Quick question: When you hear the word "menopause," what do you think of? Hot flashes? Irritability? Little lapses in memory? Endless stale jokes on sitcoms? How about the positive side: Freedom from menstruation? A hallmark in the natural process of life? Whatever you think of, menopause is one of the major changes a woman will undergo and represents an opportunity to take a fresh look at the body's changing needs. With menopause comes more changes in your body than you may even know about—changes that could present some long-term health risks.
First of all, menopause is a process that occurs over a period of time. Loosely divided into three stages, menopause is the means by which the body leaves its childbearing years behind. After decades of hard and usually dependable work, the ovaries stop producing eggs and greatly diminish their production of the female sex hormone known as estrogen. While some surgical and hormonal treatments—such as hysterectomy—may hasten menopause, here we will focus on the "normal" course of natural menopause, which occurs in three stages.
The Stages of Menopause
Perimenopause: Perimenopause, which literally means “around menopause,” refers to the onset of menopause. Estrogen levels rise and fall erratically and periods may become irregular. Well-known symptoms such as hot flashes, breast tenderness, and decreased sex drive all happen here. This stage typically lasts 4-8 years and occurs in the middle to late 40s, although it can begin a decade earlier. Aside from passing bouts of hot flashes and fuzzy thinking, women in perimenopause may experience mild depression, often brought on in conjunction with other life changes occurring at this time. Other than this, perimenopause brings no significant health risks.
Menopause: Menopause refers to the 12-month stage after a woman's final period and can only be diagnosed retroactively. During full-blown menopause, egg production has stopped and estrogen levels fall. As with perimenopause, there are no long-term health risks brought on by the experience of menopause.
Postmenopause: Postmenopause begins 12 months after a woman's final period, typically in her late 40s to early 50s. Hot flashes and other symptoms fade away, and no blood flow from the uterus occurs. Incidentally, if blood flow occurs during postmenopause, a doctor should be consulted immediately because it could be a sign that some other problem is present. Unlike the first two stages of menopause, the decline in estrogen levels and the cessation of ovarian function does present some long-term health risks. The most significant of these are osteoporosis and coronary artery disease.
The Health Risks of Menopause
Osteoporosis: Osteoporosis is a disease of the bones. Essentially, bone mineral density begins to deteriorate, making people more vulnerable to "frailty fractures," particularly in the hip, wrist, and spine. A drop in estrogen levels is the primary cause of osteoporosis, but some long-term risk can be mitigated by lifestyle. While osteoporosis may happen to anyone, women make up 80 percent of osteoporosis cases over the age of 50.
Moderate endurance exercise and light weightlifting can increase bone density, and cessation of smoking and heavy drinking is, of course, helpful. Research on prescribed medications and the use of dietary supplements is ongoing, but researchers do know that a class of drugs called bisphosphonates have been effective in treating osteoporosis. One problem with bisphosphonates, however, is that they interfere with the body's natural production of CoQ10, which the body must convert into Ubiquinol, which could make taking supplemental CoQ10 or Ubiquinol a good idea.
Coronary Artery Disease: Coronary artery disease is the most common type of heart disease and is the number one cause of death for both men and women in the United States. It results when plaque builds up and reduces the flow of blood to the heart. While some risk factors are genetic and cannot be modified, managing harmful cholesterol levels is seen as a key step in combating the development of coronary artery disease. Diets rich in fruits and vegetables are key, and decreasing your intake of trans fats and saturated fats can help reduce the risk of coronary artery disease and do so much more for your health.
Medications often prescribed by doctors to treat and help prevent coronary artery disease include aspirin, beta-blockers, and statins. The whole purpose of statins is to lower the body's production of cholesterol. However, as we saw with bisphosphonates in the treatment of osteoporosis, statins also inhibit the body's ability to produce CoQ10, so Coq10 or Ubiquinol in supplemental form may also be a good idea for those taking statin drugs.
How to Talk to Your Doctor
As you approach the transition of menopause, you should be aware of the menopausal stages and the health risks associated with each stage. Exercise regularly, eat fruits and vegetables, and talk with your doctor about medications such as bisphosphonates and statins, as well as supplements that promote heart health and cellular energy.
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Kalyan S, Huebbe P, Esatbeyoglu T, Niklowitz P, Côté HC, Rimbach G, Kabelitz D. Nitrogen-bisphosphonate therapy is linked to compromised coenzyme Q10 and vitamin E status in postmenopausal women. J Clin Endocrinol Metab. 2014 Jan 13:jc20133648.