BECAUSE THE AVERAGE life expectancy for women is now more than 80 years, women can expect to spend at least one-third of their lives after menopause. In fact, one-third of the women in the United States have been through "the change." Learning what to expect from these hormonal and age-related changes is vital, especially for those who have MS, because certain peri-menopausal symptoms may be confused with a worsening of the disease.
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| Menopause And MS Multiple Sclerosis |
Hormones have indeed been found to have some impact on MS. This impact is greatest during and after pregnancy. In addition, the symptoms of MS may increase at ovulation (midway through the menstrual cycle) when body temperature rises slightly and the estrogen level is at its peak. During the next 2 weeks until the period occurs, the temperature remains slightly elevated while the estrogen level gradually declines.
Estrogen, which declines during menopause, plays a major role in the health of the body, especially of the bones and heart. It is because of estrogen that women are much less likely than men to begin having heart attacks before the age of 60. When estrogen levels decline, bone density or thickness likewise decreases. Although bone density can begin to decline long before midlife, a truly dramatic decline begins at menopause. This trend is most often reflected in women's increased fracture risk (especially of the hip, wrist, and spine) after age 60.
Women should, therefore, make every effort to arrive at menopause with the maximum bone density possible. Promoting healthy bones is best accomplished with weight-bearing exercise and calcium intake starting in childhood and continuing through the teens and twenties, when the body's maximum bone mass is developing. Once this bone density has been established, it needs to be maintained in the thirties, forties, and thereafter.
Adults with MS or other risk factors for osteoporosis (thinning of the bones leading to risk of fractures) should also have special screening tests done. While osteoporosis is common in women after menopause, especially if they are thin and of Caucasian or Asian ancestry, it can also occur in men and women of any age who use steroids or who have limited mobility. It is now possible to determine a person's bone density using a DEXA (dual energy X-ray absorptiometry) scan, which is a simple, painless, and safe test that predicts a person's relative fracture risk based on a computer-generated graph.
There are also other methods of osteoporosis screening that your healthcare provider may recommend. Women or men who have osteoporosis may be prescribed a medication such as alendronate, which can increase bone density and help prevent fractures. As always, exercise and calcium must also he a part of the treatment.
Because menopause is the beginning of the rest of a woman's (long) life, the recommendations for preventive health care continue to apply during midlife and beyond. In general, physical exercise and a low-fat diet that includes the recommended 25-35 grams of daily fiber and adequate calcium continue to be essential to promote wellness. Routine preventive testing should include cholesterol screening, mammograms, Pap testing for cervical cancer, and screening for diseases such as colon cancer, high blood pressure, and diabetes.
Hormone replacement therapy is an important issue that all women of menopausal age need to consider. In years past, health practitioners routinely recommended hormone replacement for postmenopausal women because preliminary data suggested that estrogen supplements would decrease women's risk of heart attacks, strokes, cognitive problems, osteoporosis, and fractures. These preliminary studies were mostly of an observational variety, which could only suggest health benefits without truly proving them.
Proof depended on nationwide trials that would yield more definitive data by randomly assigning women to hormone replacement or to placebo medications, tracking outcomes over multiple years. When these long-term trials began to yield results, they showed that hormone replacement did not provide the expected preventive benefits. Not only did estrogen and progestin not prevent heart attacks, they indeed seemed to cause them.
The research also found that postmenopausal hormone replacement therapy increased the risk of breast cancer. Even though the studies found that hormone replacement prevented osteoporosis and fractures, relatively few physicians believe this benefit outweighs the increased risks of heart disease and breast cancer, especially since there are safe and effective treatments available for osteoporosis.
There are good reasons that some women may choose to use estrogen and progestin after menopause. Women bothered by hot flushes or other menopausal symptoms, for instance, might discuss with their physicians whether they should try hormone replacement for a period of time. Vaginal dryness or similar symptoms that may be MS-related, however, will not improve with hormone therapy.
A woman's use of estrogen and progestin for short-term relief of menopausal symptoms should depend on discussions with her practitioner about the potential benefits and risks given her particular medical history, family history, and symptoms. Most physicians no longer recommend long-term use of hormone replacement therapy for the goal of preventing heart disease, osteoporosis or other medical problems.
Many over-the-counter remedies can alleviate perimenopansal symptoms. Vaginal moisturizers (KY Jelly, Astroglide, Replens and others) can increase comfort. Vitamin E (400 IU per day) has long been thought to reduce hot flashes. Soy products (soy milk, tofu) can result in healthier hearts and bones and can decrease hot flashes. Natural and health food stores encourage the use of dong quai, ginseng, black cohosh, wild yam root, and other products. Be careful, however, because acceptable studies are only now under way to assess the risk-benefit ratio of many complementary and alternative therapies.
We all want to make the right decisions about our health, knowing we will be living with them for a lifetime. Unfortunately, women (and men) are faced with decisions for which there are no guarantees and may be no obvious right answers. Medical recommendations vary from doctor to doctor and from study to study. The important thing is to be well informed, to discuss the issues thoroughly with your doctor, and to re-evaluate your choices as new research becomes available.
THIS POST HAS described some of the important health and wellness concerns of individuals with MS and their family members. Careful attention to health-promoting behaviors will make you an active participant in the teamwork that is required for you to enjoy the highest possible quality of life and be able to respond, "I am well, thank you" to all who inquire. It is important to make sure that the practitioners with whom you are working are sensitive to these concerns and attentive to problems other than those directly related to MS.
Although this discussion of general wellness has highlighted the health of the person who has MS, the same recommendations hold true for family members and friends. It is not only people who have a chronic illness who tend to forget preventive health care measures. Caregivers of very disabled individuals may find themselves so involved with MS-related demands that they neglect their own health or withdraw from healthy and relaxing activities that the person with MS can no longer share.
On the other hand, people with MS who are able and willing to strive for wellness may find themselves becoming role models who inspire those around them. Whatever your own personal and family situation, it is essential to pay attention to your own health and well being. To the extent that everyone can adopt this approach, life's stresses - including the stresses of MS - will become smaller factors in what should be a happier and healthier family life. To find out more, you can check out Menopause And MS Multiple Sclerosis.