by Guest | Dec 28, 2024 | Being Well, Featured, Uncategorized
With the introduction of hormone therapy in the 1960s, women flocked to their doctors to treat their menopause symptoms. The therapy was groundbreaking and provided relief for millions of women. The treatment grew in popularity until the early 2000s. The use of hormones abruptly dropped after a women’s health study raised serious concerns over risks. With few other options available, the fallout from the study left an entire generation of healthcare providers struggling to treat women in their menopausal years. This gaping hole in women’s health is now getting addressed with more education, research, and a look back at that sentinel study that stopped it all.
What is menopause
Natural menopause occurs when a woman or person identified as female at birth has gone 12 months without any period. This defines the end of not just menstruation but also the end of fertility, as the ovaries are no longer functioning as effectively. This decreased function results in less hormone production, primarily the estrogen hormone. An estimated 1.3 million women enter menopause each year, with approximately one-third of their lives spent in menopause. The average age for natural menopause is 51 years. But symptoms may begin up to 10 years before menopause in what is known as perimenopause or the menopause transition.
Surgical menopause involves removing both ovaries with a surgery known as an oophorectomy. The removal of ovaries relates to medical issues, which can occur at any age. The missing ovaries will trigger menopause symptoms due to the lack of hormones they typically produce.
Common Menopause Symptoms
| Hot flashes are the sudden sensation of warmth in the face, neck, or chest with or without sweating |
Night sweats are hot flashes with sweating that occur at night |
| Difficulty sleeping, which may cause daytime fatigue and irritability |
Thinning of bones (osteoporosis), which may cause bones to break more easily |
| The vaginal skin may become thin or dry, causing irritation and painful sex |
Urinary issues such as recurring urinary tract infections (UTIs) and incontinence |
| Mood changes, such as depression or irritability |
Anxiety |
| Joint pain, aches, or stiffness |
Hair loss or thinning |
| Memory or concentration problems, commonly called “brain fog” |
Heart palpitations where your heart beats suddenly become more noticeable |
| Decreased interest in sex |
Tinnitus, a constant ringing in the ears |
| Weight gain |
Increased facial hair |
Types of hormone therapy
Hormone therapy is the use of prescription medications to boost hormone levels in the body. For the treatment of menopause, this therapy replaces the declining estrogen and progesterone. For menopause, this therapy comes in two types.
Systemic therapy. Estrogen and progestin, or similar compounds, are absorbed into the blood and travel throughout the body to treat symptoms. This method is very effective at treating hot flashes. Systemic therapy comes in the form of:
- Oral pills
- Patches placed on the skin
- Gels or sprays placed on the skin
- Ring inserted into the vagina
Low-dose therapy. Also known as vaginal estrogen therapy, this medicine treats just the vaginal area in the form of topical or vaginal creams. Low doses rebuild and moisturize vaginal tissue. Because of the small doses of this therapy, there are fewer risks as only a minimal amount enters the bloodstream.
Concerns about hormones for the treatment of menopause
In 1991, the Women’s Health Initiative (WHI) began a long-term study on women’s health. The study focused on cardiovascular disease, cancer, and osteoporosis-related fractures. In 1998, the study looked at hormone therapy use with both estrogen and the combination of estrogen and progestin. By 2004, researchers had stopped both studies early after finding increased risks of heart disease, stroke, pulmonary embolism, and breast cancer. The halting of the studies made headlines, leading many women to stop using hormones. Women aged 52-65 had the greatest decline as use dropped 88% in this group.
The impact of the WHI study was profound. Few other treatments were well studied. An entire generation of healthcare providers were left lacking information on treating menopause, and women felt this. A survey in 2021 found that 73% of women ages 40-65 were not getting care for their menopause symptoms. An additional 65% said they would not consider hormone therapy.
The benefits of treating symptoms
About 70-80% of women have menopause symptoms negatively affecting their quality of life. Hot flashes are the most reported symptom and can last more than a decade. However, up to 40% of individuals will continue to have symptoms into their 60s, and up to 15% will have hot flashes into their 70s. Hot flashes affect not only physical comfort but also sleep and mood.
The tide is changing with menopause treatments. Since the WHI study, research has shown hormone therapy is safer in younger women. Starting MHT within 10 years of the onset of menopause or before age 60 poses less risk. Hormone therapy is the most effective method of treating vasomotor symptoms like hot flashes. About 80% of women get relief from symptoms within two weeks of starting hormone therapy. There are still risks, and each individual should discuss their personal risk with their healthcare provider. Risks associated with hormone therapy:
- Stroke
- Uterine cancer
- Blood blots
- Breast cancer
For many, the benefits of hormone therapy outweigh the risks.
