The Women’s Health Initiative at first seemed to clarify, but ultimately left many women in a state of confusion, about the best ways to stay healthy during menopause.
“Not all menopausal women are created equal, and to put out blanket recommendations is not great science,” says Yale University clinical professor of OB/ GYN Mary Jane Minkin, M.D., who has been training doctors and treating patients daily for more than 25 years.
“Much of the WHI data is like closing the barn door after the horse is gone, and what’s worse, it’s totally non-individualized. If there’s one state of affairs that requires individualization, it is menopause,” she explains.
Minkin, who sees hundreds of women each month in her New Haven medical practice, cuts through the post-WHI fog with a few simple rules of thumb, based not on conjecture but on good science:
• Lose the flab. The WHI concluded that a low-fat diet may not be better than a higher fat diet in preventing killers like cancer and heart disease, but later surveys revealed that study subjects were often lax in maintaining the low-fat regimen.
Many replaced calories from fat with the same number of calories from carbohydrates. Get real — no matter what you’re eating, being more than 20 percent above your ideal body weight is unhealthy.
• Don’t drop calcium. The WHI concluded that subjects did not need calcium supplements but failed to ask what any good doctor would ask, i.e., if the women were already receiving calcium through other sources like milk and yogurt.
Almost all older women need calcium, and many require medications as well.
Studies around the world have shown that everyone needs vitamin D, with older women often needing as much as 800 mg of it to help maintain bones.
• Natural solutions. If a woman develops hot flashes and sleep disorders, the most common complaints of perimenopausal women, she should try some simple maneuvers like layered dressing, and avoiding hot and particularly caffeinated beverages.
Some women also benefit by adding soy to their diets.
• Don’t dismiss HRT. The big WHI curve ball was that it suggested that hormone replacement therapy had terrible consequences. However, the study group consisted of women who were on average about 63 years old, with an average weight of 170 pounds and 12 years beyond menopause.
Half were smokers or former smokers, and one-third were on medications for elevated blood pressure. Clearly, the group did not comprise average women in menopause. Today, many are reluctant to take a pharmaceutical, but HRT may be appropriate for some women.
• Hit the ground running. Women should get themselves into as good shape as possible. They should exercise regularly, the more the better.
• Ditch the cigarettes. Smoking is one of the leading causes of osteoporosis and heart disease.
• Limit alcohol. How much? No more than two drinks a day. Even two glasses of wine a day has been shown to increase the risk of breast cancer.
• Talk to a health-care provider. A survey conducted by Enzymatic Therapy, Inc., in 2005 revealed that most women are hesitant to discuss menopause treatment options with their physicians.
Not talking to a doctor is a mistake. There are medications — both hormonal and nonhormonal — to help mitigate symptoms.
This article was prepared in cooperation with Obstetrics/Gynecology and Menopausal Physicians Practice of Gilford, Conn.
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