Menopause Support Blog » heart disease

The Role of Hormone Therapy in the Management of Menopause

Charla Blacker, MD — Mon, 05 Apr 2010 01:58:35 +0000

In the most recent issue of Obstetrics & Gynecology, Jan Shifren and Isaac Schiff reviewed the literature about the use of hormone therapy (HT) in the menopause. The principle indication for hormone therapy remains the treatment of hot flushes and night sweats. Benefits generally outweigh the risks for healthy women with bothersome symptoms who elect to HT at the time of menopause. Although hormone therapy increases the risk of coronary heart disease, recent analyses confirm that this increased risk occurs primarily in older women and those a number of years beyond menopause. These findings do not support a role for HT in the prevention of heart disease but provide reassurance regarding the safety of use for hot flushes and night sweats in otherwise healthy women at this difficult time of life. An increased risk of breast cancer with extended use is another reason short-term treatment is advised.

Hormone therapy prevents and treats osteoporosis but is rarely used solely for this indication. Estrogen is as effective as the other treatments for osteoporosis, so most women using HT for menopausal symptoms will not need additional treatment for their bones except for adequate calcium and vitamin D intake. If only vaginal symptoms are present, low-dose local estrogen therapy is preferred. There are creams, pills, and an estrogen ring which can be used to treat vaginal symptoms. They are all equally effective and which is used may be based on the woman’s preference. The risk profile for vaginal therapy is very different from systemic therapies, and there is no data that suggests a link between use of vaginal estrogen and the development of breast cancer or heart disease. There are safety studies up to 1 year showing no adverse endometrial effects, but studies of long-term effects of low-dose vaginal estrogen therapy are lacking. Therefore, women using vaginal estrogen therapy should report any vaginal bleeding and should undergo thorough evaluation.

Contraindications to HT use include breast or endometrial cancer, cardiovascular disease, history of blood clots, and active liver disease. Alternatives to HT is advised for women with or at increased risk for these conditions. The lowest effective estrogen dose should be used for the shortest duration necessary. Women should be informed of the potential benefits as well as the risks of all therapeutic options. Care should be individualized, based on a woman’s medical history, needs, and preferences.

Yoga for Wellness- Interview with Julie Levinson RYT

Deborah McBain, CNM MSN — Wed, 24 Feb 2010 18:47:26 +0000

Julie has a BFA in dance from the University of Michigan and has been teaching creative movement and ballroom dancing since 1977. She completed her yoga teacher training and began teaching in 2000. She has taught a wide variety of classes in the community for all age groups and continues to teach classes at West Bloomfield Parks and Recreation. In 2008, she completed training in a yoga therapeutic program, “Yoga of the Heart,” based on Dr. Dean Ornish’s study on reversing heart disease. She feels proud and fortunate to be an employee at Henry Ford Vita Wellness Center, teaching yoga classes which focus on the health benefits of yoga. In addition to the daily yoga classes, she also teachs Zumba, Ballet Stretch and Tone and Dance Your Way to Fitness. She recently answered my questions about how Yoga may benefit women during menopause and beyond.

I know you teach a Yoga for Wellness class now and have offered a Yoga for Menopause class in the past. What prompted your interest in yoga and specifically yoga for menopause?

When I began my first yoga classes in 1995, I truly had little understanding of yoga. I was recovering from a dance injury and thought yoga would be a good way to stay in shape while I was recovering. I quickly recognized that yoga was as much about the body as it was about the mind. In short order I began to notice the many benefits from practicing yoga. I was inspired from my earliest classes to become a yoga teacher, guiding others to discover the benefits. The overall benefits of yoga, which include stress reduction, improved focus, mood regulation, improved sleep as well as strength, balance and flexibility have served me well as I have made the transition through menopause.

Yoga is well known for its benefits in managing stress. How is it specifically helpful for menopausal symptoms?

