As women age, new adventures come. Some, like travel and new hobbies, can bring joy. Others can bring stress.

One of those stressors is perimenopause, the time you’re transitioning to menopause, when you permanently stop having menstrual periods and can no longer get pregnant.

“There’s a stigma around this time of life,” says Lindsay Orr, an advanced practice nurse at OSF HealthCare. “It’s not an illness. It’s just a natural part of aging.”

Perimenopause basics

Orr says during perimenopause, the ovaries stop producing testosterone, estrogen and progesterone regularly.

“Think of it as a short fuse or a fuse that’s not quite connected,” Orr describes. “Every month, the hormones secrete. But ovaries have a shelf life. So some months they work, and some months they don’t. It ebbs and flows during the perimenopause transition period before they go into menopause.” 

Orr says women typically notice changes that signal perimenopause at around age 40. The perimenopause period can be over quickly, especially if you have surgery that impacts your ovaries. On the other hand, Orr has seen some women be in perimenopause for 10 years. Regardless, health professionals define the perimenopause to menopause transition as over when you have not had a period for one year.

Orr says some women can have little to no perimenopause symptoms. For others, the time can bring disruptions to many parts of your life – work, sleep, relationships and more. Sudden hot flashes, mood changes, joint aches, brain fog, trouble with urination, anxiety, disrupted sleep and fatigue are all possible.

“A lack of estrogen can affect bone density,” Orr adds. “So women with smaller frames are more predisposed to bone issues if they fall. Or, a decline in estrogen can have cardio-protective effects. It can increase your risk for cardiovascular issues like heart disease.”

Anorexia, bulimia, high stress, smoking, drinking alcohol and being a high intensity athlete can also make perimenopause come sooner and be more intense, Orr says.

Treatment – proactive and reactive

Orr says if perimenopause symptoms are impacting your quality of life, it’s time to see a provider. Providers can’t make perimenopause go away, but they can help with symptoms. First, Orr asks if her patients are prioritizing what she calls the “four pillars of health”: exercise with resistance training, hydration, a healthy diet with plenty of protein and healthy sleep.

A provider might also recommend a supplement, such as diindolylmethane (or DIM, for short). Orr calls DIM broccoli in a pill. It helps keep hormones at a healthy level. Other supplements that could help include calcium D-glucarate, evening primrose oil, black cohosh and ashwagandha.

Orr also urges women to start the conversation with their primary care provider or OB/GYN before perimenopause hits. Ask what you can do now to lessen symptoms or duration. Be honest about how your body is feeling and what medications you’re on, as new medications could negatively interact with current ones. Orr also recommends women use a smartphone app to track their periods.

“The apps help you be in tune with your body. You go through your day-to-day life and kind of recognize things, but you don’t really put it all together. Then when you put the information in the app, you might say ‘Oh yeah, I am symptomatic. This is happening.’” Orr says. “You can track temperature changes, bleeding issues, hormone fluctuations and sleep. It all plays a role.”

What about pregnancy?

Yes, women can still get pregnant during perimenopause, though it’s not as common as pregnancies in your 30s and younger, Orr says. However, in general, Orr says the higher in age, the higher risk for pregnancy complications.

“Balanced hormones help maintain a good uterine lining for housing a fetus,” Orr explains, noting perimenopause disrupts that hormone balance. “So, a later-life pregnancy would require closer monitoring.” In other words, you’d likely have more trips to the doctor to make sure your pregnancy is healthy.

The bottom line

Orr reiterates: perimenopause is a part of life. Give yourself grace, take advantage of the help that providers can give and recognize that it’s about progress, not perfection.

“Some of the women I see are frazzled, disheveled and anxious. Sometimes they’re upset during the visit. It’s sad to see,” Orr recounts. “Then we start treatment, and I see them three months later. They look like a different person. They’re glowing. They have a zest for life again. It’s rewarding to see.”

Learn more

Read more about perimenopause and menopause and women’s health overall on the OSF HealthCare website.

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The transition to menopause – when a person permanently stops having menstrual periods – can bring symptoms like hot flashes, night sweats, irregular periods and anxiety. Women may want to find assistance with these symptoms.

