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Unexpected Health Risks of Menopause


If you’re approaching menopause or are postmenopausal, you already know about bothersome symptoms such as hot flashes and night sweats. And you’re likely aware that your risk for serious health conditions, including osteoporosis and heart disease, is now higher.

What you may not know is that the shift in hormone levels that occurs during menopause and continues into postmenopause may be behind other physical and emotional changes—everything from achy joints to dry skin.

We asked Dr. JoAnn V. Pinkerton, executive director of the North American Menopause Society, about some of the less obvious effects menopause and postmenopause may be having on your life and your health…and what you can do.

Changes in your skin. Your biggest organ, the skin, takes a hit from menopause-related hormonal changes in several ways…

• You lose collagen, a protein that gives skin its elasticity. Women lose up to 30% of skin collagen in the first five years after menopause, although the exact link to menopausal estrogen loss isn’t clear. The less collagen you have, the looser, drier and flakier your skin looks and feels.

Acne, which probably has not been a problem since you were a teen, may rear its head again. Blame a shift in the balance between estrogen and androgen. This hormone-­related acne usually develops on your lower face or around your chin, jawline, neck and even upper back.

• A more rare, yet disturbing, skin issue that can be related to menopause is formication—an itching, tingling sensation that feels like ants crawling on your skin! It usually develops during early postmenopause. Short-term hormone therapy—two to 12 weeks—may relieve symptoms. It also can have nonhormonal causes, such as allergens or side ­effects from medications.

What you can do: Follow basic rules of good skin care—drink plenty of water, exercise, eat well, get a good amount of sleep and avoid sun exposure. If you take estrogen in the first five years after menopause (the safest time to do so), it may help you maintain collagen and avoid some of the issues of aging skin…but not all studies agree that it helps. Dr. Pinkerton’s advice: Don’t take hormone therapy for the sole purpose of skin care. But it might be an added bonus.

Achy bones and joints. Waking up with more than your usual aches and pains? It’s a normal part of aging, but women after menopause have it worse than men. Compared with men their age, twice as many postmenopausal women develop osteoarthritis—a “wear and tear” degenerative joint condition. Although how estrogen affects women’s joints is not well understood, it is known that there are estrogen receptors in muscles, tendons and cartilage, which all support and protect joints. So it stands to reason that there would be some effect when estrogen levels dip.

Observational studies reveal clues. In the Women’s Health Initiative study, the largest US study of postmenopausal women, women on estrogen therapy had fewer hip replacements than women who didn’t take estrogen. Those who were taking both estrogen and progestin had less joint stiffness and pain. Finally, women who take aromatase inhibitor drugs to block estrogen (usually to treat estrogen-fueled cancers) commonly do have joint pain.

What you can do: As with skin issues, while hormone therapy may help ward off arthritis, it is not a good reason to start taking it. Instead, whether you take hormone therapy or not, remain as active as you can, since moving your muscles and joints is key to preventing arthritis. Look for low-impact activities that don’t stress joints, such as brisk walking, swimming or tai chi. If you’re overweight, losing even a small amount of weight can relieve stress on joints. A healthy Mediterranean-style, anti-inflammatory diet may help even if you don’t lose weight.

Sleep apnea. Sleep problems are common in menopause, especially if hot flashes and night sweats interrupt sound sleep. And after menopause your risk of developing sleep apnea, a sleep disorder characterized by repeated pauses in breathing during sleep, also rises. Sleep apnea makes you more vulnerable to heart disease and stroke, among other problems.

Postmenopausal women are twice as likely to develop sleep apnea as premenopausal women. In one large study, researchers found that postmenopausal women had different apnea symptoms than men. Men’s apnea symptoms were primarily snoring or interrupted breathing at night, while women were more likely­ to suffer from insomnia, morning headaches, tiredness, depression or anxiety—or even bed-wetting. The increased risk after menopause is believed to be related to hormonal decreases, which may be associated with weight gain. But it can happen even if you don’t gain weight.

What you can do: Lifestyle approaches, such as losing weight, not smoking and sleeping on your side, may help. An oral appliance that shifts your jaw position may help, too. But if these approaches don’t work, you may need to use a continuous positive airway pressure (CPAP) machine to keep your airway open so that you can breathe normally all night long. If you even think that you might have sleep apnea, talk to your doctor to get diagnosed. In small trials, hormone therapy improved sleep-disordered breathing and sleep disruption.

Changes in your senses. Some women report that their sense of taste, specifically for salty, peppery or sour foods, shifts after menopause. And some women report a strange burning mouth sensation.

There is also evidence that declining estrogen may hasten hearing loss. Your eyes undergo changes, too—they may become dry and itchy after menopause.

What helps: In the case of sensory changes and complaints, research isn’t clear about the role of estrogen—or hormone therapy. But understanding that they may be related to the normal menopause process can ease your mind.

Note: Just because some of these health issues are more likely after menopause doesn’t mean they’ll happen to you! But if you are concerned, talk to your doctor.

And although declining estrogen levels can trigger these conditions and symptoms, the best treatment may not be hormone therapy. Always weigh the benefits against your individual risks.

Source: JoAnn V. Pinkerton, MD, NCMP, executive director of the North American Menopause Society, Pepper Pike, Ohio, and professor of obstetrics and gynecology and division director of Midlife Health at the University of Virginia Health Center, Charlottesville. Date: December 1, 2017
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