Equal, yes, but there’s no arguing that men and women are different. How many men go through perimenopause or BRCA gene testing, for example? With different anatomies come different ailments and concerns; we need to understand our bodies to fully understand ourselves.
[perimenopause]
a marathon, not a sprint
While menopause technically means the absence of a menstrual cycle for one year, the transition into menopause—perimenopause—can last much longer. “On average, perimenopause will last three to five years,” says Dr. Ashley Ryan, of Genesis OB/GYN. “Typically between 45 and 55 years old, the body decreases estrogen and progesterone production, and a woman’s cycles begin to shorten and become irregular, skipping cycles here and there. Women may also have more problems with PMS.”
The length and severity of symptoms can vary widely. Ryan says some will not even notice they’re beginning to transition to menopause, while symptoms in other women will decrease their quality of life. And some women experience symptoms well into their 60s or even early 70s!
dr. jekyll & ms. hyde
The symptoms of menopause, including hot flashes and night sweats, occur when there is a dramatic drop in hormone levels, explains Dr. Teresa Knight of Women’s Health Specialists of St. Louis. “Most begin to experience these symptoms in their late 40s, often before their period. The symptoms can be especially severe for women who are put into menopause surgically, because they go rapidly from having hormones to having none,” she says.
Other common symptoms include insomnia, mood change, low libido, vaginal dryness, weight gain, tender breasts and headaches. Green says symptoms tend to have a domino effect. “A decrease in estrogen can trigger anxiety and nervousness, which can lead to insomnia and moodiness,” she notes. “These hormonal changes can also lead to male-pattern weight gain in the stomach.”
staying sane
“It’s important to realize that menopause is a natural process,” Knight says. “It’s amazing to me that given all the changes in longevity, diet and culture, the average age of menopause—52 years old—has been the same since the beginning of time. It’s only becoming an issue now because we’re living so much longer.”
You don’t have to suffer with menopause, both doctors say. “Natural supplements are very popular. Women like the idea of taking something that is natural, and there are a number of options,” suggests Knight. She says it’s important to note that plant-based estrogen, sometimes made from soy, is very different from human estrogen, but it works for only some women.
Bioidentical hormone supplements, many of which are FDA-approved and available with a prescription, are molecularly identical to the hormones our ovaries naturally produce, says Knight. They function the same as our body’s natural estrogen, and the body cannot differentiate between them, she says. There are also supplements that can help support adrenal gland function, which is the body’s only source of female hormones after menopause.
But hormone replacement therapy is not for everyone, adds Green. “There are certain risks, the main being cardiovascular health. Some studies have found hormone replacement therapy can increase a woman’s risk for heart disease and slightly increase the risk for breast cancer. The risks will increase the longer you’re on the therapy,”she says.
aftermath
Osteoporosis, a condition in which bones become weak and can break easily, is a concern post-menopause, says Green, since women have been losing bone mass since age 30 and the process becomes more rapid when the body quits producing estrogen. According to the National Institute on Aging, half of American women over age 50 will probably have a bone break or fracture because of osteoporosis. Exercise, including walking and light weights, can help prevent osteoporosis, along with eating a diet rich in calcium and vitamin D.
Another concern is heart health, says Green, since the female hormones provide some protection from heart disease, the No. 1 killer of women. And for vaginal dryness and painful intercourse, there are effective treatment options like topical estrogen, water-based lubricants and moisturizers.
[myth v. fact]
myth>You’ll experience menopause when your mother did.
fact> The age at which you began to menstruate influences your menopause age, as do smoking and hysterectomy.
myth> It’s all in your head.
fact> Unusual bleeding could be a sign of uterine cancer.
myth> Only hormones help the side effects of menopause.
fact> Regular exercise and eating a healthy diet have been shown to mitigate those effects.
myth> Birth control delays the timing of menopause.
fact> Our eggs have an expiration date and will begin dying, period.
[20 years after brca]
Since Angelina Jolie went public with her preventive double mastectomy, there has been an active public dialogue about hereditary breast cancer, genetic testing and cancer prevention. Local experts agree, though, that there are still many misconceptions about genetic testing.
buyer beware
The BRCA 1 and 2 genetic test is much more complicated than a simple blood draw and should only be done by a credentialed genetics professional. SLU’s Mahon says interpreting the results can be challenging and should be left to a genetics counselor. “Anyone who has concern about hereditary risk should see a credentialed genetics professional who can sort through the issues. Is genetic testing indicated? Who is the best person to test in the family? How to interpret the results?” A list of credentialed genetics professionals is available at nsgc.org.
testing+/– you are a candidate for testing if:
>> Cancer occurs at a much younger age than average, such as breast or colon cancer before age 50.
>> Cancer occurs in several close relatives on the same side of the family.
>> More than one type of cancer occurs in the same close relative.
>> Cancer occurs in paired organs (such as cancer in both breasts).
>> Cancer occurs in more than one generation.
>> Several rare cancers occur in a family.
>> You are of Ashkenazi ancestry,who have significantly higher risks.
after testing positive
“Testing is offered if it will change screening or surgical decisions,” says Mahon, “and the age at which the cancer has occurred in the family is a driving force.” She notes that women who test positive for a mutated BRCA 1 or 2 gene have an approximate 90 percent chance of developing breast cancer once by the age of 85. Likewise, the chance of developing ovarian cancer can be as high as 50 percent. BRCA gene mutations also are associated with other cancers, including uterine, colon, pancreatic, prostate and melanoma.
“Bilateral prophylactic mastectomy is the most effective risk reduction strategy for gene carriers. The risk reduction is around 95 percent,” Dr. Diane M. Radford, a Mercy Clinic breast surgeon, says. Additionally, women who test positive for the BRCA 1 or 2 genes are strongly encouraged to undergo oophorectomy (ovary removal) between the ages of 35 and 45, after childbearing is complete, because ovarian cancer is very difficult to detect and treatment can be very difficult, Mahon says.
one woman’s story
Joanne Kelly’s aunt, grandmother and great-grandmother died of ovarian cancer. Her mother also was diagnosed with breast cancer at age 48. Because her mother tested positive for the BRCA 1 mutation, Kelly knew she had a 50/50 chance of inheriting the mutation.
“Even before I had the test, I had pretty much prepared myself for a positive result. It was just a matter of when,” Kelly says. “Still, it was a shock when I got the results.” Results came in September 2008, and she underwent a bilateral prophylactic mastectomy at only 32 years old. A few years later when she turned 35, Kelly had a hysterectomy and oophorectomy, as well.
“The side effects, including hot flashes, trouble sleeping and weight gain, have been pretty difficult,” Kelly says. Still, she has no regrets. “I absolutely made the right choice.”
[myth v. fact]
myth> A negative test result is good news.
fact> “If there is not a known mutation in the family, a negative test result means that the individual did not have a detectable mutation in the gene(s) tested. There may or may not be hereditary risk,” clarifies Suzanne Mahon, DNSc, director of the Hereditary Cancer Screening Program at Saint Louis University Cancer Center.
myth> BRCA 1 and 2 genes are the only ones associated with breast and ovarian cancers.
fact> BRCA 1 and 2 genes are believed to be responsible for only about 30 percent of hereditary breast cancers. In reality, there are more than 20 genes known to be associated with breast and ovarian cancers, and probably still more to be discovered.
By Sara Savat
