Menopause – thirdAGE https://thirdage.com healthy living for women + their families Tue, 13 Jun 2023 00:54:58 +0000 en-US hourly 1 https://wordpress.org/?v=5.7.2 Hormones and Hypertension https://thirdage.com/hormones-and-hypertension/ Tue, 13 Jun 2023 12:49:00 +0000 https://thirdage.com/?p=3077101 Read More→]]> Women ages 45 years and older taking estrogen hormone therapy in pill form were more likely to develop high blood pressure than those using transdermal (topical, applied to the skin) or vaginal formulations, according to new research published today in June 2023 in Hypertension, a peer-reviewed American Heart Association journal.

A woman’s body produces less estrogen and progesterone after menopause, changes that may increase the risk for cardiovascular diseases including heart failure, according to the American Heart Association.

Hormone therapy may be prescribed to relieve symptoms of menopause, in gender-affirming care and in contraception, and previous studies have found that some hormone therapies may reduce cardiovascular disease risk in menopausal women under 60 years of age or for whom it has been fewer than 10 years since menopause. The authors of this study noted that while high blood pressure is a modifiable risk factor for cardiovascular disease, the potential effects of different types of hormone therapy on blood pressure in menopausal women remain uncertain.

“It’s really important to have greater knowledge on safe and effective hormonal treatments for women during menopause. At the end of the day, it’s an individualized decision about what is best for the person going through menopause and should include open dialogue with their physician or health care team,” Ahmed said. “We need large, randomized studies factoring in all the complexities of hormone therapy around this important transition period in the female lifecycle.”

“We know estrogens ingested orally are metabolized through the liver, and this is associated with an increase in factors that can lead to higher blood pressure,” said lead study author Cindy Kalenga, an M.D./Ph.D.-candidate at the University of Calgary in Alberta, Canada.

“We know that post-menopausal women have increased risk of high blood pressure when compared to pre-menopausal women. Fthermore, previous studies have shown that specific types of hormone therapy have been associated with higher rates of heart disease,” Kalenga said. “We chose to dive deeper into factors associated with hormone therapy, such as the route of administration (oral vs. non-oral) and type of estrogen, and how they may affect blood pressure.”

This study involved a large group of over 112,000 women, ages 45 years and older, who filled at least two consecutive prescriptions (a six-month cycle) for estrogen-only hormone therapy, as identified from health administrative data in Alberta, Canada between 2008 and 2019. The main outcome of high blood pressure (hypertension) was identified via health records.T

First, researchers investigated the relationship between route of estrogen-only hormone therapy administration and risk of developing high blood pressure at least one year after starting the treatment. The 3 different routes of hormone therapy administration were oral (by mouth), transdermal and vaginal application. Additionally, researchers evaluated the formulation of estrogen used and the risk of developing high blood pressure. For this study, the researchers reviewed medical records of individuals taking estrogen-only hormone therapy. The two most common forms of estrogen used by study participants were estradiol — a synthetic form of estrogen that most closely mimics what is naturally produced in women’s bodies in the premenopausal years — and conjugated equine estrogen, an animal-derived form of estrogen and the oldest type of estrogen therapy.

The analysis found:

Women taking oral estrogen therapy had a 14% higher risk of developing high blood pressure compared to those using transdermal estrogen and a 19% higher risk of developing high blood pressure compared to those using vaginal estrogen creams or suppositories.

After accounting for age, a stronger association was seen among women younger than 70 years of age compared to women older than 70.

Compared to estradiol, conjugated equine estrogen was associated with an 8% increased risk of developing high blood pressure.

Taking estrogen for a longer period of time or taking a higher dose was associated with greater risk of high blood pressure, the authors noted. According to Kalenga, the study’s findings suggest that if menopausal woman take hormone therapy, there are different types of estrogen that may have lower cardiovascular risks.

“These may include low-dose, non-oral estrogen — like estradiol, in transdermal or vaginal forms — for the shortest possible time period, based on individual symptoms and the risk–benefit ratio, Kalenga said. “These may also be associated with the lowest risk of hypertension. Of course, this must be balanced with the important benefits of hormone therapy, which include treatment of common menopausal symptoms.”

The average age of natural menopause among women worldwide is about 50 years of age. Current evidence supports that initiating menopausal hormone therapy in the early stages may have cardiovascular benefits, though not in the late stages of menopause, according to the American Heart Association’s 2020 Statement on Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. Previous studies have found that menopausal hormone therapy may help relieve symptoms of menopause, including hot flashes, night sweats, mood changes or sleep disturbances.

“Over a quarter of the world’s population of women are currently older than the age of 50. By 2025, it’s estimated that there will be one billion menopausal individuals on the planet,” said study co-author Sofia B. Ahmed, M.D., M.M.Sc., a professor of medicine at the University of Calgary, Alberta, Canada. “Approximately 80% of people going through menopause have symptoms, and for some it lasts up to seven years. While menopause is a normal part of the aging process, it has huge implications for quality of life, economic impact, work productivity and social relationships. We need to give people the information they need to choose the most effective and safe hormonal treatments for menopause.”

The study had several limitations. The impact of different forms of hormone therapy on high blood pressure outcomes were based only on medical records. The study did not include women younger than the age of 45 and did not collect data about hysterectomies or menopausal status; however, the researchers used initiation of estrogen therapy in women over the age of 45 to indicate postmenopausal status. The researchers included estrogen-only therapy in this study, which is most often prescribed for women who have had a hysterectomy (surgical removal of the uterus), whereas women with an intact uterus may receive a combination of estrogen and progestin, another type of hormone. This means these findings may only be considered for women taking estrogen-only hormone therapy, the authors noted. Additionally, the study’s findings cannot offer definitive insights on other populations who may benefit from estrogen hormone therapy, including women who have an intact uterus or women who experience premature or early menopause.

The research study reviewed women in Canada, which may present differences. However, current guidelines in Canada align with U.S. guidelines from the American College of Obstetricians and Gynecologists. Both recommend the use of hormone therapy in women with appropriate indications and note that hormone therapy should not be considered as prevention or treatment of hypertension or heart disease.

]]> A pragmatic approach to the management of menopause https://thirdage.com/a-pragmatic-approach-to-the-management-of-menopause/ Fri, 26 May 2023 04:00:00 +0000 https://thirdage.com/?p=3077058 Read More→]]>
KEY POINTS

  • Menopausal symptoms can occur for as long as 10 years before the last menstrual period and are associated with substantial morbidity and negative impacts on quality of life.

