1. Video Clip: Hot Flash Havoc

2. MENOPAUSE: Changes and Treatments By Dr. Julie Weinstein Wawa Family Health Team

3. DISCLAIMER

5. Though so many women experience what we are going to discuss tonight, they may feel embarrassed to discuss it with their health care provider.

6. My goal for this presentation is to help you recognize that these body changes are normal, that you are NOT alone, and you don't need to suffer in silence.

7. By understanding what's happening in your body and what you can do about it, I hope you will feel more comfortable talking to your health care provider and figuring out the best treatment options for you.

8. Outline ● Menopause Explained ● Symptoms ● General Lifestyle Management ● Non-Hormonal Treatment ● Hormonal Treatment ● Indications ● Options ● Safety ● Side effects

9. Definitions ● “Perimenopause”: the transition to menopause, anywhere from 4-10 yrs, stopping 12 months after the last period ● As we age, the ovaries start making less and less hormones and eventually stop working ● This transition is marked with wide fluctuations in estrogen, wreaking havoc and causing the common symptoms

10. Definitions ● “Menopause”: the menstrual period has stopped for 12 consecutive months and a woman is no longer fertile. ● Most women experience this between 45-55; average 51 yrs old

11. Definitions ● “Postmenopause”: once the menopause has happened ● could last for several years as hormones continue to drop and fluctuate over time.

12. The Truth

13. You might be in menopause if...

14. Symptom Score Sheet 0 = None1 = Mild2 = Moderate 3 = Severe __1. Heart beating quickly and strong__12. Feeling dizzy or faint __2. Feeling tense and nervous__13. Pressure or tightness in head or body __3. Difficulty Sleeping__14. Body feeling numb/tingly __4. Excitable__15. Headaches __5. Attacks of panic__16. Muscle or joint pains __6. Difficulty concentrating__17. Loss of feeling in hands or feet __7. Lacking in energy__18. Difficulty catching breath __8. Loss of interest in most things__19. Hot flushes __9. Feeling unhappy or depressed__20. Night sweats __10. Crying spells__21. Loss of interest in sex __11. Irritability

15. In case you needed reminding...

16. General Lifestyle Management ● Stress management, relaxation techniques ● Sleep hygiene ● Healthy diet ● Smoking cessation ● Regular exercise (aerobic and weight) ● Moderate alcohol and caffeine consumption

17. Non-Hormonal Treatment

18. Hot Flashes

21. Hot Flushes: Facts and Fixes ● 60-80% have hot flashes, up to dozens of times a day ● For 20% women, these are very severe and causing significant impairment ● Most stop within 3-5 years, but in 10-15% of women they last for 15 years or more ● Risk factors: smoking, obesity, physical inactivity

23. Hot Flushes: Facts and Fixes ● Lifestyle measures: ● Dress in layers ● Take cool showers ● Use a fan at work or in the bedroom ● Breathing exercises ● Healthy weight ● Stop smoking ● Regular exercise ● Recognize and avoid triggers like alcohol, spicy food ● Meds: Gabapentin, Anti-depressants, Clonidine, Bellergal

24. Vaginal and Bladder Symptoms

25. Vaginal and Bladder Symptoms: Facts and Fixes ● Estrogen loss causes changes in the vagina and bladder with symptoms in 40% women ● 1 in 5 will speak with a health care provider ● Only worsen over time

26. Vaginal and Bladder Symptoms: Facts and Fixes ● Vaginal atrophy: lack of estrogen causes the vulva and vaginal tissues to become thinner, less elastic and the vagina to shorten ● The pelvic floor loses muscle tone ● uterus, bladder and bowel sag into the vagina – pelvic pressure, back pain, and “stress incontinence” or leaking of urine with coughing or laughing

28. Vaginal and Bladder Symptoms Checklist ● Are you experiencing: ● Vaginal dryness before or during intercourse? ● Vaginal discomfort not involving sexual activity? ● Pain during sex? ● Vaginal itching or burning? ● Itching or irritation of the labia? ● Frequent or recurrent urinary tract infections? ● Yeast-like symptoms? ● More frequent trips to the bathroom to urinate? ● More night-time trips to the bathroom?

