>> I would like to preface my talk
by saying it is so liberating
to be a woman of certain age, okay?
Those of you in the audience
who can understand what I'm saying,
you know, those of you who are younger,
you'll get there, it'll take a few years
but you know, it just,
my kids are all grown, I've raised them,
now it's all about me
and what I want to do,
what my passions are with regards to bringing healthcare,
adequate healthcare to women of menopause
and post-menopause years
because for too long we have been ignored
and we now know that there's approximately 50 million
menopausal, post-menopausal women in the United States.
We are a major force
and we can be a major economic force
if we got ourselves activated
and so, you know, to spend a third of your life
not in perfect, okay, maybe not perfect
but optimal functioning condition
is just not acceptable
and at this point we need more research
into menopause medicine
and to tell the white, male bastion
that controls medical institutions
that you know, sorry, guys,
you need to pay attention and invest in us too.
Okay?
(clapping)
So,
I'm preaching to the choir, aren't I?
So, okay.
So, let me start and my opening sentence
is well, not sentence,
opening terminology, sex matters, okay?
It does matter in more ways than one
and I'm talking about sex versus gender, okay?
Males and females have very different lifespans
and the types of illnesses such as autoimmune diseases,
cardiovascular diseases and obesity.
Every single cell in our bodies has a sex,
every single cell is either XX versus XY.
The maternal or paternal X chromosome
from our parents,
so sex is the biological and physical characteristics
that define men and women.
Gender, on the other hand,
is a socially constructed roles,
behaviors, activities and attributes
that a given society considers appropriate
for men and women.
So, sex and gender are very different
and I'm here to talk about what sex does
to women's health as we age.
So, the NIH Office of Research on Women's Health
because of Dr. Bernadine Healy
from Johns Hopkins,
she became the first female head of NIH
and she established this office
because she recognized as a cardiologist
that there was a difference in how women's heart aged
and how women's heart disease occurred
as opposed to that for men.
And so, because of this Office
for Research on Women's Health
there is now a focus on the differences
between men and women for autoimmune diseases,
cancer, cardiovascular diseases,
depression and brain disorders, diabetes,
infectious diseases, obesity and substance abuse.
Just to talk about some autoimmune diseases
which is a favorite topic of mine.
If I hadn't gone into gynecology,
I probably would have loved to be a rheumatologist.
And for example, lupus, systemic lupus erythematosus.
The disease activity decreases after menopause
due to decreased levels of estrogen
and the use of menopause hormone therapy,
however, does not seem to increase the number
of severe flares that lupus patients can have,
so for a very long lupus patients
have been told no, you cannot go on hormone therapy
after you've reached mesopause
even though you're miserable
because your flares are gonna get worse.
No, we have done an extensive literature search
and yes, you will have minor flares
but severe flares do not seem to occur
if you go on hormone therapy
but the damage accrual on your organs
do seem to increase after menopause
or basically as part of aging
and for example, rheumatory arthritis, okay?
Estrogen and progestogen seem to be protective
against RA, okay?
So, it may delay the increase in symptoms of RA
if you go on hormone therapy
during the perimenopause,
so again, this is another area
where hormones seem to have a big effect
on the progression of disease.
Metabolic syndrome.
That is defined as three or more of the following,
central obesity, elevated serum triglycerides,
low serum, high density lipoproteins,
elevated blood pressure
and fasting plasma glucose
graded in 100 milligrams per deciliter
and this is epidemic in the United States at this point.
So many of us have metabolic syndrome
because of our lifestyles,
because of our diet
and so, when you have the metabolic syndrome
you are at increased risk
for heart disease, for strokes
and for having peripheral vascular disease.
So, it is very, very important
that this is something that is managed,
not just by your internist
but also the fact that hormone therapy
may help prevent or slow down
the progression of some of these issues.
So, I'm not promising you the moon,
I'm not saying go on hormones, go on estrogen
and you'll live forever and you'll be young forever
but it is something to keep in mind
that if you are somebody who qualifies
for estrogen or estrogen/progesterone hormone therapy,
then that might be a really good option to consider, okay?
And the prevalence of metabolic syndrome,
in premenopausal women it's only 13.8%
of premenopausal women have the metabolic syndrome.
In post-menopausal women,
more than 60% have the metabolic syndrome,
so you can see the huge impact that aging and menopause has
on our health.
And so, it increases,
if you have metabolic syndrome
it increases your oxidative stress,
increases inflammation
and the prothrombotic process.
So, these issues could result
in higher risk for cancer,
higher risk for heart disease,
higher risk for Alzheimers.
So, this is also where something like transdermal estrogen
can be very, very helpful in slowing this process.
Hypertension.
So many of us have hypertension.
Before 50 years old, more men than women have hypertension
but after 65 years old
nearly 70% of women have hypertension.