  • Menopausal hormone therapy is indicated as first-line treatment of vasomotor symptoms, and is a safe treatment option for patients with no contraindications.

  • Though less effective, nonhormonal treatments also exist to treat vasomotor symptoms and sleep disturbances.

  • It is critical that clinicians inquire about symptoms during the menopause transition and discuss treatment options with their patients.

Menopause is defined as 1 year of amenorrhea caused by declining ovarian reserve or as the onset of vasomotor symptoms in people with iatrogenic amenorrhea. It is preceded by perimenopause or the menopause transition, which can last for as long as 10 years. Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment. In this review, we summarize the evidence for treating menopausal symptoms and discuss their risks and benefits to help guide clinicians to evaluate and treat patients during the menopausal transition (Box 1).

Box 1: Evidence used in this review

We searched PubMed from inception until April 2022 using the term “menopause” with keywords “symptoms,” “diagnosis” and “treatment.” We also reviewed relevant articles from the reference lists of selected articles. Selected articles included a combination of systematic reviews, practice guidelines, randomized controlled trials and cohort studies.

What is the prevalence and impact of menopausal symptoms?

The median age of menopause is 51 years, which has remained consistent over the last century, despite a trend toward an earlier age of menarche.1,2 “Symptoms of menopause often start during the perimenopausal period, even as early as 10 years before the last menstrual period.1,3 Globally, 1.0%–3.7% of women experience premature ovarian insufficiency, which leads to menopause before age 40 years and has a variety of causes, including chromosomal abnormalities, autoimmune processes, cancer treatment, surgery or idiopathic etiologies.4

Menopausal symptoms are variable and reflect a complex interaction between biological, psychological and social factors. Vasomotor symptoms (e.g., hot flashes, night sweats) are the most commonly reported and may affect as many as 80% of women.5 Most vasomotor symptoms persist for fewer than 7 years after the final menstrual period; however, 25% of women may experience flushing for as long as 10 years, and 10% have these symptoms for more than 10 years.6 In addition, vasomotor symptoms have been shown to independently predict increased cardiovascular risk, bone loss and high bone turnover.7,8

A higher burden of menopausal symptoms is associated with decreased mental and physical quality of life.9 The transition into menopause, irrespective of symptoms, has also been associated with decreased health-related quality of life.10 Symptoms can substantially affect work productivity, as well as health care use and costs.9,11,12

How is menopause diagnosed?

For people older than 45 years who have symptoms of menopause or amenorrhea, a work-up with laboratory tests and imaging is not indicated unless symptoms are suggestive of an alternative diagnosis. Pregnancy should be ruled out among sexually active patients who are not using contraception.

For patients younger than 45 years who present with irregular or absent menstrual cycles, clinicians should order follicle-stimulating hormone (FSH) levels, although FSH levels vary considerably during perimenopause.13 Endocrine disorders should be ruled out as causes of secondary amenorrhea (e.g., hyperprolactinemia, hypothyroidism), as well as pregnancy (Table 1). For patients younger than 40 years who present with irregular cycles and menopausal symptoms, clinicians should conduct a complete work-up for secondary amenorrhea, including a FSH and serum estradiol.

Table 1:

Investigations for secondary amenorrhea when indicated for patients younger than 45 years

 

For patients with vasomotor symptoms that are atypical, more frequent than would be expected or associated with other symptoms not usual in menopause, alternative diagnoses should be considered — such as carcinoid syndrome, pheochromocytoma, and hematologic or solid organ malignant diseases — and investigated accordingly (Table 2).

Table 2:

Red flags and secondary work-up to consider for menopausal patients with vasomotor symptoms

 

How should troubling symptoms be treated?

Menopausal hormonal therapy

Several international societies, including the Society of Obstetricians and Gynaecologists of Canada and the North American Menopause Society, recommend menopausal hormone therapy as the first-line treatment for vasomotor symptoms for both menopausal and perimenopausal patients.14,15 The estrogen component of menopausal hormone therapy reduces bothersome menopausal symptoms, while the progestin protects the endometrium from hyperplasia and reduces the risk of endometrial cancer. Treatment with combined estrogen and progestin regimens (or estrogen alone, in patients who have had a hysterectomy) reduces the frequency and severity of hot flashes and night sweats by around 75%.16 In Canada, systemic estrogens are available in oral form, or as a transdermal patch or gel; vaginal formulations exist in the form of creams, vaginal tablets or an insertable ring. Transdermal estrogen formulations bypass the first-pass effect of the liver and may be safer than other formulations with regard to stroke and clot risk.14 Progestins are available as both synthetic progestins and micronized progesterone, and come in the form of oral pills, transdermal systems (in combination with estrogen) and an intrauterine device (Table 3).

Table 3:

Systemic menopausal hormone therapy products available in Canada

 

Newer, single-dose combination treatments like tissue selective estrogen complexes (TSECs; e.g., conjugated estrogen and bazodoxifene) and selective tissue estrogen activity regulators (e.g., tibolone) can also be used as first-line treatments in place of traditional combination estrogen–progestin products. Tibolone carries similar risks to standard menopausal hormone therapy. 17 Although TSECs have similar adverse effects as menopausal hormone therapy, they are associated with less break-through bleeding and mastalgia; however, they have been unavailable in Canada since 2020 because of a packaging problem that has recently been resolved.

In the absence of contraindications, menopausal hormone therapy is the treatment of choice for patients within 10 years of their final menstrual period or, if this is unknown, younger than 60 years (Table 4).14,16 Standard doses of menopausal hormone therapy for patients of average menopausal age are included in Table 3; doses for patients with premature ovarian insufficiency should be higher.18 Duration of treatment after starting menopausal hormone therapy is no longer limited to 5 years, but rather is individualized, where the safest regimen is used at the appropriate doses to control symptoms.15 For patients with premature ovarian insufficiency, hormone replacement should continue until the average age of menopause, irrespective of symptom burden and in absence of contraindications.

