Women's Health Archive

Besides hot flashes and extra-heavy periods, what else might the menopausal transition have in store for you? Possibly major depression, according to findings from the Study of Women's Health Across the Nation (SWAN), a multi-ethnic study of women's health at midlife. Perimenopause begins several years before menopause (the end of menstruation) and ends a year after the last menstrual period. During this transition, ovarian hormones are in flux, resulting in irregular periods and sometimes vasomotor symptoms (hot flashes and night sweats). Many women also report depressive symptoms, but it's unclear whether women are at increased risk for major depression at this time — and if so, whether hormones play a role. The SWAN findings suggest that perimenopause and early postmenopause are a high-risk time for major depression — and the risk is independent of hormone levels and hot flashes. Results were published online in Psychological Medicine (Feb. 9, 2011).

The study. Researchers at the University of Pittsburgh tracked the development of major depression through menopause in 221 women (144 white and 77 black) who were premenopausal when the study began. At the start of the study and annually for the next 10 years, the women provided extensive health data and blood samples (for measuring levels of estrogen, follicle-stimulating hormone, and testosterone). They were interviewed about past depression and evaluated regularly for major depressive symptoms. The researchers also collected information on vasomotor symptoms, negative life events, and menopausal status.

Q. I have a family history of cardiovascular disease. Although I don't have high blood pressure, high cholesterol, diabetes, or any other risk factor, I'm concerned about how my cardiologist is screening me, because women can have small-vessel disease and not necessarily arterial disease. How should I be screened?

A. In general, the decision to screen a woman for cardiovascular disease depends on her risk for the disease and whether she has symptoms. The risks include some things that are out of our control, such as a strong family history (that is, heart attack or stroke in a father or brother before age 55 or in a mother or sister before age 65). But we can prevent or lessen many other risks through lifestyle changes, or, if necessary, medications. Major risk factors include obesity, smoking, physical inactivity, high blood pressure, high cholesterol, and diabetes. All of these affect both genders, but several have a greater impact on women. For example, diabetes raises the risk of heart disease in women more than in men.

Q. I enjoyed your article on diverticular disease and the fiber content of various foods. However, could you make some distinctions between soluble and insoluble fiber? Some fiber makes me feel very bloated.

A. Dietary fiber, sometimes referred to as roughage, consists of the indigestible parts of plant foods. As you note, there are two kinds. Soluble fiber dissolves in water; insoluble does not. Both are important for healthy digestion; both can help prevent not only diverticulitis and constipation but also heart disease, obesity, and diabetes.

A sudden and dramatic reduction in female hormones after the procedure may explain why.

An astounding one in three American women has a hysterectomy (the surgical removal of the uterus) before age 60. Only a small percentage undergo the operation to fight uterine cancer or other life-threatening conditions. Most have a hysterectomy to halt heavy menstrual bleeding, combat endometriosis, or stop pelvic pain.

Women tend to develop heart disease about 10 years later than men — in part, it's believed, because of the heart-protective effects of ovarian estrogens, which are around until menopause. But the female advantage seems to end there. Because women develop heart disease later, they're more likely to have coexisting conditions, like diabetes, which can complicate treatment and recovery. And because they have smaller hearts and coronary vessels, surgery can be more difficult for them. Women are more likely to die after procedures such as bypass surgery and angioplasty.

But now a study suggests that one treatment for heart failure actually works better in women than men (Journal of the American College of Cardiology, Feb. 15, 2011).

Q.I am 53. I've had fibroids for some time but have experienced heavy menstrual bleeding lately. A recent ultrasound showed fibroids and polyps. What are my options?

A. As you know, you're almost certainly in perimenopause, the four to eight years leading up to menopause and the complete cessation of menstruation. Every woman's script for the transition to menopause is a little bit different, but it's very common for the menstrual cycle to be irregular and the amount of blood flow to vary. Erratic ovulation — the release of eggs from the ovaries — may result in hormonal changes that cause the lining of the uterus (the endometrium) to become thicker than usual, so when it sloughs off, the menstrual bleeding is heavier and more prolonged than women are used to.

Extra fat that accumulates around the abdomen goes by many names: beer belly, spare tire, love handles, apple shape, middle-age spread, and the more technical “abdominal obesity.” No matter what the name, it is the shape of risk.

Mindfulness meditation can ease stress. It also seems to do a lot more, like help with physical and psychological problems from high blood pressure and chronic pain to anxiety and binge eating. New research shows that mindfulness meditation changes the way nerves connect.

Many postmenopausal women and their clinicians are avoiding hormone therapy (HT) because of the health risks, but there's been some hope that it might be safer in younger women near or at menopause. In the case of breast cancer, at least, that isn't so, according to results from the Million Women Study in the United Kingdom. In this study, taking HT in early menopause was actually associated with a higher than average risk of breast cancer. Also important — for the many women wondering about the impact of their past HT use — results showed that soon after quitting HT, a woman's breast cancer risk was no greater than that of a woman who never had HT. Finally, the study found little or no increased breast cancer risk among women taking estrogen-only HT who waited at least five years after menopause to start taking hormones. Results were published online Jan. 28, 2011 in the Journal of the National Cancer Institute.

Other research has consistently found higher rates of breast cancer in women taking HT — in particular, combined estrogen and progestin. But few studies have investigated the timing of HT and how that influences breast cancer risk. The Million Women Study is the first to look specifically at the relationship between breast cancer incidence and when women started HT.

Q. I'm 50 years old and have never had an HPV test. Do I need one as part of my health screening?

A. The short answer to your question is, no, you don't need the HPV test for routine cervical cancer screening. However, it's complicated, and there have been some changes in screening guidelines for cervical cancer that women should know about.