When women enter menopause, there are many attendant health concerns that can cause worry or stress. But addressing those potential issues has become a great deal easier over the last couple of decades, both through preventative care and treatment.

Osteoporosis is one of the first things that comes to mind for many women, as decreased estrogen production during menopause can lead to a loss of bone density without any corresponding symptoms. Indeed, most women with osteoporosis don’t know it until they break a bone from what would otherwise be a mild or harmless fall.

But menopause isn’t the sole contributor to osteoporosis developing in women. As Dr. Sandra Eisele of The Christ Hospital explains, the medications many people take to treat diabetes, chronic pulmonary issues and arthritis can reduce bone strength over time and make someone vulnerable to osteoporosis.

As much as anything else, a woman’s activity level can affect her risk of developing osteoporosis. Those with issues that limit their ability to exercise—even if it’s just walking—are vulnerable.

“When your activity is low, your bones tend to be weaker,” explains Esiele. “Bones really respond to the impact of weight bearing. So if your weight bearing is limited, your bones will be weaker as well.”

That makes it all the more important for women who are mobile and able to exercise in middle age to maintain healthy bones through activity as a way to mitigate the deterioration caused by menopause. Walking daily is a simple and easy way to keep bones strong, as is yoga. For those who have ankle or foot issues or anything else that makes walking difficult, pool exercises and swimming can help, though not as much as weight-bearing activities.

“If you don’t have any of these predisposing conditions,” Eisele says, “without really knowing what your bone strength is you want to maintain what you have as much as possible.”

Diet is also both a potential contributing factor in developing osteoporosis and, through healthy eating, a way for women to combat its onset. Many people know from childhood that calcium helps build and maintain strong bones, but vitamin D is particularly important in tandem as it helps bones retain their calcium.

Dairy products are a common source of both, but women who are lactose intolerant can find products enriched with vitamin D and calcium—like orange juice—or pair foods together that are rich in either. Eggs and many kinds of fish provide plentiful vitamin D while soy, broccoli, kale, okra, beans and almonds pack a good amount of calcium into small servings. Premenopausal women should target getting 1,000 milligrams of calcium and 600 to 800 international units of vitamin D daily. Women 50 and older should increase their daily intake to 1,200 milligrams of calcium and 800 to 1,000 international units of vitamin D.

Women who are concerned about their bone density can get a DEXA scan if they want to know if they are at risk or have already developed osteoporosis. The procedure is usually covered by insurance for women 50 or older and can be approved for younger women with prior conditions that heighten their risk of weakened bones.

But bone health is hardly the only health concern that comes with menopause. As menopause entails the end of a woman’s menstrual cycle, the lack of estrogen being produced by her ovaries can cause issues in areas that have sensitive estrogen receptors such as the breast, vaginal and vulvar tissue. Less internally produced estrogen can also affect the lower part of a woman’s bladder, potentially causing incontinence, and other areas.

“When you take estrogen away from those areas,” explains The Christ Hospital’s Dr. Michael Karram, “they undergo certain changes.” Dryness, irritation and atrophy can occur which can lead to various issues spanning from discomfort during intercourse to increased vulnerability to tract infections.

Though these effects can be persistent concerns for women in menopause, one of the more negative effects Karram points out is a corresponding anxiety or depression that stems from not feeling normal.

“One of the things we try to promote is don’t let it get to this point because there are things that we can do to stop the process or reverse the process to make you feel better,” says Karram. Gynecologists want to make sure that women know there are actions that can be taken that weren’t available 10 or 20 years ago, but they need to be willing to bring their concerns or issues up with their doctor.

Karram recommends that menopausal women append their diet with foods that contain natural phytoestrogens. Soy products are particularly rich in these. Some herbs and other foods are also particularly effective, such as black cohosh, ginger and some legumes. Eating foods rich in natural estrogens should be done in tandem with regular activity in order to keep the body from producing other estrogens that have negative effects on a woman’s body.

“Once you get overweight and your [body mass index] goes up, you start to produce different estrogens from different parts of your body,” Karram says. Fat cells produce an estrogen called estrone that adds to weight gain and increases swelling and tenderness in tissue.

An emerging issue is alternatives to hormone replacement. Women with breast cancer cannot go through estrogen therapy as the sensitive estrogen receptors in the breast tissue can cause cancer cells to spread. As such, even just five years ago, they had to deal both with their cancer and the fact that they couldn’t get menopausal relief through estrogen supplements, which would exacerbate any physical or emotional health issues they were experiencing.

But there are now effective alternatives. Chief among them is the MonaLisa Touch low frequency carbon dioxide laser, which is used in a simple, 10-minute procedure that can relieve genitourinary issues. The Christ Hospital started utilizing it in 2014 and, along with Stanford University, has led the way in utilizing the laser for treating menopausal women through encouraging vaginal cell regeneration.

The key, Karram stresses, is that women be aware that new treatment options exist now that can relieve discomfort and genitourinary issues. All it takes is being open with their doctor who can illuminate the many options that relieve menopausal issues and help them enjoy happier, more comfortable living after 50.

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