Table 4:

Contraindications to systemic menopausal hormone therapy14

 

In Canada, no product for testosterone treatment has been approved or recommended for menopausal symptoms, but the International Menopause Society has a position statement regarding the off-label treatment of menopausal hypoactive sexual desire.19

Nonhormonal therapies

Although less effective than menopausal hormone therapy,17 nonhormonal options should be considered if menopausal hormone therapy is not appropriate because of contraindications or patient preference.14 Options include certain selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), gabapentinoids, clonidine and oxybutynin (Table 5). Gabapentionoids are particularly useful when taken at night to help alleviate nocturnal symptoms. A newer class, still awaiting approval, is the neurokinin-3 receptor antagonist, which acts to stabilize the temperature control centre in the hypothalamus. 20 Although some herbal supplements have been associated with improvement in menopausal symptoms, a review of nonpharmacologic treatments is beyond the scope of this article; the topic was recently reviewed in a menopause practice guideline by the Society of Obstetricians and Gynecologists of Canada.14

Table 5:

Nonhormonal menopausal treatments and suggested doses14

 

What are the benefits and risks of menopausal hormone therapy?

Benefits

Menopausal hormone therapy can improve vasomotor symptoms by as much as 90% in patients with moderate-to-severe hot flushes.21 It also improves sleep quality22 and mood disturbances. 23,24 Although systemic menopausal hormone therapy may also alleviate genitourinary syndrome of menopause, patients being treated primarily for this issue can be treated with lubricants, moisturizers, vaginal estrogens or oral selective estrogen receptor modulators alone.

Despite early concerns of an increased risk of cardiovascular events with menopausal hormone therapy after the Women’s Health Initiative (WHI) trial,25 increasing evidence shows a possible reduction in coronary artery disease (CAD) with menopausal hormone therapy among younger menopausal patients, specifically those who start menopausal hormone therapy before age 60 years or within 10 years of menopause.26–30 Data from both randomized controlled trials (RCTs) and observational studies consistently show that menopausal hormone therapy is associated with a reduction in CAD events among these patients; menopausal hormone therapy should therefore be preferentially started during these time windows.29 A reduction in overall mortality among patients who begin menopausal hormone therapy before age 60 years has also been reported.27,31

The metabolic benefits of menopausal hormone therapy include an improvement in lipid profile (increase in high-density lipoprotein, decrease in low-density lipoprotein, decrease in lipoprotein [a]), although oral estrogen may also increase triglyceride levels.32 Some studies suggest an improvement in insulin sensitivity and, perhaps, a reduction in risk of diabetes.33–35 For both lipid and insulin sensitivity, the benefits are seen primarily with oral estrogen therapy rather than transdermal formulations, given their hepatic first-pass effects.

Menopausal hormone therapy has been consistently associated with a reduction in the incidence of osteoporosis-related fractures.25,36,37 The WHI study provided the best evidence on fracture risk reduction with menopausal hormone therapy, reporting a 34% reduction in hip fractures, a 34% reduction in vertebral fractures and a 23% reduction in other osteoporotic fractures among women who took hormone therapy compared with those who did not.25 Although menopausal hormone therapy is not recommended by most osteoporosis guidelines as a primary treatment, it should be considered as a second-line treatment in symptomatic menopausal patients.38

Risks

Although many RCTs and observational studies have shown an increased risk of breast cancer with menopausal hormone therapy, these findings need to be interpreted carefully in the context of the individual patient. The WHI first reported that patients treated with combined menopausal hormone therapy had an increased risk of invasive breast cancer (hazard ratio 1.2).39 However, the attributable risk is much lower among people aged 50–59 years or among those who start treatment within the first 10 years of menopause, for whom the additional risk of breast cancer is estimated at 3 additional cases for every 1000 women who use combined menopausal hormone therapy for 5 years.40 In the WHI 20-year follow-up study, patients on conjugated estrogen alone showed a lower risk of breast cancer than those on placebo. Other studies also showed a lower risk of breast cancer among those on estrogen alone, compared with those on combined menopausal hormone therapy,41,42 with synthetic progestins conferring a higher risk of breast cancer than micronized progesterone.43 In patients with additional risk factors for breast cancer (e.g., family history, obesity, alcohol intake), the lowest effective dose of micronized progesterone or no progestin should be considered, if appropriate (i.e., TSEC or estrogen alone).

Although early RCT data suggested an increased risk of ischemic stroke among patients on menopausal hormone therapy (odds ratio 1.29), more recent data suggest that this risk is primarily among older patients (aged > 60 yr) who start menopausal hormone therapy after the 10 years following the onset of menopause. 44 For those younger than 60 years, the absolute risk of stroke from standard dose hormone therapy is about 2 additional strokes per 10 000 person-years of use. With regard to venous thromboembolic events, the WHI reported a twofold increased risk with hormone therapy, with the risk highest in the first year of use and with higher doses.25 The reported absolute risk was 2–10 cases per 1000 users with short-term use (< 2 yr) and up to 28 cases per 1000 users with long-term use (> 7 yr).45 Most recent studies show a lower risk of venous thromboembolic events with transdermal estrogen formulations compared with oral treatments.46–48

What are the considerations for starting menopausal hormone therapy?

For average-aged menopausal or perimenopausal patients with no contraindications for menopausal hormone therapy and no specific individual risk factors, no specific hormone regimen is preferred for menopause management. When starting a patient on menopausal hormone therapy, clinicians should consider the patient’s individual risk of disease (e.g., breast cancer, venous thrombolic events, stroke), preferred mode of delivery (oral v. transdermal, combination v. separate dosing), need for uterine protection and cost. Patients with risk factors for specific diseases like breast cancer should be offered an individualized regimen (e.g., the TSEC, conjugated estrogen alone, combination therapy with cyclic progesterone). Similarly, a patient at risk for venous thromboembolic events should be offered low-dose transdermal therapy.

Common adverse effects of menopausal hormone therapy include vaginal bleeding, mastalgia and headache. Unexpected vaginal bleeding is the most common adverse event with menopausal hormone therapy. Investigations for endometrial hyperplasia or cancer should be performed (i.e., ultrasonography, endometrial sampling) if the bleeding persists beyond 4–6 months, or in a patient with risk factors for endometrial cancer. It is not necessary to cease use of menopausal hormone therapy while investigations are ongoing. Options for decreasing unexpected vaginal bleeding include sequential progestin dosing (i.e., 12–14 days of the month); use of a levonorgestrel-releasing intrauterine system, tibolone or the TSEC (when available); or, in rare cases, hysterectomy. Evaluation of the endometrium with ultrasonography and histologic sampling, and titration of the dose of estrogen or progestin based on thickness and histologic phase, can be performed with or without referral to a gynecologist based on the comfort of the managing physician.

