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Women's health: Women in their 50s face changes, choices like hormone therapy

Oregonian (Portland, OR)


June 20--For women in their 50s, lower estrogen levels lead to menopause and a whole set of health concerns.

"This is the beginning of the aging process," says Kate Beadle, a Kaiser Permanente nurse practitioner who specializes in menopause.

Dr. Audrey Curtis, who's helping start a women's health clinic at Legacy Meridian Park, says: "A lot of women feel like they're on a roller coaster. Their hormone levels are doing what they did in the teenage years, really up and down."

For some women, the answer is hormone replacement therapy to deal with symptoms of menopause. But the 50-year history of HRT has been as wild as the mood swings it is supposed to prevent. And the changing recommendations for women, as well as cancer fears, have led to confusion and stress.

Introduced in the 1960s, long-term estrogen treatment was marketed as a wonder therapy to combat aging, disease and depression. Two 1975 studies indicating increased cancer risk made a temporary dent in sales, but it didn't last as other hormones like progestin were added to the therapy, supposedly eliminating the added cancer risk.

In 2002, a major study by the federal Women's Health Initiative made a much bigger impression, linking estrogen-based treatment and elevated cancer risk. And estrogen was not a miracle drug that prevented certain chronic diseases, contrary to an earlier study.

Since then, the Women's Health Initiative has been criticized for design flaws by medical researchers and other experts, and even its authors have backtracked on some of their warnings of elevated risk of heart disease.

In 2012, the U.S. Preventive Services Task Force issued a review of published research, including the Women's Health Initiative, and did not address the use of HRT to treat symptoms of menopause. However, it recommended against the use of HRT by post-menopausal women to prevent chronic disease.

The task force concluded:

Estrogen plus progestin and estrogen alone decreased risk for bone fractures.

Estrogen plus progestin and estrogen alone increased risk for stroke, thromboembolic events, gallbladder disease and urinary incontinence.

Estrogen plus progestin increased risk for breast cancer and dementia

Taking estrogen alone decreased risk for breast cancer.

The federal task force tries to be the last word on science. But then came a newer study late last year out of Denmark. It found that timing the short-term use of hormone replacement therapy close to the advent of menopause led to a clear improvement in cardiovascular health, and no increase in cancer rates -- and the younger when HRT began, the better.

So many health care providers have warmed back up to hormone replacement therapy, even as patients remain understandably skeptical. The Women's Health Initiative "perpetuated some bizarre concepts that have really infiltrated into the medical world," says Duncan Neilson, chief of women's services for Legacy Health Systems.

Gary Hoffman, head of women's services at Providence St. Vincent, is more measured. "The studies of HRT end up all over the map," he says, adding that the use of HRT is not for everyone and "is more of a temporary treatment to deal with the symptoms of menopause."

Other issues to track

Of course, women in their 50s are not just concerned about menopause. Tracking their memory and bone health becomes more important.

Half of post-menopausal women will have osteoporosis-related bone fractures, according to the U.S. Preventive Services Task Force. About a quarter of those will suffer a vertebral deformity and a sixth of them face hip fractures.

When it comes to bone density and osteoporosis, moderate exercise in your 50s is still a good idea. But one possible little-known help: a daily alcoholic drink after menopause.

While the research is not conclusive, an Oregon State University study last year found striking evidence that very moderate intake of alcohol after menopause can help prevent the deterioration of bones. The study focused on women consuming an average 1.4 drinks per day.

That doesn't mean everyone should start drinking. After all, alcohol is associated with a higher risk of breast cancer, particularly those having two drinks a day or more. And heavy drinking is associated with bone loss.

Regardless, the OSU researchers found that a blood marker associated with bone decay appears to drop dramatically in women who drank moderately. In an interview last year, Oregon Health & Science University bone researcher Eric Orwoll said the OSU results aren't airtight, but are consistent with previous research that found the greatest bone fracture risk in those who drink heavily or not at all.

"The changes that they saw make sense," he said.

Stay on top of screenings

Health screening schedules become more important with age.

There's a higher risk of colon and skin cancer and heart disease, changes of metabolism, and a stepped-up need for cholesterol, thyroid and diabetes screening, bone-density testing and more.

Despite debate over mammograms, false positives and unintended harms, every year or two remains the recommendation for women in their 50s. And -- good advice at any age -- exercise remains key for mental and physical health, especially as arthritis might be creeping in.

-- Nick Budnick


(c)2013 The Oregonian (Portland, Ore.)

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