Dennis Sands, MD, is an OSF HealthCare gynecologist and chief medical officer at OSF HealthCare Saint Anthony’s Health Center in Alton, Illinois. He cautions you to be wary of over-the-counter medication that claims to help with all menopause symptoms.

“In general, a lot of the at-home remedies are marketed very well. They are touted as cure-alls or things that will work for the most common complaints, like hot flashes,” Dr. Sands says. “What we’ve found is most of them don’t work.”

Dr. Sands adds that these medicines are marketed as dietary supplements, not pharmaceuticals. So, there’s more wiggle room to make claims about their benefits. Dr. Sands says he’s seen menopause medicine labels at the pharmacy that tout vitamin, soy or phytoestrogen ingredients. Equelle is a common brand name. Dr. Sands says these medicines can have a minor effect on menopause symptoms in healthy people, but they are not cure-alls or effective for all people. In particular, he says irregular bleeding usually requires a treatment plan laid out by a health care provider and an evaluation to rule out something more serious.

That’s where your gynecologist comes in, with Dr. Sands reminding that treatment is different for everyone. The first advice you’ll likely hear: keep up with your health.

“We’ve noticed that people who are healthy overall, exercise well, sleep well and are in good relationships generally do pretty well in the menopausal transition,” Dr. Sands says. “The more stress people are under, the more they’re not as healthy as they could be, the more their sleep is disturbed. It seems a lot of those people tend to have a more difficult transition.”

Estrogen patches and progesterone creams can also help, especially in younger women. A provider may also see if other medications you’re taking are making your menopause symptoms worse.

“If you’re struggling, see your provider and review all the options,” Dr. Sands suggests. “There are some great options that are effective and safe. Generally, they’re only used for a short time to get people through the transition.”

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Early menopause (menopause that occurs before age 45) has been found to increase the risk of heart disease. 

According to a study by the American Diabetes Association, that included data from nearly 10,000 postmenopausal women, researchers looked at the connection between early menopause, Type 2 diabetes, and cardiovascular disease (CVD) risk in women. The data showed that women who experienced early or premature menopause had a higher risk of heart disease, especially if they also had Type 2 diabetes.

According to Kathleen Meade, APRN, a nurse practitioner with OSF HealthCare, estrogen helps protect the heart. The drop in estrogen levels that occur during menopause can lead to higher cholesterol, blood pressure and body fat levels — all of which are factors leading to heart disease.

Cardiovascular disease is the leading cause of death among women of all ages. More than 60 million women in the U.S. have some type of heart disease. “For women, heart disease is very serious,” says Meade. “A lot of times we think of the other things that might potentially affect our life and our quality of life, like cancers, but with heart disease, it’s the most prevalent cause of death in women.”

For women who encounter early menopause, these changes happen over a longer period. They increase the lifetime heart disease risk compared with those who reach menopause around the average age of 50 to 52. When hormonal changes occur with menopause, blood vessels can stiffen, blood pressure can rise and cholesterol balance may change, all of which increase the risk of heart disease.

“When women go through menopause, they fail to produce any estrogen,” explains Meade. “Estrogen is a vital link between vascular flexibility, and that would increase their chances of having hypertension. And it increases their risk of plaque buildup, or if they have high cholesterol or hyperlipidemia. So, you put those together, that's what causes the increased risk of heart disease.” 

Besides menopause, other major risk factors for cardiovascular disease for women include high blood pressure, high cholesterol, an unhealthy diet, obesity, smoking and physical inactivity. “Women can take several steps to decrease their cardiovascular risk,” Meade says. “One would be to maintain an active lifestyle. We recommend 150 minutes of exercise per week. Follow a low fat, heart healthy diet. The Mediterranean diet is an excellent way to provide healthy oils and low fat and good protein.” Meade also recommends limiting alcohol and processed foods, increasing fruits and vegetables and getting at least eight hours of sleep.

Tailoring a treatment plan 

Knowing the link between menopause and heart disease can help health care providers like Meade treat her patients more effectively now and in the future.