Mastalgia is a common estrogenic adverse effect and can raise concerns regarding breast cancer. It will usually improve over the first 3–4 months of treatment. Approaches to managing mastalgia include minimizing estrogen to the lowest effective dose or using conjugated estrogens, cyclic progestin dosing, tibolone or the TSEC (when available).49

Migraine is not a contraindication to the use of systemic menopausal hormone therapy. Migraine symptoms can be improved for some patients by using regular, continuous dosing of both estrogen and progesterone. For patients with contraindications to menopausal hormone therapy, escitalopram and venlafaxine have evidence both for improvement of vasomotor symptoms and migraine suppression.50

Conclusion

Menopause and perimenopause can be associated with distressing symptoms and reduced quality of life. Menopausal hormone therapy is the first-line treatment for vasomotor symptoms in the absence of contraindications. Patients with contraindications to estrogen and progestin therapy can be offered nonhormonal alternatives. Choice of menopause treatments depends on symptoms, patient preference, risk factors, absolute contraindications, availability and costs. Complex patients should be referred to specialists. Important clinical questions remain unanswered and should be tackled by future research (Box 2).

Box 2: Unanswered questions

  • What is the optimal duration of treatment for menopausal hormone therapy?

  • Are any hormonal formulations superior for either cardiovascular or bone protection?

  • What are the optimal hormonal formulations to minimize risk from menopausal hormone therapy with regards to breast cancer and venous thromboembolic events?

  • Will newer nonhormonal agents that act directly on brain receptors offer cardiovascular or bone protection?

  • What is the work-up for vasomotor symptoms that are suspected to be nonmenopausal in etiology?

  • What is the evidence for nonpharmacologic and lifestyle approaches to menopause management?

Footnotes

  • Competing interests: Iliana Lega holds research funding from the Canadian Institutes of Health Research (CIHR) and Canadian Menopause Society, and has received travel support from Diabetes Canada. Michelle Jacobson reports funding from CIHR, travel support from Women’s College Hospital and consulting fees from Abbvie, Astellas, Biosyent, Duchesnay, Lupin and Pfizer. She has received honoraria from Abbvie, Bayer, Biosyent, Duchesnay, Lupin, Organon, Pfizer and Searchlight. She consults on Duavive, Tibolone, Mirena and Estrogel. She is a vice chair with the Ontario Medical Association, and sits on the advisory boards of Pfizer, Duchesnay, Astellas, Lupin and Eisai. No other competing interests were declared.

  • This article was solicited and has been peer reviewed.

  • Contributors: Iliana Lega, Alexa Fine and Michelle Jacobson were involved in the conception and design of this manuscript. All of the authors drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

  • Funding: There is no funding associated with this manuscript.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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Canadian Medical Association Journal: 195 (19)
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Vol. 195, Issue 19
15 May 2023
 

