Cardiovascular Disease (CVD)
The risk of heart problem increases with menopause. The loss of estrogen causes
- An increase in blood pressure
- Changes in carbohydrate metabolism and increased risk of diabetes
- Increase in atherosclerosis (heart / vessel blockage)
- Palpitations
- Altered lipid metabolism leading to increased LDL (bad cholesterol), lowered HDL (good cholesterol) and increased triglycerides levels. In women, an increase in triglyceride level is seen as the main risk factor for cardiovascular disease (CVD). An increase in total cholesterol levels even by 1%, is equally dangerous. Reversal of HDL / LDL ratios leads to formation of atheromatous plaques which then cause thrombus formation and strokes.
- A decrease in metabolism, leading to an increase in weight which is mainly over the midriff, leading to increased cardiovascular problems
Coronary heart disease in women
| Unmodifiable Risks | Modifiable Risks |
|---|---|
| 1. Family history of MI or sudden death in male relative before the age of 55 years or female relative before the age of 65 years 2. Female >55 years 3. Premature Menopause < 40 years 4. Pre-eclampsia or gestational diabetes during pregnancy or delivery of an IUGR (growth restricted baby) 5. History of bilateral oophorectomy prior to menopause |
1. Sedentary lifestyle 2. Obese / overweight 3. Smoking or using any tobacco related products 4. High blood pressure + diabetes mellitus 5. Altered lipid profile • Elevated serum cholesterol levels (> 6.2 mmol/l) • Low plasma HDL levels (<0.9 mmol/l) • Raised triglycerides 6. Excessive alcohol intake 7. Use of oral contraceptives 8. Metabolic syndrome 9. Increased levels of C Reactive Protein (CRP) 10. Stress |
Cardiovascular disease (or heart disease) is the biggest killer in Malaysia.
The average age of a heart attack is 58 years. More than half of those with heart attacks have diabetes, high blood pressure, high cholesterol or are obese.
After menopause more women are at a risk for heart disease. Women are more likely to die from a heart attack when compared to men.
Osteoporosis
Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density and structural deterioration of bone tissue which then leads to fragile bones and an increased risk of fracture of the spine, wrist and hip. Bone loss is exaggerated by menopause and estrogen deprivation. In the first 5-7 years after menopause, a woman might lose about 20% of her bone, while an average woman loses half her bone by the age of 70 years. Osteoporosis is twice more common in females as compared to males.
Peak bone mass is achieved in men and women by the age of 25 to 30 years. Factors that determine the peak bone mass are genetics, physical activity and diet. Bone loss is highest in small built, fair skinned women. In 1997 alone, the Chinese women in Malaysia accounted for 44.8% of hip fractures in Malaysia.
Risk factors for osteoporosis
| Non- modifiable | Modifiable |
|---|---|
|
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The common areas of fracture are to the spine, wrist and hip
The Incidence of Hip Fracture in Malaysians above 50 years of age: variation in different ethnic groups
| Age Group | Male | Female | Overall |
|---|---|---|---|
| 50-54 | 10 | 10 | 10 |
| 55-59 | 20 | 30 | 20 |
| 60-64 | 40 | 50 | 40 |
| 65-69 | 60 | 100 | 80 |
| 70-74 | 100 | 230 | 170 |
| >75 | 320 | 640 | 510 |
Malaysian data on Osteoporosis has shown that:
- Chinese women had the highest incidence of hip fractures (44.8%)
- 20% of men and women die in the first year after a hip fracture
- Only 25% of men and women resume normal activity after a hip fracture
- 25% will always need a walking aid for the future
A Summary of the Malaysian Clinical Guidance on the management of post menopausal and male osteoporosis 2015.
Swan Sim Yeap, Fen Lee Hew, Premitha Damodaran, Winnie Chew, Joon King Lee, Emily Man Lee Goh, Malik Mumtaz, Heng Hing Lim, Siew Pheng Chan.
The above table shows that osteoporosis is clearly an important problem as one gets older. The risks of an osteoporotic fracture is greater than the combined risk of heart attacks, stroke and breast cancer.
The skeleton which holds the body’s frame is 99% calcium. 1000 to 1300 mgs of calcium is needed daily at various stages of one’s life.
Calcium is important for building bone in the first 25 years of one’s life, after which its role is in sustaining bone health until the inevitable age related bone loss occurs.