30. Vaginal and Bladder Symptoms: Facts and Fixes ● Avoid irritating soaps and detergents ● USE IT OR LOSE IT! ● Lubricants/Moisturizers: Replens, KY, Astroglide ● Kegel's, physiotherapy, vaginal cones ● Smoking cessation and weight loss ● Pessaries ● Medications, surgery

32. LIBIDO

33. A Word About Sexual Function ● Menopause does not = sexual dysfunction! ● Common conditions ● Low Sexual Desire ● Sexual Pain Disorders ● Relationship Issues

34. Sexual Function ● Some tips: ● Healthy lifestyle ● Healthy body image ● Experiment – with yourself, with your partner – books, videos, toys ● Talk to your healthcare provider ● Talk to your partner ● Consider self-help books, counseling

36. Osteoporosis

37. Osteoporosis: Facts and Fixes ● Bone density decreases more rapidly during menopause ● Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined ● Lifestime risk of hip, vertebral and wrist fractures: 40% ● Lifetime risk of hip fracture: 1/6; more than breast cancer ● Complications of fractures: loss of mobility, loss of independence, diminished quality of life and death

39. Osteoporosis: Facts and Fixes ● Reduce your risk! ● Stop smoking ● Limit alcohol and caffeine ● Get enough Calcium and Vitamin D ● Regular weight-bearing, aerobic, core, balance, gait exercises ● Prevent Falls ● Screening tests? ● Medications: Bisphosphonates (Actonel, Fosamax, etc.)

40. Bioidentical Hormones ● molecularly identical to those in our bodies ● made by a compounding pharmacist from a physician's prescription ● Not regulated, no uniform standards ● Difficult to know if you are getting the right or pure amount of hormone ● No evidence on effectiveness or safety

41. Hormone Therapy

42. Hormone therapy ● Indicated for: ● Hot flashes, other menopausal symptoms ● Vulva, vaginal and bladder symptoms ● Osteoporosis with menopausal symptoms

43. Hormone Therapy ● Benefits ● Decreased hot flashes/night sweats ● Decreased risk of fractures ● Decreased atrophy ● Decreased joint and other pain ● Decreased risk of colorectal cancer ● Mood stabilization

45. Systemic Hormone Therapy ● For the relief of menopausal symptoms, prevention of osteoporotic fractures ● Estrogen (Premarin) ● Progesterones (Provera/Prometrium) ● Patches (Climara) ● Gels (Estrogel)

46. Hormone Therapy ● Contraindicated ● Undiagnosed vaginal bleeding ● Known or suspected breast cancer ● Acute liver disease ● Active blood clot ● Pregnancy ● Caution ● History of: cardiovascular disease, high triglycerides, previous breast cancer, blood clots ● Not contraindicated ● Smoking, Diabetes, Hypertension, Migraine

47. Local Hormone Therapy ● Increases thickness of vaginal tissue and improve bladder function. ● Tablets (Vagifem) ● Creams (Premarin) ● Vaginal ring (Estring) ● Vaginal therapy for vaginal symptoms! ● No need for progestin to protect endometrium

49. Hormone Therapy: Is it Safe? ● Hormone therapy, when used correctly, does not increase a women's health risks ● Use the lowest dose for the shortest time ● This may be your answer...talk to your health care provider

50. Hormone therapy: Is it safe? ● Breast cancer: ● <5 yrs – safe ● >5 yrs – same risk as a woman who drinks alcohol every day, doesn't exercise, is significantly overweight ● Heart disease: ● Short term, within 10 yrs menopause – no increased risk ● Stroke: ● Lower dose, “micronized” progestin, transdermal – no apparent increased risk ● Blood clot: ● Slight increased risk; lower risk with lower dose and with patch ● Age, smoking, being overweight are greater risks than HT

51. Hormone Therapy: Side Effects Estrogen-relatedProgesterone Fluid retention, bloatingFluid retention Breast tenderness HeadacheHeadaches/migraines Nausea, reflux/heartburnMood swings Leg crampsDepression Acne Lower abdominal pain Backache

52. In conclusion ● Menopause is a life transition ● Few women have NO symptoms ● By gathering tonight, we're opening up dialogue ● Few of us talk to our health care providers ● Not all health care providers invite conversation ● There are MANY options for the MANY symptoms, including lifestyle and medications

55. For more information... ● www.sogc.org www.sogc.org ● www.menopauseandu.ca www.menopauseandu.ca ● www.osteoporosis.ca www.osteoporosis.ca ● www.sexualityandu.ca www.sexualityandu.ca ● www.sigmamenopause.com www.sigmamenopause.com

56. Thank you!