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  • Vacancies: 3 Terms of Employment: This is a full-time position 36 to 40 hours per week Must be available daytime, evenings, and weekends. Part-time, Casual or Locum opportunities are also available. Anticipated Start Date: As soon as possible Salary: Fee for Service (Approximately $235,000 to $335,000 per year) Location: 407 Iroquois Shore Rd. Oakville, ON L6H 1M3 Experience: Minimum one year Education: Doctor of Medicine Work Setting: Medical Clinic Language: English License : CCFP / College of Family Physicians Certificate Licensure by Provincial or Territorial Authorities / Medical Council of Canada Medical Council of Canada Qualifying Examination (MCCQE 1) Family physician’s primary duties: Examining patients and taking their histories Order laboratory tests, X-rays, and other diagnostic procedures Consult with other medical practitioners to evaluate patients’ health Prescribe and administer medications and treatments Inoculate and vaccinate patients to prevent and treat diseases Advise patients on healthcare Communicate health promotion/disease prevention to patients Provide Counselling and support to patients and their families on a wide range of health and lifestyle issues Please apply by: Mail or in-person: 407 Iroquois Shore Rd. Oakville, ON L6H 1M3 Email: onehealthoakville01@gmail.com
  • The Saskatchewan Cancer Agency is looking for a Clinical Associate Locum to join our team in Regina. The Clinical Associate will work with in a multidisciplinary team to provide safe patient-centered care. In collaboration with the oncologist, they will participate in daily rounds, provide care to oncology hospital in-patient, hospital and Cancer Centre outpatients and provide after hour care as per the on call duty schedule. The outpatient role involves primarily assessment and follow-up care. Practice Location: Allan Blair Cancer Centre, 4101 Dewdney Ave, Regina, Saskatchewan Canada S4T 7T1 Population Base: Saskatchewan has a population of 1.2 million. The Allan Blair Cancer Centre provides comprehensive cancer care to those living in the southern parts of the province. Job Requirements: Education: Degree in medicine with subspecialty certification in internal medicine or oncology. Preference given to candidates Oncology experience. Completion of a Canadian Oncology fellowship is considered an asset. Certification through the Medical Council of Canada (or successful completion of the MCCQE1 exam) Credentials: Must be eligible for licensure with the College of Physicians and Surgeons of Saskatchewan. Must be eligible for membership and privileges with the Saskatchewan Health Authority in Regina. Other: Criminal record check CMPA Coverage Written and verbal fluency in English. A minimum of 7.0 in all categories in IELTS exam is required for all international medical graduates. Salary Details: A competitive compensation package is offered and will be commensurate with experience. Salary range for this position is $263,455 – $352,030, plus benefits. How to Apply: For more information regarding this opportunity, contact Dr. Magdi Ali, Regina Team Lead – Clinical Associates, at Magdi.Ali@saskcancer.ca . Interested applicants are invited to submit their letter of intent and curriculum vitae to: Physician Recruitment and Retention Consultant Saskatchewan Cancer Agency 130-1804 McOrmond Drive Saskatoon, Saskatchewan Canada S7S 0A6 p hysician.careers@saskcancer.ca Deadline for application : Applications will be accepted until filled. We thank all candidates for their interest. Only those selected for an interview will be contacted. In accordance with Canadian immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada.
  • The Saskatchewan Cancer Agency operates prevention and early detection programs, conducts innovative research and provides safe, patient and family-centred care at our two comprehensive cancer centres – the Allan Blair Cancer Centre in Regina and the Saskatoon Cancer Centre. The provincial hematology program focuses on the diagnosis and treatment of patients with both benign and malignant hematological conditions, including full provision of autologous and allogeneic stem cell transplant services in our Saskatoon location. Practice Loctation(s): Regina Hematology Clinic, 4545 Parliament Ave, Regina, SK, S4W 0G3 Allan Blair Cancer Centre, 4101 Dewdney Ave, Regina, SK, S4T 7T1 Job Duties: We are looking for two hematologists to join the Saskatchewan Cancer Agency in Regina on a permanent, full-time basis. The positions will have responsibilities in the care of both benign and malignant patients, the proportion of each to be determined in collaboration with the team. A competitive compensation package is offered and will be commensurate with experience. The current salary range is $340,263 to $439,113, plus benefits. Call Schedule Description: The call schedule will be established based on an equal rotational basis with other hematologists in the department(s). Compensation for on-call coverage at the standard rate of payment prescribed by the the Saskatchewan Ministry. Our hematologists are eligible for a clinical appointment in the Division of Oncology, College of Medicine at the University of Saskatchewan and are also involved in teaching medical students and Residents including at the undergraduate and graduate level. Job Requirements: The successful applicant will have obtained or be in the final stages of obtaining certification in Hematology with the Royal College of Physicians and Surgeons of Canada or have equivalent education, training and experience. They must be able to work in a multidisciplinary setting, and engage collaboratively with the team. The successful candidate must also be eligible for licensure with the College of Physicians and Surgeons of Saskatchewan , meet the requirements for membership in the medical staff of the Saskatchewan Health Authority (Regina) and hold valid CMPA coverage. Other Requirements: Criminal record check Written and verbal fluency in English Population Base: The population of Saskatchewan is 1.2 million. The Allan Blair Cancer Centre and Regina Hematology Clinic provide comprehensive cancer care to those living in the southern parts of the province. Saskatchewan is a growing and prosperous province. Saskatchewan offers a world of endless possibilities. Interested applicants are invited to submit their curriculum vitae to: Physician Recruitment and Retention Consultant Saskatchewan Cancer Agency 120-1804 McOrmond Drive Saskatoon, Saskatchewan Canada S7S 0A6 E-mail: physician.careers@saskcancer.ca We thank all candidates for their interest. Applications will be accepted until the position is filled. Review of applicants will be ongoing. Only those selected for an interview will be contacted. For more information on this opportunity, please contact Regina Hematology Team Lead Dr. Abdulhakim Eswedi at Abdulhakim.Eswedi@saskcancer.ca. Community Information: City of Regina: www.regina.ca; www.tourismregina.com Province of Saskatchewan: www.saskatchewan.ca; www.sasktourism.com; www.saskatchewan.ca/immigration Please note, In accordance with Canadian immigration requirements, preference will be given to Canadian citizens and permanent residents of Canada.
  • The Division of Respirology in the Department of Pediatrics at Dalhousie University and the IWK Health Centre is seeking a full-time (1.0 FTE) physician at the Assistant, Associate or Full Professor level. The individual will join a team of two respirologists. The Division provides care to children with a wide variety of respiratory conditions like asthma, sleep medicine, complex respiratory care, home ventilation, non-CF bronchiectasis/PCD, and is the regional Centre for Cystic Fibrosis. In addition to outpatient care, the division provides usual ward care, consult service, and equally divided on-call coverage. Bronchoscopy skills are essential. Additional training in interstitial lung disease, aero-digestive and/or sleep medicine will be an asset to complement our group practice. The successful applicant will contribute to the academic mission of the Department of Pediatrics through research and teaching trainees at different stages of their training. The IWK Health Centre is a tertiary care children’s and women’s facility serving the Maritime Provinces of Canada. Dalhousie University, Atlantic Canada’s leading research university, offers a range of collaborative research and teaching possibilities. Cross-appointment to relevant Departments is possible for interested candidates. Qualifications include an MD degree (or equivalent) from an accredited university, certification in Pediatrics and certification in Pediatric Respirology Medicine (or equivalent). Eligibility for medical licensure in the Province of Nova Scotia is essential. Compensation and academic appointment is commensurate with experience and qualifications. Dalhousie University < http://www.dal.ca/ > is located in Halifax < http://www.halifaxinfo.com/ > , a cosmopolitan port city and the capital of Nova Scotia < http://www.novascotia.com/ > . Halifax is alive with culture and heritage and embraced by the Atlantic Ocean. Interested applicants must submit a current CV and a statement outlining their academic, teaching and research interests. Candidates must also provide the names and contact information for three referees (two of which must be academic). Applications will be accepted July 26, 2023 To apply for this position, please go to: http://dal.peopleadmin.ca Dalhousie University commits to achieving inclusive excellence through continually championing equity, diversity, inclusion, and accessibility. The university encourages applications from Indigenous persons (especially Mi’kmaq), persons of Black/African descent (especially African Nova Scotians), and members of other racialized groups, persons with disabilities, women, and persons identifying as members of 2SLGBTQ+ communities, and all candidates who would contribute to the diversity of our community. For more information, please visit www.dal.ca/hiringfordiversity

 

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]]> 5 Signs That You’re Entering Menopause https://thirdage.com/5-signs-that-youre-entering-menopause/ Fri, 12 Jun 2020 04:00:37 +0000 http://thirdage.com/?p=3072523 Read More→]]> Menopause is a natural part of aging for women, but there is no predictable pattern or timeline for the symptoms, doctors say.

While hot flashes, irritability and weight gain are generally well known, symptoms like anxiety, hair loss, and incontinence can catch a woman by surprise and cause concern, even though they’re normal.

Many myths exist about what to expect when going through menopause. It’s important to know your body well enough to know what’s happening and get reassurance that what’s going on is normal.

Here are five normal menopausal symptoms women can watch for:

  • Anxiety/depression.

    Depression and anxiety shouldn’t be ignored; they can appear as your body changes, and need to be treated. “If you have a history of anxiety and/or depression, you are likely to experience it again in perimenopause – the menopause transition. Decreasing progesterone and overactive adrenals may be partially responsible for the anxiety you’re feeling, and progesterone has been implicated in depression, too. So, don’t think depression and anxiety are just ‘all in your head.

  • Hair loss and hair growth. 

    Hormone changes can cause hair growth where you least want it. At the same time, these hormone changes – specifically, decreasing estrogen and the changing ratio of estrogen to testosterone – are responsible for thinning hair on the scalp, especially on the crown and near the forehead.

hair loss woman

  • Behavioral changes. 

    Behavior can tip off a woman to menopausal symptoms. If you’re not feeling like yourself and your partner has complained about you treating them differently. It could be an indication of lower estrogen levels. Estrogen is actually a key driver of women’s nurturing behavior and desire to take care of others. When levels decline in perimenopause, women can find themselves thinking, feeling and behaving in a way that’s unfamiliar. This biological change can have huge consequences for family dynamics.”

  • Appearance of vagina.