“You can more individually tailor their care accordingly to when they went through menopause and when you possibly put them on hormone replacement therapy,” she says. “Look at all the other cardiovascular risk factors – address hypertension, hyperlipidemia or cholesterol, look at their sleep patterns, at exercise routines and weight management. We can put all that together to try to reduce their chances of having a heart attack or a stroke.”

Hormone replacement therapy is medicine prescribed to replace the estrogen the body stops making after menopause, which is when periods finally stop for good. This therapy is used to treat common symptoms, such as hot flashes. It’s also been used to prevent bone loss after menopause. Meade says for the best results, hormone replacement therapy should be tailored to each person but first discussed with your health care provider.

Meade can relate to her patients who experience menopause issues. She has traveled along a similar journey. “I’ve gone through menopause, and I'm happy to say that I feel great,” she says. “I generally bring it up in our conversations when the time is right. A lot of times they bring it up, because it does impact our lives in every aspect. I feel like I can walk beside them, help them and give them expert advice and treatment options.”

For more information on women’s health, visit the OSF HealthCare website.

Interview Clips

Breast cancer is one of the most common cancers in the United States, says Heather Thompson. And she would know. Thompson is a breast health navigator at OSF HealthCare, helping patients navigate appointments, insurance and more. And Thompson is, herself, a breast cancer survivor.

But what many in the cancer space might not realize, Thompson says, is that breast cancer can affect men. It’s rare, with 1% of men statistically getting it, Thompson says. But it’s worth knowing how to spot, prevent and treat it.

“There can be severe cases. A lot of times, men don’t notice things or worry about things like women might,” Thompson says. “The cancer is there longer and has a chance to metastasize [spread] and get into their lymph nodes. A lot of times, men will get gynecomastia. That can cause swelling in the breast tissue and a mass.” Those gynecomastia masses can limit a man’s ability to feel a cancerous lump, delaying care.

Breast cancer basics

Genetics (i.e. a family history of cancer), alcohol use and smoking all put you at a higher risk for breast cancer.

So do men need to do monthly self-checks and get mammograms like women are told to? Not always, Thompson says. You should talk with your primary care provider about a plan, especially if you have a family history of breast cancer. That plan could involve genetic testing or blood work to check estrogen levels (since estrogen feeds cancer cells). But day to day, Thompson says to just keep an eye on your breasts. Look for inverted nipples, lumps, redness or achiness.

“Men really do not require regular screening or imaging for breast tissue. That is not in the American Cancer Society guidelines or any other guidelines,” Thompson says. “However, men should monitor their bodies for anything irregular. Then, get it addressed right away. Don’t wait. You might be in that 1%.” Thompson adds that if any type of cancer spreads, it can be fatal.

Treatment for male breast cancer typically involves a mastectomy, or the removal of breast tissue, Thompson says. This could be after cancer is found. Or it could be preventive if you’re at high risk, like the case of actress Angelina Jolie.

“There’s not much tissue that a man has,” Thompson points out, allaying fears that your chest will look significantly different. She says you won’t have a nipple, and your chest will be flat. But that’s about it. “We will still test those lymph nodes during surgery to make sure the cancer hasn’t spread.

“After that, there’s special testing called oncotype,” she adds. This looks at the likelihood of cancer returning. “If it’s a high score, those people sometimes have to have chemotherapy or radiation.”

Changing minds

Thompson knows men can be apprehensive about seeing a doctor in general. But when breast cancer enters the conversation? She’s heard things like “I’m not a woman. I don’t need to worry about that.”

At OSF Moeller Cancer Center in Alton, Illinois, where Thompson works, she sees one to two men per month come in for imaging. Most, she says, are cases of gynecomastia that can be managed by the person’s primary care provider. But some do hear the words “It’s cancer.”

“I tell them they’re not alone,” Thompson says. “Other men have gone through this. We have a roadmap to treat it.”

Learn more

Read more about cancer care, specifically breast cancer care, on the OSF HealthCare website. Cancer care at OSF includes the OSF Cancer Institute in Peoria, Illinois.