Metabolic Syndrome
The increase in abdominal fat in a menopausal lady increases the risk of diabetes and insulin resistance. She puts on weight which is more of a midriff weight. The main features of metabolic syndrome i.e. high insulin levels, insulin resistance and obesity is common in many post-menopausal woman. In these women, there is increase in oxidative stress, inflammatory and clotting processes all leading to an increased risk of heart problems.
Mental and physical tiredness leads to lack of exercise. The menopausal woman is at this phase in life when she needs to be reenergised to look after herself. Genetic factors come in with age which add to the preexisting health issues she has. This worsens the problems and the risk of Type 2 diabetes increases.
In the last 5 years (2100-2016), the number of Malaysian men and women with diabetes has jumped from 15.2 % to 31%. This is in comparison to the world average of 2.8%.
We are also an obese nation ranking highest in BMI in comparison to our Asian partners.
Genitourinary Symptoms
Menopause causes changes in the vaginal tissue and bladder muscles.
The vaginal skin changes with the menopause becoming dry and flaky. This then leads to sexual problems such vaginal dryness, lack of lubrication, discomfort and pain during sexual activity. There can also be tearing of vaginal skin and bleeding with intercourse. The vagina becomes a sensitive area thereafter leading to infections and itchiness.
The common bladder problems are urgency (feeling of going to the toilet often), painful or difficult urination and recurrent urinary tract infections. The menopausal lady experiences incontinence which may be stress related (leaking while laughing, sneezing or coughing) or due to urge incontinence or overactive bladder whereby she is not able to reach the toilet in time.
The pelvic muscles may get weakened with childbirth and other conditions such as diabetes, nerve damage and muscle sclerosis. Thus these symptoms of leaking may not be solely due to aging and weak pelvic muscles.
The first line of handling bladder problems is to do Kegel’s exercises regularly. If done correctly, frequently and continuously it can help improve pelvic floor tone and decrease the risk of incontinence.
Cancers
The risk of cancers increases as we age. By the age of 75 years, 1:4 of Malaysian men and women will have cancer. The commonest cancer in the Malaysian woman is breast, colorectal,, cervical, ovarian and nasopharyngeal cancer. Uterus cancer is also more common in the older age group. Family history, reproductive history, inflammatory bowel disease, personal history of precancerous polyps and history of exposure to environmental tobacco smoke and pollution all increase risk of cancer. At times, we can get cancer without presence of risk factors or despite regular screening.
Nevertheless, it is always important to see your doctor for a full medical review regularly.
For more information about Cancers, please click here.
Mental Health
Hormone changes can lead to depression, anxiety and mood swings. The mood swings that occur in the menopause can actually come along, all of a sudden and it is always important to try keep this under control as it may hurt others’ feelings.
It is always difficult to identify true depression and anxiety as many symptoms are linked to each other. For example hot flushes and night sweats can lead to anxiety, sleeplessness, headaches, tiredness, mood swings and then depression. However true depression can happen if:
- there are prior episodes of depression
- significant stress in your life
- a negative attitude to things happening around you
- dissatisfaction with relationships
- low self esteem
- poor body image
- poor lifestyle such as little exercise or high intake of alcohol
- previous history of mental, physical or sexual abuse
Most women regard menopause in a negative light, a time of stress and midlife crisis. Then when small symptoms happen (which usually they would have been able to handle), they worry and get stressed unnecessarily, and this starts a vicious cycle that exaggerates every symptom.
What many women find that they cannot do with the menopause is to multitask which then gives them a feeling of insecurity and anxiety. They are not the same person they used to be: they are growing old.
Coping with this phase is important as women need to understand that:
- Every women need to menopause: if not their risk of cancers of the breast and uterus may increase.
- Accept menopause with a challenge and prepare for it as other activities are planned in their lives.
- Do not wait till in the 40’s to prepare for menopause.
- Accept that multi-tasking may not be possible and prioritise things that need to be done one by one.
- Accept that you cannot do everything.
- Accept that you may need some help
- Talk and communicate your feelings and insecurities with family members and friends
- There is no stigma attached to seeing a psychologist or psychiatrist if necessary
- Look after your health with the correct food and exercise
- Have a time out for your self
For more information about Mental Health, please click here.