    Age and hormones affect the appearance of the vagina. The pubic hair can go gray, thin, or disappear altogether; the skin can change color; and the labia minora can lengthen or sag. All of these changes are completely normal.

  • Incontinence.

    Decreasing estrogen is responsible for the thinning of the vaginal walls, and that means the urethra doesn’t have the support it used to in order to hold urine in. Urine leakage is very common; around 50% of women will experience some form of incontinence in their lifetime.

Every woman is different, but there’s no need to worry and suffer in silenc. Talk with your gynecologist to learn more about the symptoms, discuss what you’re experiencing, and ways to treat them.

Dr. Arianna Sholes-Douglas, MD, FACOG(www.drarianna.com), author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35, is the founder and visionary of Tula Wellness Center, a unique medical practice in Tucson, Ariz., focusing on women’s health and beauty. Dr. Sholes-Douglas has dedicated her career to helping women through the stages of life but currently focuses on treating women experiencing perimenopause and menopause. She is board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. Dr. Sholes-Douglas, who has practiced medicine for 29 years, specializes in integrative women’s health, a subspecialty of gynecology that incorporates evidenced-based alternative medical therapies to promote healing. She has served as clinical faculty at UCLA, the University of Maryland, and Johns Hopkins School of Medicine. Dr. Sholes-Douglas has made numerous media appearances on the Discovery Health Channel and served as the “Woman’s Doctor” on Baltimore’s NBC news affiliate. Her writing has been published in Good Housekeeping and Essence, and she’s also appeared in Yahoo! News and Prevention.

 

]]> Is Hormone Therapy Safe for You? https://thirdage.com/is-hormone-therapy-safe-for-you/ Thu, 26 Dec 2019 05:00:12 +0000 https://thirdage.com/?p=3071504 Read More→]]> Who doesn’t want to look and feel younger? A flock of anti-aging products and medical clinics cater to this desire, but health experts caution that pursuing the so-called fountain of youth without being properly informed can be hazardous to your health.

Determining fact from fiction can be a challenge in today’s sea of contradictory Internet information, and hormone replacement therapy (HRT) is a good example. HRT, a popular choice of women to combat the effects of menopause, can pose health risks, while some medical organizations say it also can bring benefits.

The Internet is cluttered with myths and outdated information about hormone therapy, Nobody makes HRT easy for the patients — or most doctors — to understand. There is much debate in the medical community about who should be on HRT and who should not. But it is most important to see a provider who has your long-term health in mind.

Here are some important thoughts to consider when weighing hormone replacement therapy as an option:

  • Remember: Not all hormones are created equal.

    Given the risks and potential side effects of traditional hormone therapy, women have considered bioidentical hormones as an alternative. These are manufactured from a plant chemical extracted from yams and soy, and they are identical in molecular structure to the hormones women make in their bodies. But bioidentical hormones carry the same risks as synthetic hormones. Bioidentical hormones are controversial, and the FDA has been slow to approve them. Yet whether you choose bioidentical hormones or traditional hormones, the three most common hormones that we try to balance through hormone replacement and supplementation are estrogen, progesterone, and testosterone. If you’re going to replace a hormone, it makes sense to replace it as closely as possible to the one that your body already produces

bioidentical hormones

  • Weigh carefully the risks versus the benefits.

    Don’t avoid replacing certain hormones because you think they might cause cancer. Even if a drug therapy has a theoretical risk, it’s not a risk for every person the same way. Genetics, diet, and toxic exposures all play integral roles. Estrogen in and of itself isn’t always the culprit. Do your research and discover the realities. Ask your gynecologist to evaluate the risks and benefits in your own case.

  • Choose carefully where you get your hormones.

    FDA scrutiny of compounding pharmacies increased after such a facility distributed products that weren’t sterile, resulting in numerous deaths. Still, even with more FDA oversight, caution is advised. One of the trickiest aspects of prescribing hormones to patients is the role of compounding pharmacies. It’s important to do your research before enlisting one.

  • Use sparingly.

    The goal of hormone replacement is to give you the lowest dose for the least amount of time. It’s probably going to benefit you most in your mid-40s to your mid-50s, an age range when hormones are generally considered safe, especially if you’re taking a low dose for a short period of time.

Most women can manage menopausal symptoms through diet, lifestyle, and supplements. But for some, HRT can be the difference between living your best life or suffering through “the change”. It’s not an easy road to navigate, which is why it is so important to be an informed patient.

Arianna Sholes-Douglas, MD, FACOG (www.drarianna.com), author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35, is the founder and visionary of Tula Wellness Center, a unique medical practice in Tucson, Ariz., focusing on women’s health and beauty. Dr. Sholes-Douglas has dedicated her career to helping women through the stages of life but currently focuses on treating women experiencing perimenopause and menopause. She is board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. Dr. Sholes-Douglas, who has practiced medicine for 29 years, specializes in integrative women’s health, a subspecialty of gynecology that incorporates evidenced-based alternative medical therapies to promote healing. She has served as clinical faculty at UCLA, the University of Maryland, and Johns Hopkins School of Medicine. Dr. Sholes-Douglas has made numerous media appearances on the Discovery Health Channel and served as the “Woman’s Doctor” on Baltimore’s NBC news affiliate. Her writing has been published in Good Housekeeping and Essence, and she’s also appeared in Yahoo! News and Prevention.

]]> Hormone Therapy and Cognitive Impairment https://thirdage.com/hormone-therapy-and-cognitive-impairment/ Fri, 22 Jun 2018 04:00:05 +0000 https://thirdage.com/?p=3064682 Read More→]]> It’s well known that hormones can affect everything that goes on in a woman’s body, from sexual libido to weight gain and overall mood. Now, though, a new study shows that in the right combination, they may also help with mild cognitive impairment (MCI) in post-menopausal women.

The study was published in Menopause, the journal of The North American Menopause Society (NAMS).

MCI is defined as that intermediate stage between normal aging and dementia. Persons with MCI have an increased risk of progressing to Alzheimer’s disease or other dementia, with roughly 20% of this population crossing over from MCI to a more severe level each year. To date, no pharmacologic treatment has proven effective in managing MCI.

According to a news release from NAMS, the article, “Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial,” reviews the results from a recent Korean study regarding the effect of hormone therapy on cognitive function. The study followed postmenopausal women who were diagnosed with MCI and taking donepezil (Aricept) over a 24-month period and showed that cognitive test scores for the women who received hormone therapy [plus donepezil] significantly increased during that time. Although the study group was small, the study offers promising results, demonstrating that the combination of transdermal estradiol and an oral progesterone can slow down cognitive decline. This is the first known study to evaluate the effect of hormone therapy on MCI.

