Dr. Clayton Fulbright, OB/GYN at North Georgia OB/GYN Specialists, recently discussed women’s midlife health and the menopausal transition.
“This is one of the areas of my job that I find the most fulfilling and joy in learning, growing and researching all the new things that are coming out and ways to manage and optimize health during this time in a woman’s life,” he said.
Understanding menopause
The average age of menopause is 51 and a half.
“Some women start that process early in their 40s, others right around that early 50s mark,” Dr. Fulbright explained.
By the end of the 50s, most women have entered menopause and are experiencing the effects of declining estrogen. Hot flashes, night sweats and vaginal dryness are the most common symptoms.
“The FDA-approved reasons for using menopausal hormone therapy are for those vasomotor symptoms, those hot flashes and night sweats, as well as for what’s termed as genitourinary syndrome of menopause, or GSM,” he said. GSM can include vaginal dryness, pain with sex or recurrent urinary tract infections.
While not FDA approved for other uses, Dr. Fulbright said hormone therapy can also help prevent bone loss and reduce fracture risk.
“For the vast majority of women who are less than 60, or 10 years out from menopause, the benefits far outweigh the risks in healthy women for managing these symptoms,” he added.
Bone, joint and heart health
During the menopausal transition, women can lose up to 20% to 30% of bone mass. The Menopause Society™ recommends calcium, vitamin D, weight-bearing exercise and avoiding smoking or excess alcohol.
Heart disease is the leading cause of death for women in midlife.
“Major things that we need to be talking about are screening blood pressure regularly, screening cholesterol, screening for diabetes, maintaining a healthy lifestyle, which includes diet and exercise, active weight management, and again, avoiding some of those things that are counter to the goals,” Dr. Fulbright said.
Hormone therapy, when started early in menopause, may improve glycemic control and reduce the risk of new onset type 2 diabetes.
Mental, emotional and sexual health
Women ages 40 to 59 have the highest rates of depression among adult age groups.
“It’s not surprising when you consider the kind of symptoms that most women going through menopause are experiencing, especially when they’re not managed correctly,” Dr. Fulbright said. He recommends holistic approaches, such as exercise, mindfulness and counseling, along with medications if needed.
Sexual health also requires attention.
“Until a woman is truly menopausal or has gone a year without a period, it is still possible that you could ovulate. And if you could ovulate, you can get pregnant,” he warned. Vaginal dryness and pain can often be managed with low-dose vaginal estrogen or alternatives such as DHEA creams, lubricants or moisturizers.
Sleep, weight and lifestyle
Sleep disturbances and insomnia increase during perimenopause, often linked with hot flashes.
“Menopausal hormone therapy can improve sleep onset and quality in many women,” Dr. Fulbright said. Poor sleep is linked to worse mood, higher stress and difficulty maintaining a healthy weight.
Weight gain is also common.
“On average, we see about a one and a half pound per year gain,” he said. While hormones are not a weight loss tool, therapy may lessen abdominal fat gain and improve energy for lifestyle changes. Dr. Fulbright emphasized weight-bearing exercise, healthy diet and tobacco and alcohol avoidance.
Preventive care
Midlife is the time to prioritize screening. Dr. Fulbright recommends annual mammograms beginning at age 40, cervical cancer screening until age 65, colorectal screening starting at 45, and bone density scans at 65 or earlier with risk factors.
“Midlife is a really pivotal time,” he concluded. “It’s fraught with various unpleasantries and challenges. A healthy lifestyle is foundational across all domains — bone, heart health, mental health, metabolism, sleep. Much of this comes back to proactive health maintenance and open dialogue with your health care professionals.”
Talk to your provider about what screenings and therapies are right for you.
Find a provider near you and schedule an appointment online.
