American Medical Association Family Medical Guide - American Medical Association [571]
Changes in mood
While some women going through menopause may experience depression, anxiety, irritability, difficulty concentrating, lack of confidence, or sleep disturbances, most do not. For many women, menopause does not cause unpredictable mood swings or depression. In some women, menopause even seems to improve mental health. Many cases of depression in middle-aged women develop in response to life stresses as they struggle to cope with children who are leaving home or aging parents who require extended care. Lower estrogen levels may bring about a decline in sexual interest. However, sexual activity may increase in some women who are relieved that pregnancy is no longer a concern.
For many women, engaging in regular moderate aerobic exercise such as walking at least 5 days a week helps improve their mood by enabling them to sleep better. Better sleep can enhance concentration and memory. If you experience emotional problems related to menopause or other life changes, see your doctor, who may prescribe an antidepressant (see page 712) or refer you for counseling.
Bone loss
One of the most serious health issues for menopausal women is the bone-thinning condition osteoporosis (see page 989). Directly connected to declining estrogen levels in women, osteoporosis causes loss of bone tissue, especially in the first several years after menopause, which can result in thin, brittle bones that are highly susceptible to fracture. Roughly 300,000 women in the United States fracture a hip each year, often becoming unable to walk and requiring extended care.
The best strategy to combat osteoporosis is prevention, which requires building strong bones in adolescence and young adulthood (see page 452). However, it’s never too late to adopt health-promoting practices that can keep you healthy in general and help you maintain the density and strength of your bones after menopause. Get in the habit of exercising at least 5 days a week—even moderate exercise such as walking and light weight lifting are helpful. Fit exercise into your daily routine by trying to take the stairs instead of the elevator whenever possible, or parking farther away from your destination. Eat a balanced diet rich in calcium; you should take in 1,500 milligrams of calcium each day if you are not taking a bone-preserving medication (see page 993). Quit smoking (see page 29) if you smoke, and limit your intake of alcohol—smoking and excess drinking increase the rate of bone loss.
The most effective medications for women who have osteoporosis are estrogen or estrogenlike drugs. For women who cannot or choose not to take estrogen, other effective bone-preserving medications are also available, such as raloxifene, alendronate, and calcitonin.
Menopause and heart disease
Heart disease is the No.1killer of American women, causing half of all deaths in women over age 50. After menopause, the incidence of heart disease increases in women until it reaches that of men. Menopause brings changes in the levels of fats in a woman’s blood. The level of HDL (good cholesterol) tends to decline, while the level of LDL (bad cholesterol) rises. These changes are thought to be caused by the drop in estrogen. An unhealthy cholesterol level profile (that is, low HDL, high LDL) can boost your risk of stroke and heart disease.
Taking estrogen in hormone therapy was once thought to reduce the risk of some types of heart disease in women after menopause. However, a combination of estrogen and a specific progestin called medroxyprogesterone acetate (MPA) in hormone therapy has been found to increase the risk of heart attack, stroke, or blood clots in some women. Research is continuing on the link between heart disease and other combinations of estrogens and progestins and on estrogen alone (without a progestin). (Women who do not have a uterus because they have had