“This encouraging, small pilot trial suggests a possible benefit of hormone therapy when given to women diagnosed with MCI who are also taking donepezil, a cholinesterase inhibitor,” Dr. JoAnn Pinkerton, executive director of NAMS, said in the news release. “Higher global cognition was seen in two of the three key evaluation criteria in those women using estradiol gel plus an oral micronized progesterone compared with those in the placebo group. Larger trials are needed to evaluate the effect of hormone therapy use before the full onset of Alzheimer’s disease.”

]]> Menopause and Weight Loss https://thirdage.com/menopause-and-weight-loss/ Wed, 28 Mar 2018 04:00:36 +0000 https://thirdage.com/?p=3060944 Read More→]]> Editor’s note: If, like so many women, you’re confronting the issue of weight gain and menopause, here’s some advice from Dr. Deena Solomon, a Santa Monica-based weight management expert and the author of Immaculate Consumption: The Path to Lifelong Weight Management:

Develop Patience: Neutralize your mindset by reframing menopausal types of experiences. Being informed about the effects of estrogen provides a greater sense of control. First and foremost, women will need lots more patience to achieve weight loss during menopause, since the process is ultimately more demanding. It’s important for women to understand that they will have successful weight loss, but it will just take a bit more time to see results.

Recognize Various Hormonal Changes in the Body: Women may feel depressed for long periods, but it may be the hormonal changes going on in their bodies. It’s very possible to experience mood swings from being sad for a time, to feeling very happy overnight.

Consume Less Salt: After eating Chinese food, which is high in sodium, I typically show a three- or four-pound weight gain the following day. Pre-menopause, it might have taken only one day to lose this gained weight. Post-menopause, it can take two to three days.

Take Control of Emotions and Anxiety: Becoming familiar with physical sensations during hormonal changes will de-emotionalize the event. Saying to oneself, “This is not something bad but merely my body’s natural reaction to hormonal changes.” This will provide an immediate sense of relief. If people start to experience counterproductive emotions because of their body’s changes and resistance to dieting protocols, I suggest doing exercise to get a handle on these negative feelings. Finally, becoming aware why dieting protocols, which were once effective in the past, seem to be ineffective now will help manage anxiety during this time. As noted previously, knowing more about the effects of hormonal changes during menopause will allow women to begin to experience less frustration and feelings of hopelessness regarding weight management issues.

For more on Dr. Solomon’s work, click on her byline, above.

]]> Depression and Menopause https://thirdage.com/depression-and-menopause/ Fri, 15 Sep 2017 04:00:42 +0000 https://thirdage.com/?p=3057713 Read More→]]> Experts from the London Women’s Centre tell you how to handle the depression that too often occurs with menopause:

Women are particularly vulnerable during menopause, as they tend to experience huge hormonal changes, often significantly affecting moods. During menopause, women are four times more likely to suffer from depression than those under the age of 45.

What is depression?

Depression is a common but serious mental health illness that affects how a person feels, thinks and acts. It is the feeling of extreme sadness and can lead to various other problems, both emotional and physical, if not properly treated. For a diagnosis of depression, symptoms must last for at least two weeks.

If you are constantly feeling unhappy or worthless, losing interest in things you used to enjoy, are noticing changes to your appetite or sleeping pattern, have a loss of energy or are having suicidal thoughts, then it is likely you are suffering from depression.

Depression and sadness are not the same

The death of someone we love, the ending of a relationship, or losing your job are all stressful experiences that normally lead to feelings of grief and sadness, of which a person might describe themselves as feeling “depressed”. While the grieving process is difficult and shares many of the same symptoms of depression, depression is a mental illness which requires medical attention and is not to be confused with sporadic episodes of sadness or mood swings.

Depression and menopause

The underlying cause of depression in menopausal women is a hormonal imbalance caused by decreased estrogen levels. Estrogen stimulates our serotonin levels – the mood-boosting neurotransmitter in our brains which is responsible for making us feel good. Therefore, a decrease in estrogen often means a decrease in serotonin and thus a lower mood.

Menopause symptoms are often the same as those faced by people with depression, including sadness, feeling irritable, sleep disturbances, anxiety and lack of concentration. As such, women may think that these problems are a natural part of the aging process and fail to seek the right medical diagnosis and treatment. If depression is left untreated in older women, it can increase the risk of developing serious health conditions such as heart attacks and bone fractures.

Diagnosis and Treatment

If you think you are suffering from depression, you should speak to your doctor immediately. The doctor will carry out an evaluation and may take a blood test to rule out other health issues such as a thyroid problem. Thankfully, depression is treatable and many options exist to help improve the lives of its sufferers.

  1. Medication

For depression that is moderate to severe, a doctor may prescribe antidepressants, which often need to be taken for several weeks or months before noticing a real improvement in symptoms. If the medication is not working, or having negative side effects, the doctor may decide to prescribe a different type.

Hormone Replacement Therapy (HRT) is often prescribed to menopausal women to replace the lost estrogen and progesterone in a woman’s body, helping relieve symptoms.

  1. Psychotherapy

Therapy is an effective treatment option for many people with depression. Cognitive Behavioral Therapy (CBT) aims to alter thinking and help people see things in a different light, by attempting to change behaviors and recognize distorted thoughts. The number of sessions needed will depend on individual circumstances and the severity of depression.

  1. Self-care

There are a number of actions a person can take to help manage their symptoms themselves. This includes making positive lifestyle changes, such as exercising regularly, having a balanced and nutritious diet, avoiding alcohol and establishing positive sleeping habits. Moreover, ensuring you have a good support network around you and taking time to do things you enjoy are indispensable in helping fight depression.

 

 

]]> Vaginal Atrophy: How to Reduce Vaginal Dryness after the Menopause https://thirdage.com/vaginal-atrophy-how-to-reduce-vaginal-dryness-after-the-menopause/ Wed, 28 Jun 2017 04:00:48 +0000 https://thirdage.com/?p=3056162 Read More→]]> By Dr Demetri C Panayi and Dr Pandelis Athanasias of the London Women’s Centre

Vaginal atrophy (also known as atrophic vaginitis or vulvo-vaginal atrophy) is a condition that affects many women, particularly following the menopause. When a woman experiences the joys of the menopause, she typically produces less oestrogen and this often results in vaginal atrophy, which is the thinning, drying and inflammation of the vaginal walls.

