ages 45 to 54. Funded by the Kronos Longevity Research Institute, the study is evaluating an oral tablet containing estrogen, a skin patch delivering estrogen and a placebo.

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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,187 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.

Hit the 40s? Watch out for peri menopause symptoms

From The Sunday Times, Sri Lanka, Sunday October 18, 2009
By Dr. Melanie Amarasooriya

It is the time in life when mothers are at their busiest. With the enormous responsibilities they hold in raising a family, working and running a home, often their health is not given enough attention. The slightly changing physiological processes are often passed off as ‘normal at 40’.

Unfortunately, this is the time that a number of physiological changes occur in women in relation to their reproductive systems. If you are around 40, you should be watchful for this is the time to detect those growing abnormalities early. Normally menopause, for many women will occur around the age of 50 years. Yet, significant individual variations will occur, meaning that it may occur at 48 years or even 53. If your mother or sisters had early menopause, the chances are that you may also experience the same.

Even though menopause usually occurs around the age of 50, the ovaries prepare for the impending ‘shut down’ a few years earlier. So from a few years before, you will start feeling the symptoms of declining oestrogen levels in your body. This transition period is called peri menopause and will last for one year from your last period.

How do you know if you are in peri-menopause?

The common symptoms are:

* Menstrual irregularities
* Irritability, mood swings and fatigue
* Sleeplessness
* Vaginal dryness
* Reduced sexual drive
* Hot flushes and night sweats- a sudden feeling of intense heat which encompasses your entire body and may be followed by day or night sweats
* Headaches
* Palpitations
* Lumpy or tender breasts
* Unexplained weight gain
* Urinary incontinence
* Vaginal dryness

Menstrual irregularities at this time could be that the menstrual flow could be heavier or lighter, the time between periods lengthen or shorten, or even become irregular. This could be due to reducing levels of oestrogen and progesterone hormone levels in your body. Some women will experience heavier flow lasting for several days with passing of blood clots.
Pic courtesy passions and soapboxes.com

If you need to change fully soaked sanitary towels every hour for a few consecutive hours, if you pass large clots, if your clothes are wet by the time you wake up or you have to change sanitary protection at night, if your daily routine is disturbed because of the menstrual periods, or if there is a recent change in the pattern you may need to seek medical advice. Menstrual flow lasting more than 7 days is also considered abnormal.

The common reasons are physiological changes that occur during peri menopause, fibroids, non cancerous polyps, and other medical causes like impaired thyroid gland function or hypothyroidism. Rarely malignant changes in the inner lining of the womb/ uterus which is called the endometrium can give rise to abnormal bleeding.

Clinically the doctor will diagnose what the more likely cause is- whether it is a gynaecological problem - that is something wrong in the reproductive system or a medical problem - a problem related to other organ systems like thyroid gland.

Fibroids or non cancerous growths in the uterus/ womb are present in one in every three women above 30. They are harmless and may be asymptomatic, or can cause heavy periods, painful periods, bleeding or spotting in between two menstrual periods. Uterine polyps, again harmless mucosal growths can also cause spotting or bleeding between two menstrual periods or after intercourse.
However one sinister cause for bleeding after intercourse is cancer of the cervix.

Therefore all women after forty who have bleeding after intercourse should take it seriously and seek medical advice, though it could be due to dryness of the vaginal wall.

If you are over 40, have a pap smear test every three years to exclude cervical cancer or predisposing conditions to cervical cancer. Cervical cancer is a common gynaecological cancer and can be cured if detected early.

Thyroid problems can also affect the menstrual cycle, though they occur with certain other symptoms not solely menstrual.

Whatever the cause, in abnormal heavy bleeding, or shorter menstrual cycles, it is wise to check the blood for haemoglobin level, as the blood loss could make you anaemic. At your first consultation with the doctor you need to tell him/her about the other medical conditions you have or other drugs you are taking as they may have a role in your current problem as well.

Then you need to be seen by a gynaecologist, if other medical problems are unlikely causes. An ultrasound scan will help in identifying uterine fibroids. If there are no fibroids or any other obvious pathology, abnormal uterine bleeding after the age of 40, needs endometrial tissue sampling. That is to collect cells from the endometrium to be examined under microscope so that the abnormalities at the cellular and tissue level can be identified.

This may be done by hysteroscopy, but in our country, the commonly performed procedure is ‘dilatation and curettage’ or ‘D and C’. This is now done as a day procedure, and usually patients can get admitted with six- hours fasting and go home a few hours after the procedure.

Depending on the histology report, the treatment will vary.

If there are abnormalities in the report, in the first instance the doctor may offer you medication. But if the changes are significant or pre-cancerous, he would discuss with you the possibility of a hysterectomy or surgical removal of the uterus. If there are multiple fibroids and you do not expect to preserve fertility after 40, hysterectomy is the common answer. However, unless you are close to menopause, ovaries can be conserved to produce oestrogen, a hormone that has many beneficial effects. In patients who are close to menopause, hysterectomy will accompany removal of ovaries as those will anyway give up their function shortly at menopause.

The other important point about peri menopause is that even during this time you can get pregnant, though your fertility is reducing. Therefore, if you are not expecting a baby you need to use a contraceptive method.

Menopause before the age of forty is called premature ovarian failure and is associated with a number of disease conditions like osteoporosis, as the beneficial effects of oestrogen are no longer there. So if you experience early menopause or there are signs that you are approaching menopause, seek medical advice. Though it is not possible to stop it, the doctor may advise you on hormonal replacement therapy.