- Reduced menopause symptoms
- Relief of vaginal discomfort and dryness
- Improved bone health
- Ease symptoms of overactive bladder
- Lower risk of cardiovascular disease
- Reduced risk of developing type 2 diabetes
But hormones aren’t the only treatments. More research backed non-hormonal options are available to treat a variety of symptoms.
When to see a healthcare provider
Menopause treatment is in the spotlight with organizations nationwide. Locally, Oregon Health and Sciences University (OHSU) began offering training on menopause care. The classes are offered statewide to primary care providers and community health partners. With this program, OHSU focuses on reaching healthcare providers located in rural areas, including Tillamook County.
The impact of menopause symptoms cannot be understated. They are disruptive for many women daily, affecting how they feel, work, and relate to others. Perimenopause and menopause symptoms last for a decade or more, yet 1 in 8 adults still avoid talking about menopause. If you have perimenopause or menopause symptoms, talk with your healthcare provider. You can discuss:
- Whether you have reached menopause
- The symptoms you have and how much they affect you
- Your health risks based on your age and general health
- Whether hormone therapy is a good option for you
- Alternative treatment options to hormone therapy
If you need assistance in finding a provider to treat your menopause symptoms, check The Menopause Society’s website for a link to menopause specialists. If you are in the Columbia Pacific CCO, look at their Find a Provider page.
Written by: Leanna Coy, FNP-BC, Freelance Health Writer
References:
Menopause definitions. (2024). The Menopause Society. Retrieved December 2, 2024. https://menopause.org/patient-education/menopause-glossary
Menopause. (2024). Society for Women’s Health Research. Retrieved December 2, 2024. https://swhr.org/health_focus_area/menopause/
Walsh, J. (January 10, 2024). How gaps in research lead to gaps in care for aging women. Harvard Medical School News & Research. https://hms.harvard.edu/news/how-gaps-scientific-data-lead-gaps-care-aging-women#:~:text=Ambrosio%3A%20Menopause%20is%20inextricably%20intertwined,third%20of%20their%20lives%20postmenopausal.
Signs and symptoms of menopause. (March 14, 2023). NHS. https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/signs-and-symptoms-of-menopause/
Hormone Therapy. (2024). The Menopause Society. Retrieved December 2, 2024. https://menopause.org/patient-education/menopause-topics/hormone-therapy#:~:text=What%20Is%20Hormone%20Therapy?,night%20sweats%2C%20and%20sleep%20disturbances.
Kohn, G.E., Rodriguez, K.M., Pastuszak, A.W. The history of estrogen therapy. Sex Med Rev. May 27, 2019. PMID: 31147294
About WHI. (2021). The Women’s Health Initiative. Retrieved December 2, 2024. https://www.whi.org/about-whi
Iyer, T.K., Manson, J.E. Recent trends in menopausal hormone therapy use in the U.S. JAMA Network. September 27, 2024. PMID: 39331374
Elflein, J. Treatment of menopause symptoms among older U.S. women as of 2021. Statista. August 5, 2021. https://www.statista.com/statistics/1255552/treatment-of-menopause-symptoms-among-older-us-women/
The Menopause Society. September 4, 2024. Hormone therapy usage rates still low despite proven benefits. https://menopause.org/press-releases/hormone-therapy-usage-rates-still-low-despite-proven-benefits#:~:text=It’s%20estimated%20that%2070%25%20to,continue%20to%20have%20hot%20flashes.
Yang, J. (November 20, 2023). Share of U.S. adults who avoid talking about menstruation or menopause as of 2022. Statista. https://www.statista.com/statistics/1424427/menstruation-and-menopause-taboo-us/
Solving the mysteries of menopause, one conversation at a time. (October 24, 2024). Oregon Health News Blog. https://covidblog.oregon.gov/solving-the-mysteries-of-menopause-one-conversation-at-a-time/?utm_medium=email&utm_source=govdelivery
by Guest | Nov 21, 2024 | Featured, Uncategorized, Why I'm In
Written by: Sarah Ermer, MPH, CHES; Prevention Specialist at Tillamook Family Counseling Center
What drew you/your organization to partner with Tillamook County Wellness?