The cells in the vagina are most lacking in moisture after the menopausal years, which can result in this uncomfortable condition. However, women need not suffer in silence. It is wise to speak to a GP or experienced gynaecologist if vaginal atrophy is seriously affecting your quality of life.

Nonetheless, not all cases will require medical attention and there are now many self-help methods you can use to reduce vaginal dryness during menopause.

Vaginal Moisturisers and Lubricants

For milder cases of vaginal atrophy, over-the-counter self-help options are recommended. Thankfully, there is a wide range of moisturisers on the market that can be used to help restore some much needed hydration into your vaginal area. This should typically be applied 2-3 times a day to temporarily relieve your discomfort.

As an alternative, a water-based lubricant can be used to reduce vaginal dryness discomfort, particularly where the woman is finding it difficult to enjoy sex. We recommend avoiding products which contain glycerine, as this chemical tends to intensify any burning or irritation.

Topical Oestrogen

Where your vaginal dryness is definitely the result of menopause, your GP or gynaecologist may prescribe you with vaginal oestrogen. This type of treatment is great for helping to increase any lost oestrogen and can be distributed in several different ways.

Treatment options include pessaries, whereby pills are placed into the vagina, vaginal rings and vaginal creams. You can discuss with your doctor the best type for your body, lifestyle and comfort. Generally, all work in the same way and are just as good as any at helping relieve symptoms of this issue.

Topical oestrogen is the most effective way to treat vaginal dryness for menopausal women, though it may take several weeks to notice positive changes. Therefore, it is recommended that women use this method in conjunction with a lubricant or moisturiser.

Hormone Replacement Therapy (HRT)

As mentioned, the menopause causes hormones to be lost, resulting in vaginal dryness. To replace these lost hormones by supplying oestrogen to the body, HRT may be prescribed by your GP. HRT can be taken in a number of ways, including gels, patches, tablets and implants and will typically have a stronger effect on your body than the above treatments.

As such, HRT is usually recommended where symptoms of menopause, such as hot flushes, are more intense. However, this treatment has a few side effects, which may deter you from choosing it to help with your vaginal atrophy.

MonaLisa Touch Laser Therapy

Now, a new, innovative treatment exists for those suffering from vaginal atrophy. The MonaLisa Touch uses groundbreaking technology to rejuvenate the atrophic vaginal tissue and stimulate lost collagen in the vagina.

You might be discouraged by the word ‘laser’, thinking all manner of things. However, this treatment is minimally invasive, pain-free, and quick and results in significant reduction in dryness, burning, painful sex and urinary problems often caused by vaginal atrophy.

Finding the Right Option for You

So there you have it, there are many options out there for treating a condition that affects a significant number of menopausal women. As such, you no longer have to suffer the often debilitating and embarrassing symptoms of vaginal atrophy. Simply talk to your GP or gynecologist to discuss the right option for you!

]]> Better Sleep During and After Menopause Can Lead to Better Sex https://thirdage.com/better-sleep-during-and-after-menopause-can-lead-to-better-sex/ Mon, 13 Feb 2017 05:00:30 +0000 https://thirdage.com/?p=3053762 Read More→]]> Sleep disturbance is common for many women during menopause, which can lower the odds of sexual satisfaction. That is the finding of a study published February 1st 2017 in Menopause, the journal of The North American Menopause Society (NAMS).

A release from NAMS explains that according to data analyzed for 93,668 women aged 50 to 79 years who were enrolled in the Women’s Health Initiative Observational Study, short sleep duration (defined as fewer than seven to eight hours per night) was associated with lower odds of sexual satisfaction. Of the participants, 56% reported being somewhat or very satisfied with their current sexual activity, and 52% reported partnered sexual activity within the last year. Insomnia prevalence was 31%.

The Menopause article, “Association of sleep disturbance and sexual function in postmenopausal women”, describes how the relationship between sleep length and quality with sexual satisfaction remained even after adjusting for other possible causes of sleep deprivation, including depression and chronic disease. This relationship, however, did vary across age groups. Older women, for example, were less likely to be sexually active if they slept fewer than seven to eight hours per night compared with younger women. In fact, women aged older than 70 years who slept fewer than five hours were 30% less likely to be sexually active than women sleeping seven toeight hours. It is already known that the prevalence of sleep problems increases with age.

The release quotes Dr. JoAnn Pinkerton, NAMS executive director, as saying, “Women and healthcare providers need to recognize the link between menopause symptoms and inadequate sleep and their effects on sexual satisfaction. There are effective treatment options to help with sleep disruption and sexual satisfaction, including hormone therapy, which this study confirmed to be effective at menopause for symptomatic women.”

]]> Decline in Sexual Function During the Menopause Transition https://thirdage.com/decline-in-sexual-function-during-the-menopause-transition/ Thu, 17 Nov 2016 05:00:35 +0000 https://thirdage.com/?p=3052355 Read More→]]> Although most medical professionals (and their patients) agree that sexual function declines with age, there remains debate about the contribution of menopause to sexual activity and functioning. A November 2016 study using data from the Study of Women’s Health (SWAN), however, provides a more detailed timetable of sexual decline over the menopause transition. The study is published online in Menopause, the journal of The North American Menopause Society (NAMS).

A release from NAMS explains that sexual function data was gathered from nearly 1,400 women who were in either the natural menopause or hysterectomy groups of the SWAN study. No decline in sexual function was documented until 20 months before the final menstrual period. From this time until one year after the final period, sexual function scores decreased by 0.35 annually and continued to decline more than one year afterward but at a slower rate. The decline was smaller in black women and larger in Japanese than in white women. Women who had a hysterectomy before the final menstrual period did not show a decline in sexual function before surgery but did experience a decline afterward. In total, sexual decline persisted for five years after the final menstrual cycle.

Although menopause is often accompanied by such related symptoms as vaginal dryness, depression, and anxiety, these factors did not explain the effect of menopause or surgery on sexual function. The problem of declining sexual function is a serious one, because more than 75% of the middle-aged women in the study reported that sex was moderately to extremely important.

The release quotes Dr. JoAnn Pinkerton, NAMS executive director, as saying, “This study highlights the need for healthcare providers to have open conversations with their patients about their sexual issues, because there are many options for women to help maintain or improve their sexual lives as they transition to and beyond menopause. Low-dose vaginal estrogen, for example, which has minimal risks for most women, is an effective and safe treatment for painful intercourse as is a non-estrogen therapy called ospemifene.”

]]>