No More Hot Flashes... And Even More Good News
By Penny Wise Budoff
Looking at the first two lists above, not one of the problems is one any of us would choose to have. Is this list the inevitable effect of aging, or is the event of menopause a separate and intensifying risk factor?
Consider this analogy. Many of us take antihypertensive medications although we have no obvious problems except for an elevated blood pressure reading. Yet these medications have to be taken daily and many have side effects that are troubling. We take them to prevent a future problem, even though we feel all right today. Antihypertensive drugs have helped to decrease the incidence of stroke, heart failure, and heart attack in the United States. They have literally saved and prolonged millions of lives by decreasing the rate of heart attack and stroke in this country.
Years ago we did not treat hypertension in older individuals. We thought that high blood pressure was a normal occurrence as we aged. We reasoned that higher blood pressure was necessary to push blood through older, stiffened arteries. What we did not realize was that silent progressive blood vessel damage was slowly occurring as a result of the high blood pressure. Increase in heart size, silent heart attacks, and increased deposition of LDL cholesterol into the arterial wall are complications of high blood pressure. We now know that with good blood pressure control, good diet, exercise, and sometimes cholesterol-lowering drugs we can reverse many of these silent vascular changes. We can actually make ourselves healthier and our blood vessels younger.
There are now new blood pressure guidelines instructing doctors to prescribe antihypertensive drugs to patients at even lower blood pressure levels. What was considered "normal" blood pressure years ago is now considered high. We now know that even mild blood pressure elevations take a progressive toll and damage our cardiovascular system.
"However," you may say, "hypertensive medications are given to patients with hypertension. Estrogen is being offered to healthy women to alleviate symptoms that they, their husbands, or friends basically think are really not all that important. Menopausal symptoms may make life miserable for a year or so, or four or five, but they are not life threatening."
It is easy to comprehend that hormone replacement will get rid of hot flashes and night sweats that are severe and interfere with life. It is less easy to conceptualize long-term hormonal replacement therapy (LTHRT) to help prevent future illnesses such as heart disease and osteoporosis. This is a new and difficult concept both for you and for your doctor.
And so it might be a good idea to look at the list of menopausal symptoms one more time. are we using hormonal therapy to treat "healthy women"? As we begin to mull over this often raised objection, we need to ask, "Are we entering the postmenopausal age span already programmed for system failure?" Healthy today, but preprogrammed by our genetics and dietary and social flaws for deterioration? Are we less healthy than we think, slowly and imperceptibly getting older and less fit, brewing something akin to hypertension except that the final consequences are pathology such as heart attack, stroke, Alzheimer's, and fracture? Is it possible to circumvent or modify these problems? Is it possible to postpone these silent metabolic changes to a much later age so that we function, nearly at full capacity mentally and physically, until one night we die softly in our sleep? One day this will be possible. We stand only at the threshold.
Is it just the effect of aging that creates these problems, or does the actual event of menopause independently accelerate and adversely affect the problems? Just knowing who is at risk for which problems would be a great help. It is already possible to find out some of this information by careful determination of preexisting risk factors, present complaints, physical examination, and laboratory' analysis.
Body Changes That Accompany Menopause and Aging
One of the biggest complaints I hear is weight gain at the time of menopause. I have the same complaint. Until several years ago I could still wear many of the clothes I wore in college. I have never been on a diet in my life. Never had to. I ate more than almost any man and never gained a pound. Everyone warned me that one day it would happen. It did. In the past few years, I have added ten pounds and I know exactly where they are. Is it because I take estrogen? I believe the answer is no. It's a fact of getting older and being postmenopausal and unless you try harder than most of us have been willing, you've joined us too. Losing those extra pounds is my next project after this book is completed!
We're not alone; men have the same problem. A 175-pound man at sixty-five does not have the same build that he had at thirty, even if his weight hasn't changed by one pound. Women are no different. Both men and women lose muscle as we age and most often replace muscle with fat. We lose some 30 to 40 percent of our muscle mass by the time we reach seventy. Just take an honest look in the mirror while in your bathing suit. Men have lost the muscle in their legs and thighs. "Little chicken legs" replace those muscular columns that carried them when they played football. Fat has accumulated in their bellies. are these changes related to loss of testosterone? Trials of testosterone replacement in men have shown that this therapy can increase muscle mass and strength, bone density, give an added feeling of wellbeing, and increase libido. The effects of testosterone may depend upon the dosages used, but testosterone replacement has not had an adverse effect on the cardiovascular system, as we originally believed. In fact, some recent research suggests that testosterone replacement in men may benefit the heart and cardiovascular system. Men will have to be patient as studies are done. Their studies actually lag behind the research for women.