A third of this conference involved menopause issues; appropriate, as women spend one-third of their lives in menopause. Except for Dr. Sanjay Asthana of the University of Wisconsin, all of the presenting doctors noted below were from the Mayo Clinic.
Dr. Lynne Schuster is a specialist in internal medicine; she is in charge of the Women’s Health Clinic at the Mayo Clinic. Her talk was on the effects of hormones on moods. Women have a 21% lifetime risk of developing depression, with the highest risk in perimenopause. Women are at higher risk of depression if they previously experienced post-partum depression or PMDD (premenstrual dysphoric disorder, a severe variant of PMS). This risk is affected by genetic factors, psychological factors, social factors, physical health and one’s environment; absolute levels of estrogen and progesterone have not been linked to depression. There are many difficulties in assessing associations between hormones and mental health. These include the wide fluctuations of hormone levels that affect women daily, appreciating the time lag between hormonal changes and mood symptoms, and inaccuracies in the scales used to assess moods, and in using the menstrual cycle the indicator of hormone levels. Checking hormone levels is not helpful in determining if hormones are the cause of mood problems. It is known that estrogen acts as a neuromodulator and it shares common pathways with neurotransmitters in the brain. Research has shown that estrogen increases norepinephrine and serotonin levels, serotonin receptor activity, and endorphin levels, among other actions. All of these chemicals affect our moods. Women are at greater risk of depression than men from decreased serotonin levels. Thus while hormones affect mood, mood disorders are not due to a deficiency of hormones. Lifestyle changes with healthy diet, increased exercise and social engagement are the most important ways of treating perimenopausal depression.
Drs. Walter Rocca and Sanjay Asthana spoke on the effects of estrogen on cognition. Summarizing all of the research in the past decade on this topic has led to “The timing hypothesis for dementia”. In summary, this hypothesis states that estrogen may be strongly protective before the age of natural menopause around 50 yr; moderately protective in early postmenopause (age 50 to 59 yr); and deleterious if started in later post-menopause (over the age of 60 yr).
Dr Virginia Miller spoke about the KEEPS study. KEEPS stands for Kronos Early Estrogen Prevention Study. This study randomized 727 women to low dose estrogen, either 0.45 mg oral conjugated equine estrogen or 0.5 mcg transdermal estradiol patch, plus cyclic micronized progesterone for 12 days per month or placebo instead of any hormone. The average age of women in the KEEPS study was 52.7 yrs, and all the women were within 6 to 36 months of their final menstrual period. The initial results came out in 2012, and showed an overall favorable benefit-to-risk ratio of the hormone therapy. Positive effects were seen on bone, VMS and sexual function, while there were neutral effects on cardiovascular disease, stroke and blood clots.
Dr. Sharon Mulvagh spoke about prevention of cardiovascular disease in women. Six to ten times more women die of heart disease than breast cancer; one in three women’s deaths in the US are caused by heart disease. She reviewed the estrogen effects on the blood vessels, most of which are protective pre-menopausally. Women with chronic persistent angina who do not have obstructive coronary artery disease have a worse prognosis than women with no angina. More women die following CABG (coronary bypass) than men. A large number of women have microvascular coronary disease (MCD), which is also called female-pattern ischemic heart disease. The good news is that more than 80% of heart attacks can be prevented with lifestyle changes. Every woman should know her body mass index, waist circumference, blood pressure, fasting glucose and cholesterol. The recommendations were mindful eating with heart-healthy food choices and regular activity of 30 to 60 minutes increased heart rate daily with weight training twice a week.
Dr. Richard Sood reviewed the controversies in menopausal hormone therapy. He reviewed recommendations for HT before the WHI, when it was offered to women between ages 40 and 60, and was sometimes prescribed for prevention of CVD and osteoporosis as well as to treat menopausal symptoms. He spoke to the controversies of the WHI including overgeneralization of results and the use of relative risks instead of absolute risks to provide risk estimates. Now, 11 years after the WHI, HT is not controversial for use in a healthy, young menopausal woman (<60 and within 10 years of menopause), unless there are specific, individual contraindications. Physiatrist Dr. Edward Laskowski presented on exercise in older adults. Muscle mass declines 30% between ages 30 and 70. Basal metabolic rate declines 2 to 5 % per decade after 30. Lean muscle decreases and body fat increases to result in a gain of 10 lbs fat per decade. There is a decrease in elasticity and compliance of connective tissue with age. Regular exercise can mitigate these changes. Weak muscles contribute to falls and trouble with stairs and walking. Exercise decreases blood pressure and insulin resistance, helps prevent osteoporosis, decreases pain in osteoarthritis, has beneficial effects on mood, depression and anxiety, and helps to maintain cognitive status. Recommended to get at least 150 minutes of moderate cardiovascular exercise per week along with 2 strength training sessions and regular stretching to maintain flexibility.
Dr. Donald Hensrud spoke on the optimal diet for weight management. He stated there is no one best diet for weight loss and that diet recommendations should be individualized. Writing down everything we eat is helpful, as we tend to underestimate our caloric intake. To lose one pound in a week requires a calorie deficit of 500 Cal per day. Very low calorie diets work, but people regain the weight once they eat normally again. The Nurses Health Study found that women with the largest increase in intake of fruits and vegetables had a 24% decreased risk of becoming obese. We should emphasize eating healthy foods. Several of the many available diet programs available by book, club or online apps were reviewed. The importance of eating breakfast was noted, as were the facts eating one meal per day lowers metabolic rate and that it is best to eat small frequent meals throughout the day. The Mayo Clinic Diet was highly recommended (Dr. Hensrud is the medical editor-in-chief of the book). Further information on this may be found at www.mayoclinic.com .