I’m a recent transplant to Tillamook; I moved here at the end of January for my position at TFCC. When I was preparing to move, I was doing some searching online to learn more about health initiatives in the county. I distinctly remember sitting at my parents’ dining room table looking at the Tillamook County Wellness website on my laptop and thinking, “Wow, Tillamook County has a great system for health promotion!” After officially moving and starting at TFCC, I knew I needed to prioritize getting to know as many different people and organizations as I could in order to do my job well. One of the first people I talked to was Michelle Jenck, who is the coordinator for Tillamook County Wellness. My background and current position are well-aligned with Tillamook County Wellness, so she connected me with the Health Promotions committee. The rest is history!
What, if any, changes have you seen come about as a result of this work?
I haven’t been here long enough to say first-hand what larger changes have come about as a result of Tillamook County Wellness, so I’ll share about a moment that stands out to me. One of the first community events I went to was Healthy Kids Day at the YMCA, where the Tillamook County Wellness Access to Physical Activity committee held the Bike Rodeo. I was amazed by the number of bikes and helmets that were available to go home with families! After watching a long line of kids practice bike safety around the parking lot, I have no doubt that even that event alone created positive change.
What have you learned from being involved in this work?
One of my favorite parts of being involved in Tillamook County Wellness, and of Tillamook as a whole, is seeing how the community really does come together to make things happen. I’ve learned a lot about all the systems at play in the area, and the fact that Tillamook County Wellness brings so many of them together is an amazing model for any community that wants to build stronger coalitions. I’ve learned what it really looks like to work as a community!
What are your hopes for this work as it relates to you/your organization?
My work is focused on substance misuse/addiction prevention, and doing that work effectively means looking beyond substance use alone. If we want to prevent young people from drinking or using drugs, we have to be willing to go beyond telling them what NOT to do. It means creating an entire community that supports people who are struggling with their mental health, who need a place to go, or who need positive, healthy activities to help build their confidence. I’ve seen how effective Tillamook County Wellness is in mobilizing people to support health initiatives; I hope that we can continue to mobilize in building support for both physical and mental health access.
What are your hopes for this work as it relates to changing community health in Tillamook County.
Much like my hope as it relates to me/my organization, my hope for our community health is that our collective idea of health and wellness continues to expand. In so many communities, support for different areas of health is siloed. Mental health, physical activity, nutrition, healthcare, social connectedness, financial wellbeing… they all play into our quality of life. I hope that Tillamook County Wellness can continue to be a part of the bridge that connects all these areas of health.
Is there anything else you’d like to share?
Tillamook County has been such a wonderful place to live and work. Thank you to everyone who has been so welcoming! I’m excited to continue to be a part of this community 🙂
For more local health and wellness information, visit www.tillamookcountywellness.org or follow Tillamook County Wellness on Facebook and Instagram.
by Guest | Oct 28, 2024 | Being Well, Featured, Uncategorized
…to taking action for breast cancer prevention and healing.
October is breast cancer awareness month. It’s also my birthday month, and I’m happy to say, I’ve come a long way in my healing as I now feel honored to share my birthday month with this awareness as many of us would like to not have to touch it with a 10 foot pole. You see, I’ve learned much about breast cancer from lived experience, both my own diagnosis and one of my sisters. My sister’s story ended with her dying from metastatic breast cancer only 2 years from her original diagnosis. I’m currently 2.5 years out and doing great as I plan to continue to do.
Neither of us were paying enough attention to our risk factors and we had several. There were many factors involved including earlier cancers and radiation treatments, environmental toxin exposures (we all live in a chemical soup world, reducing our exposures and supporting our body’s pathways of elimination are key) emotional and physical overwhelm/high stress, over-nurturing others and under-nurturing the self. Sound familiar anyone? 1 in 8 are the current statistical numbers of breast cancer occurrence among women. Also, did you know? 1 in 100 men are affected. Each story is unique and there are certain things that put each of us in different risk categories.
Knowing our risk factors, how many we have and what we can do to lower our risk factors with lifestyle modification are all within our control. I knew I was in a higher risk category from having had radiation therapy in my early 20’s. I knew I functioned at a high stress level, saw signs of estrogen dominance, was persistently overweight for many years, chronically inflamed and worked nights often as a birth doula plus a few other factors. Yet I just hoped eating organically and not exposing myself to more radiation would keep me healthy. It wasn’t enough. Receiving the diagnosis of invasive ductal carcinoma right after my sister’s passing was a doozy of a hit too, but through my lifestyle adaptions it has ultimately brought me back to my earlier life goal of longevity (living to 100 or beyond!) and living that life in vibrant wellness. Good health has always been a passion of mine, but it’s funny how we can let stress and certain situations lead us to believe we should accept less for ourselves. Ultimately cancer has taught me how to live well again. Thank goodness! However, it was not easy to go through to get myself back on track. I don’t actually recommend it 😉 It is therefore, my pleasure and task to share with others what they can do to ideally avoid diagnosis by steering away from known risk factors and incorporating lifestyle habits that decrease risk factors. I love sharing preventive habits and skills in general for us all (including prevention of other diseases too I’d like to add).