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A federal panel recently advised women get a mammogram every other year starting at age 40, rather than 50.

And the American Cancer Society estimates that in 2023, nearly 300,000 women in the United States will learn they have breast cancer. About 43,700 women will lose their life due to the disease.

The headlines are reminders to know your breast cancer risks. While many risks are out of your control, there’s just as much you can control, says Heather Thompson, a breast health navigator at OSF HealthCare.

Major risks you can control

• Active lifestyle and healthy eating: Thompson puts it plainly. If you eat junk, you’ll feel like junk. And any exercise will give you more energy and burn fat. Fat produces estrogen, which feeds cancer cells.

“You want to make sure you’re well-maintained with your weight, even after menopause,” Thompson says.

• Taking hormones: This impacts your ovaries, reducing or adding estrogen. Whether you’re at a routine appointment or you have been diagnosed with breast cancer, talk to your provider about what hormones you’re taking.

“We don’t encourage people who are having menopause symptoms [like hot flashes] to take hormones,” Thompson lists as an example. “We encourage other things to help treat those. It eliminates those estrogen cells increasing.”

• Alcohol and smoking: They are a risk for any type of cancer. But Thompson says one drink per day can increase a woman’s breast cancer risk by 12%. Alcohol is sugary, and that’s a fuel for estrogen.
   
• Night shift work: Thompson says our body expects to sleep when the sun goes down. Night work throws that off.

                “You’re getting artificial light all night. That changes the melatonin that the body naturally makes,” Thompson explains. “When your melatonin is off, it increases estrogen.”

                If you don’t work the traditional day job, see if you can work different shifts so you are not up all night all the time.

Risks you can’t control

• Age: Thompson says women generally develop breast cancer at age 50 and above. 
   
• Family history and genetic mutations: A family history of breast cancer puts you at a higher risk. Thompson says the higher risk is often seen on the person’s mother’s side of the family. For example, your mother and her sister (your aunt) may have breast cancer, and so you’d need to talk to your provider about your risk.

              Some women diagnosed with breast cancer and who have a family history may undergo a genetic test.

“Those tests can tell us if this is something being passed down from generation to generation,” Thompson says.

• Reproductive history: Young women who develop menstruation before age 12 and women who go through menopause after age 55 have an increased risk.

“That gives them a longer time with their ovaries working. They’re producing estrogen,” Thompson says.

• Dense breast: More tissue and less fat mean a dense breast and an increased cancer risk, Thompson says. Usually, the younger you are, the denser your breast is. The density of your breast is something that will be noted on every mammogram result. Thompson says mammogram technology is getting better at finding cancer in dense tissue. An early diagnosis may mean a better outcome.

Takeaways

Make sure your health care provider knows about your circumstances so they can decide on the best preventive care, like a different schedule for mammograms. Some of the information to have handy: a family history of cancer and any physical change you noticed during your monthly breast self-check.

Learn more about breast health and breast cancer care on the OSF HealthCare website.

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Prevention of breast cancer starts with awareness

October is Breast Cancer Awareness Month, and that has many thinking about the disease that afflicts hundreds of thousands in the United States each year.

People like Cathy Keller. When she visited the ribbon cutting for OSF Moeller Cancer Center in 2019, she had no idea she’d be using the services two years later.

Now, the 66-year-old Godfrey resident is telling other breast cancer patients: you can get through it, too.

“You have to roll with the punches,” Keller says.

The numbers

Heather Thompson is a breast health navigator at Moeller Cancer Center and was with Keller from the beginning. She, too, is a breast cancer survivor.

Thompson says one in eight women will develop breast cancer. Older people are at a higher risk than younger, but younger people typically have more aggressive cancer.

“A huge, huge problem,” as Thompson puts it.

Thompson explains that woman make hormones, especially estrogen, all their life.

“A lot of the hormones in [a woman’s] body are like a fuel to a cancer cell,” Thompson explains. “When you get an abnormal cell, estrogen in our bodies fuels that cell and produces and produces. And you get a mass. And then you have breast cancer.”

Thompson says those breast cancer tumors can develop over time.