So, the primary risk factor is menopause.
So, adaptive immune system is implicated in hypertension.
We need to understand it better.
We need more research about why that is
and again, it is something
that we have to, you know,
discuss with our medical institutions
and make sure that research
does distinguish between male and female risks
for certain diseases.
A woman's hypertension
is not the same as a man's hypertension.
Cardiovascular disease is another area
where a women's heart attack
is not the same as a man's heart attack
and so, it has everything to do with the lipid metabolism,
the diabetes that I've mentioned so far.
And osteoporosis.
Another area where women are at higher risk
and did you know that one in two post-menopausal women
will have osteoporosis-related fracture in their lifetime?
Dr. Jan de Beur can bare me out on that.
I send all my patients with osteoporosis to her.
She probably see's the referral from Dr. Shen
and she goes arg.
So, okay.
And because you have to take it very seriously.
It's not just, you know, your grandmother
walking around humped over with a dowager's hump, okay?
As we age and we have fractures
it's not just a broken bone,
you put it in a cast
and you know, it heals and gets better.
As we age, broken bones don't heal.
Broken bones send off embolus
to your heart, to your lungs
and cause further complications
and research has shown that as we age
bone fractures we never recover from,
we end up losing our independence,
we end up losing the quality of life
that we enjoyed prior to the fractures,
and it is a huge economic hit on society.
So, it is very important
to treat osteoporosis, to prevent osteoporosis.
Again, it is something that has not been emphasized enough
in my opinion given all the steps
that could be taken to prevent osteoporosis
from setting in if only there is awareness
for screening and treatment.
And with regards to osteoporosis,
again, I am not pushing hormone therapy
but hormone therapy is preventive for osteoporosis.
So, it's one of the few diseases
that we can definitively say
take this and you will have decreased risk
for osteoporosis
but obviously there are other things
that go into having osteoporosis,
your genetics, if your mom, if your grandmom
are both really slight of build,
small boned and have had osteoporotic fractures,
obviously genetically you are at risk
and if your lifestyle,
if you don't have a physically active lifestyle,
you don't have enough vitamin D and calcium intake,
if you smoke, those also increase your risk
for osteoporosis and those are all lifestyle changes
that could be changed to help improve
your health and your bone health.
Mood, that's another issue
that I hear a lot about from my patients.
You know, it's not unusual for a patient to come in
and the hot flashes she can deal with,
the lack of sleep she can deal with
but what she is most desperate about
is her kids tell her she's the meanest mom in the world,
her husband is just about ready to walk out the door
and she just screamed at her boss that morning.
So, obviously life is tanking for her in a big way
and she is reaching out for help
and mood is something that attacks a lot of women
during the perimenopause and menopause,
and it is something that is known,
that is something that psychiatrists know about
and not all women need to go on psychiatric medication
for these issues.
It is related to menopause
and the good news is that post-menopausally,
so a few years out from your last menstrual period,
and from all this craziness, things get better.
So, there is that to look forward to.
I often describe a lot of the menopause craziness
and issues and symptoms
and everything that happens to you
is like, you know, when you fly out to California
and you're flying over the Rocky's,
how bumpy it gets
because of the winds and weather systems and whatever
and once you get to the Pacific, right?
Pacific, peace, everything calms down,
so that's the description that I give
to a lot of patients.
Once you get over the Rocky's,
things get better.
So, there is that to look forward to.
Things do get better.
Cognition.
I've had CFOs who come in and say
I can't balance my checkbook.
Help, okay?
That is also something, that brain fog
that can happen to a woman
as she's going through menopause.
Again, good news, it gets better, okay?
So, if you just need some help
to get you over the Rocky's,
once you get over to the Pacific,
things will improve, okay?
So, just keep that in mind, the visual.
And so, it's felt that, you know,
the cognitive changes are due to the fluctuating hormones
that a woman experiences as she's going through menopause.
The menopause transition is very, very hard
on a lot of women.
Not on everybody.
Some patients say meh, you know,
I don't, maybe one hot flash here or there
but no big deal.
Great.
I leave those patients alone
but it's the, right?
It's the patient who is just,
her eyes are rotating in different directions
and her hair is standing, I say okay,
we need to do something, okay?
Because this is no good for you
and I can't let you walk out of here like that.
So.
Alright.
And so, you know, so far, I have given you
a lot of bad news
and things sound really, really bad
but let me just quote you a Gallup poll
that was taken where they asked women
between 20s to 50s
at what age do they feel happiest
and most fulfilled, okay?
So, ready for this?
For those of you who are in your 20s in the audience,
I'm very sorry for you,
only 10% of you felt happiest and fulfilled.
Those in their 30s, 17% felt happy and most fulfilled.
Those in their 40s, 16%.
Those in their 50s and above, 51%.
We rock.