Know your risk factors. How many of these align with you?
Risk factors from CDC
- Being a woman
- Age: most diagnosed after 50
- Having BRCA1&2 genes (genetics can be dimmed or brightened with lifestyle)
- Reproductive history – beginning menstruation before age 12 and menopause after 50 – also – First baby after 30, no breast feeding, no full term pregnancy
- Having dense breast tissue/connective tissue (hard to read in mammograms and needs better lymph movement and movement in general) Ultrasound and thermography** are better at reading dense breast tissue **note that thermography isn’t currently utilized by conventional medicine.
- Having a personal history of breast cancer
- Other breast diseases such as atypical ductal hyperplasia, lobular carcinoma in situ
- Family history of breast or ovarian cancer (with or without BRCA gene) first degree relative; mom, sister, daughter – mother or father side
- Previous treatment with radiation (such as Hodgkins lymphoma also a sign the lymph system needs support)
- Exposure to DES drug – diethylstilbestrol – 1940-1971 – miscarriage prevention (mom and baby at higher risk)
- Not physically active
- Overweight or obesity after menopause
- HRT – hormone replacement therapy and slight increased risk seen from birth control pills.
- Drinking alcohol – risk increases with the more a woman drinks
- Smoking
- Night shift work
I would also add: environmental and food chemical additives that can overload our lymph and endocrine system as well as harm our gut microbiome.
Now to the empowering stuff!
What we can do: Taking action is key!
Eat more whole food plants! Eat more colors, eat seasonally, locally and clean/organic whenever possible. Check out the EWG’s list of clean 15 and dirty dozen to know what produce is ok to buy conventional/clean15 and which are ideal to buy organic/dirty dozen) Visit a local farm and enjoy their produce. They need our business through the cooler seasons too. Add one more vegetable to every meal and one new color a week. Ask about the farm’s growing habits. Find farms that don’t use chemicals. Many practice organic methods but don’t carry the certification yet and they’re happy to answer your inquiries.
Exercise! Move your body in ways that make you happy and feel good. Get moving every day. And this doesn’t mean stressed out running around, no, that’s counter productive. This means, enjoy a walk, hike or bike ride. Prioritize the time to commit to regular movement. You are so worth it! Walk one day, take a movement class another day such as Yoga or Joy Lymph Flow (a class I lead in Rockaway Beach and Nehalem) Tai Chi, Qigong or whatever you fancy, but it should bring ease to your body and time for repose. Turn on the music and dance! A fabulous way to heal many layers and promotes connection and health within the family if you live with others.
Quit smoking and don’t drink alcohol or limit your intake. Mocktails made with herbs are power packed with more phytonutrients that help us stay well and are an actual treat vs. a known risk factor.
Switch to natural household and personal care products. Don’t use anything with “fragrance” listed as an ingredient or chemical names you can’t pronounce or artificial colors. There are so many products out there, it can be overwhelming. Environmental Working Group also has a Skin Deep database listing products that are free from chemicals. It’s not one product that becomes the problem, it’s the many products together, it becomes a toxic load the body can’t handle. Switching to natural cleaners and personal care items actually uplifts our health instead.
Discuss your risk factors with your ND or MD and meet with a health coach like myself for support in making changes to your lifestyle at a pace that works for you to live a life that’s shown to be more preventive in lowering your risk factors and ideally avoiding this disease. I also teach breast massage for self-care and home screening. 3 This article is dedicated to those we’ve loved and let go of too early due to this disease and to those facing it now and in the future. May we all be free, live in flow, know ease and enjoy self care first so we may indeed be well and remain here for others.
Written by Elizabeth Golden Seaver, Health and Wellness Coach, Nehalem, OR and Tillamook County Wellness Coalition Member.
You can reach out to her at: goldenkeywellness.abmp.com, wingforwisdom@gmail.com
Other wellness questions? Email us at info@tillamookcountywellness.org. For more local health and wellness information, visit www.tillamookcountywellness.org or follow Tillamook County Wellness on Facebook and Instagram.