Alejandro Sanz, MD, is a surgeon at OSF HealthCare in Alton who specializes in breast cancer. He says around 233,000 U.S. residents hear the words “You have breast cancer” each year. Around 40,000 people die annually from the disease.

Expect the unexpected

Keller got her diagnosis in April of 2021, followed by a lumpectomy the next month. In June, she wound up under the care of Manpreet Sandhu, MD, and James Piephoff, MD, oncologists at Moeller Cancer Center, for chemotherapy and radiation. Keller says she knew she would get the best care at Moeller.

Keller’s first round of chemotherapy produced the serious allergic reaction known as anaphylactic shock, and at that point she wanted to quit, as the treatment was preventative. But Dr. Sandhu advised against that.

“She took it upon herself to find a chemo that would not affect me at all,” Keller says.  “And it didn't. The way it was delivered was very different from the way the first chemo was delivered. I didn't have to take the Benadryl. I didn't have to take the steroids.”

To put it a different way: Dr. Sandhu “went to bat for me,” Keller says with conviction and a slight tear in her eye.

 But Keller wasn’t out of the woods yet. Midway through the new type of chemotherapy, she began to suffer neuropathy, or nerve damage that typically results in loss of feeling in your hands and feet.

 Dr. Sandhu proposed a simple solution.

 “I would hold on to little Ziploc bags of ice,” Keller explains. “And they put them on my feet so that the smaller vessels would constrict a little bit so I wouldn't get all that chemo right back down in there.”

The life hack worked long enough to earn Dr. Sandhu’s OK to end that particular treatment.

Keller’s lesson in all this: Expect a bumpy road, but know you have to stick with your cancer treatment. And trust that your providers are doing the best for you.

 Dr. Sanz says providers will hold up their end of that commitment, too.

 “There's a lot of information involved. Patients can get confused about it. So I take care of that. I try to spend a lot of time with my patients explaining this. Going through the images,” Dr. Sanz says.

“A lot of my patients have never seen their own mammogram,” he adds.  “They’ve never seen their own tumor. How does it look?”

Find support

Keller says not only was she not going to battle cancer alone, the disease wasn’t going to interrupt her routine. She worked out with a kettlebell weight. And Keller and a friend still walked the hills near Keller’s home twice a week, sharing laughs and stories.

She got support from her biological family and work family. One female student at Alton High School, where Keller works, told Keller she temporarily lost her hair due to a serious infection.

“If she can come to school and have her peers see her with her short hair now, knowing she had long hair earlier in the year, I don't have to wear my wig anymore,” Keller says. “So I saw her two or three days after I started wearing my regular hair, and I told her, ‘You are my inspiration’.”

Watch your health

Dr. Sanz and Thompson want women to commit these numbers to memory: Start getting a yearly mammogram at age 40. If you have a family history of breast cancer and get an order from your primary care provider, you can start as young as 30.

“Screening is the best tool we have at this moment in order to decrease the mortality of cancer,” Dr. Sanz says.

Thompson adds that unless you’re approaching end of life care, there’s no reason to stop getting the yearly breast checks.

“Women who are thriving and are doing well and have the chance of living the next five years, by all means get their mammogram,” Thompson urges. “Because we can give them that five years by saving them and finding and diagnosing and treating right away.”

Thompson says monthly self-checks of your breasts are equally as important.

“Any woman of any age should do a monthly check. Pick a day out of the month. I want to do it on the first. I'm going to check both breasts,” Thompson suggests. “That way you know your breast. You know how they feel. You know if you have lumpy breasts or not. And so if something changes, something seems abnormal, something feels different, then you get it checked [by a health care provider].”

 Dr. Sanz is all-in on both types of breast checks, too. That’s because 80 to 90% of the patients he sees who are later diagnosed with breast cancer don’t present any symptoms like breast pain or skin abnormality. Rather, they are in Dr. Sanz’ office because a mammogram caught something.

Learn more about breast cancer prevention and treatment on the OSF HealthCare website.

Interview Clips - Cathy Keller

Interview Clips - Heather Thompson

Interview Clips - Dr. Alejandro Sanz