Menopause and Osteoporosis
by Cecilia Mullen, R.N.C., N.P.
May 5, 2000
On May 14th, the nation will celebrate Mother's Day. As families gather and reflect on the impact their mothers had on their lives, we would like to honor these women.
May 14th - 20th has been named National Osteoporosis Awareness week. Osteoporosis and menopause are two topics receiving a lot of press recently. Women's health issues, in general, are receiving more focus and attention as women take a more active role in their health care. Approximately 70 million women in the United States today are over the age of 45.
Menopause
Menopause is the end of a women's monthly menstrual period. After age 40, hormone levels decline and periods may become irregular. The period stops altogether when the ovaries stop producing hormones. This process can take up to 10 years. Menopause typically occurs between the ages of 45-55. Estrogen is the female hormone responsible for the reproductive organs. It also has other functions as well. It helps to maintain strong bones. It also has favorable effects on cholesterol levels.
The common symptoms of menopause are hot flashes, night sweats, insomnia, and mood swings. These symptoms may continue for a year or more and may last up to 10 years. Vaginal dryness and irritation may also develop as Estrogen is lost. Estrogen replacement can relieve these symptoms. Now we are recognizing the benefits of long-term estrogen replacement therapy.
Osteoporosis
Estrogen has a positive effect on bone strength. It is estimated that one in every two Caucasian women will suffer from osteoporosis (bone loss). The largest amount of bone loss occurs in the first five years following menopause. It is important to conserve bone mass to avoid debilitating fractures of the hip, spine, and wrist.
For this reason, your provider may recommend continuing estrogen replacement indefinitely. If estrogen replacement is not for you, your provider may suggest and prescribe alternate bone strengthening medications. These include a new "selective estrogen," which helps to conserve bone but does not affect the reproductive organs. This medication can cause hot flashes so is generally recommended for women who do not experience menopausal hot flashes. It is also currently being studied to see its side effects on preventing breast cancer in high-risk individuals.
Talk to your doctor about this medication, if you think you are at high-risk for breast cancer, such as having a mother or sister with a history of breast cancer. Some studies have reported that estrogen replacement is associated with a higher incidence of breast cancer. Although this is a frightening prospect for all women, the rate of death or disability from heart disease or hip fracture is much higher.
You should discuss the pros and cons of estrogen with your doctor or nurse. Other medications used to combat osteoporosis include Fosamax and Miacalcin. Fosamax in smaller doses can be used to prevent bone loss; in higher doses it will actually result in bone growth and strengthening. It is the drug of choice for most women diagnosed with osteoporosis. Because it can cause esophagus irritation, it must be taken on an empty stomach with a full glass of water. No food or medications may be taken within 30 minutes after taking Fosamax and the individual should not lie down after taking.
Miacalcin is a nasal spray used for osteoporosis management. It is generally well tolerated but does not grow bone quite as much as the above mentioned medications. It is recommended that menopausal women take calcium replacement to prevent or enhance therapy for osteoporosis: Calcium Citrate 600 milligrams and 200 units of vitamin D twice a day for minimum daily requirement.
Daily weight bearing exercise is essential during the menopausal years. It is also important to have a bone density test to determine if you have osteoporosis. Granite Medical has a bone density scanner and two rheumatologists certified and specialized in bone density interpretation and osteoporosis management.
Hormone Replacement Therapy (HRT)
The most common regimen of HRT is combined estrogen and progesterone each day. It is important to take the combination if you haven't had a hysterectomy. Progesterone prevents build-up of the uterine lining. Continuous daily usage does not usually result in a monthly menses or vaginal bleeding. If after several months, you continue to experience vaginal bleeding or spotting, your provider may decide to change to cyclical estrogen/progesterone, to regulate the bleeding or discontinue the medication. If you have had a hysterectomy, only estrogen is needed and you will not experience vaginal bleeding. Some women may experience breast tenderness with estrogen. This usually improves with time.
Many women would like to try "natural" products for estrogen replacement. No studies have documented their benefits, but some menopausal symptoms have improved in some women. Until more definitive information is available, it is not generally recommended as the sole treatment for menopausal symptoms or osteoporosis management.
The decision to take hormone replacement is a very personal choice and must be discussed with your physician. He or she can help you sort through the risks and benefits in long-term therapy and if this is appropriate for you. Ultimately, the decision is yours. Becoming knowledgeable about the risks and benefits and making an informed choice is essential.
Happy Mother's Day!
Cecilia Mullen is a nurse practitioner at Granite Medical Group. The information in this column is not intended to diagnose individual conditions. Readers should see their own doctors about specific problems.