Firstly, yoga promotes greater self-awareness. As with stress, we may not recognize it until it becomes overwhelming. For example, yoga draws our awareness inside so we may be better able to identify the subtle signs of stress as in muscle tension and shallow breathing. As menopausal symptoms begin, we as women can begin to identify these changes. We cannot begin to manage them without being aware. Diaphragmatic breathing which is used in the yoga for menopause classes, elicits the relaxation response, allowing endorphins, (feel good hormones) to be released, creating a sense of calm and improved focus. In addition, there are ”cooling” breathing techniques that can be used for relieving hot flashes. Specific yoga poses are valuable for improving sleep, regulating mood and building bone density.

What are the other health benefits of Yoga for women as they age ?

A regular yoga practice can build both strength and flexibility in both body and mind. Research shows that a regular yoga practice can improve the function of nearly every system of the body from the cardiovascular system to the digestive system. Yoga helps to keep these systems fine tuned and running smoothly.

Is Yoga safe for everyone? Are there any precautions women need to be aware of?

Yoga is for EVERYBODY!!! Of course, it’s important to get permission from your physician before beginning a regular yoga practice. Modifications for specific poses are necessary for women with high blood pressure, or osteoporosis for example. It’s important to find a teacher with knowledge and experience.

How would you recommend someone get started with Yoga? Do you have any good resources you can share?

Yoga is experiential and cannot easily be grasped by reading about it or watching DVD’s. It’s important to begin with an experienced teacher with a watchful eye. It’s important to ask if the yoga room is specifically heated for classes. Some yoga studios and gyms will heat the room as certain styles of yoga like Ashtanga, Vinyasa and Bikram require heat that can be 80 degrees. While the heat can be very good for loosening muscles, some menopausal women will find the heat very uncomfortable as their own personal thermostat is running on “hot”. All of the classes that I teach at Vita are suitable for menopausal women. New students are asked to fill out a questionnaire and with this information I will be able to make recommendations for our students, noting contraindications and adapting to their specific needs.

Go to the Henry Ford Health System link at the right to get more information about wellness classes or call 1-800-henryford.

Hearts and Hormones

Deborah McBain, CNM MSN — Sat, 06 Feb 2010 20:34:52 +0000

One of the most important and controversal questions regarding hormone therapy (HT) for postmenopausal women is “ Does Hormone Therapy reduce or increase risk for heart disease?” An important study is underway that may help answer this question. The Kronos Early Estrogen Prevention Study- KEEPS is designed to address whether or not risk depends on the age of the woman when beginning HT. It will also seek to answer whether patches are any safer than pills. Observational studies have long suggested that HT can offer protection against heart disease in some women. In 2002 another very large and important study- (WHI) Women’s Health Initiative not only failed to show protection but was stopped when participants showed increased incidents of heart attack and stroke. The average age of women in WHI was 63 and 12 years past menopause with 20% over the age of 70. KEEPS will attempt to address whether it was the older age of the WHI participants that made the difference by studying a younger group of women who more recently entered menopause. The age range for KEEPS participants is 42-58 and 6 -36 months from onset of menopause. KEEPS will also use different types of hormones than were used in WHI including bio-identical formulas. Women and those of us who advise them are anxious to see if KEEPS can offer guidance when making decisions about HT. Keep a watch out for results from this study as it comes out in the media. The only way we can know the truth about what is safe and effective is through studies like this. If you want to know more about this study, go to their web site www.keepstudy.org

The importance of heart disease prevention for women can hardly be overemphasized. Coronary heart disease is the single greatest killer of American women, extinguishing more lives (approximately one death per minute) than the next seven leading causes of female mortality. In other words heart disease accounts for 45% of deaths in women. Compare this to breast cancer which causes 4% of deaths in women or all cancers which accounts for about 21%. This is in sharp contrast to the perceptions of most women who see cancer, particularly breast cancer as the biggest threat. Women should be aware that far more is known about risk factors for heart disease than for cancer and in general, heart disease risk factors are more susceptible to interventions.

February is designated Women’s Heart Health Month. Being aware of you risks and knowing what to do to reduce risk can save your life. You can start by going to web site www.knowyournumbers.com . If you live in the Detroit Metro area, check out our Support Circle page and attend a free presentation this month. We will be discussing Women’s Heart Health with an emphasis on eating healthy.