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 heavy lift: Women and exercise

It’s no great surprise to read that men and women both benefit from working out.

But women may receive greater benefits from regular exercise than men, according to a study published in the Journal of the American College of Cardiology.

The study centered on the importance of exercise as a way to avoid dying prematurely. The researchers studied data from 400,000 people and found that women who exercised were 24% less likely to die early from any cause. Men who exercised, however, were 15% less likely to die early.

The study also revealed that the women who exercise had a 36% lower risk of dying from a cardiovascular event, compared to men at 14%. That’s important because women have twice the risk of dying from a heart attack than a man.

Mary O’Meara is a nurse practitioner with OSF HealthCare. She says society still views heart attacks more as a man’s disease. That’s simply not true.

“Usually, a male is feeling this really bad chest pressure, chest pain going in the left arm into the jaw, very pale. Women, very often, will just complain of fatigue, nausea or heartburn. ‘I feel wiped out. I just can't walk across the room. I need to sit down,’” explains O’Meara. “Unfortunately, that can be a sign of a heart attack in a female, and it gets missed quite often.”

While any movement is good, O’Meara stresses the importance of women incorporating strength and/or resistance training, such as lifting weights. Frequency and the amount of weight depend on the person and their situation.

“For a long time, women were encouraged to do more aerobics-calisthenics. We were always thought of as the weaker sex, I guess you can say, and we weren't really encouraged to do any weight bearing exercise,” says O’Meara. “A lot of research has come back that states that women should be focusing on weight bearing exercises for several different reasons.”

Strength training can also help women as menopause becomes an issue. According to O’Meara, hormones start changing between the ages of 40 and 50 – a time when women start losing muscle and see an increase in body fat. Strength training can help with that change, along with other health issues.

“We found that weight bearing exercise can reduce our risk of dementia and Alzheimer's, and also reduce our risk of osteoporosis, which is a big one,” says O’Meara.

O’Meara also has a nutrition tip for her patients. Protein, she says, is important for women to prevent muscle loss, especially during menopause. O’Meara recommends 30 grams of protein before and 15 grams after a workout, to help rebuild muscle that has been naturally broken-down during exercise.

Additionally, O'Meara is a proponent of healthy fats. She encourages patients to incorporate grape seed oils, olive oils, fish oils, flax seed oils, nuts and avocados into their diets.  Her philosophy is that good fats battle bad fats, and good fats protect our heart.

O’Meara stresses that it's never too late for women to start exercising. Even a short walk or work around the home, for instance, can go a long way to a healthier future.

“You read many testimonials from people who were couch potatoes and never exercised,” she says. “And then, they go into these exercises and do wonderful things that have really made a difference.”

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

Interview Clips 

Bob “Spider” Purcell admits he doesn’t move as fast as he used to. But he’s OK with that. At 96, Purcell is more than content getting in his exercise by swimming laps nearly every morning at the YMCA in Ottawa, Illinois.

“I'm a slow swimmer,” says the Ottawa resident and retired high school teacher. “I just freestyle for a half hour, and that's it. It keeps me going in the morning, really. I can feel down or not ready to do anything, but I get in that water, and it just peps me up.”

Purcell is not the only senior who gets his exercise in the pool. Experts agree that water exercise is the ideal choice for several reasons.

Travis Swink, DO is a family practice physician at OSF HealthCare. He has seen the benefits of swimming firsthand. When he injured his shoulder, part of his rehab was swimming to help improve his range of motion and keep his joints flexible.

“For my elderly population, I love when they're out swimming,” he says. “Because it’s less impactful, especially if they're walking in the pool, it alleviates some of the weight.”

Dr. Swink says there are many reasons to swim. The support from the water can help people overcome painful movement caused by arthritis and other health issues. It can help with weight loss, reduce the risk of heart disease and improve overall endurance. It impacts all major muscle groups – especially the upper body, core and legs.

There’s more. Dr. Swink says it can help with circulation, reduce the impact on the spine, improve balance and reduce falls. It can even help with menopause.

“It increases strength and it increases mobility. When you have more agility, you have a lot better balance,” says Dr. Swink. “So yes, people that are recovering, and you'll see it with pro athletes when they have ankle injuries, they're in a pool walking. It’s to increase that flexibility and mobility.”

Purcell, who was tagged “Spider” in high school when a classmate remarked how skinny he was, learned to swim in grade school. But he really dipped his toes in the water when he retired from teaching 40 years ago. Purcell used to walk and kayak but has found doing laps more to his liking.

He says swimming has helped him with overall endurance. Every morning, he drinks a healthy shake before heading off to swim. One day a week, he and his wife, Kathy, volunteer at OSF HealthCare Saint Elizabeth Medical Center.

Purcell says he’s had a couple of minor health issues over the years, and has noticed a loss of muscle mass, but remains healthy to this day. “I just like water,” he says. “It's really nice to be able to get in it. And it does make me feel good.”

Dr. Swink says Purcell is a great example of how swimming can benefit seniors.

“Not only is he doing something that's good for his heart, but he's also doing something that's releasing some natural endorphins, which is good for his mental health,” he says. “By doing that activity every day, he's not only helping his physical health, but his mental health. I congratulate him on that.”

And if you don’t have access to a pool, no worries. Dr. Swink suggests using band therapy or a rowing machine that will offer the same type of workout.

Purcell’s advice to other seniors is simply to get moving. No matter what you do.

“I would start with walking and build up where you can walk a couple miles every day,” he says. “I think that's probably one of the best things an older person could do. And then if you want to swim, and you know how to swim, that will really add to it.”

Dr. Travis Swink interview clips 

Bob Purcell interview clips 

B-Roll 

• Teeth issues, such as cavities and discoloration. Loose teeth (not baby teeth that are intended to come out) are also a red flag.
   
• Gum issues, such as redness, bleeding or swollen or sore gums.
   
• Chewing and swallowing issues, whether from pain or a diagnosed disorder.
   
• Chemotherapy can also negatively impact oral health, Dr. Splaingard says. So if you’re going through cancer treatment, keep a close eye for changes in your mouth.
   
• And while we can’t control our age or gender, Dr. Splaingard says to be aware: poor oral health and the poor bone health that could come with it are more common as you age. He adds that women who have reached menopause are especially at risk.

Prevention

Having good oral health is no secret. Think back to what your parents told you as kids.

• Brush and floss regularly. The American Dental Association recommends brushing twice per day and flossing once per day. If you have questions about frequency, talk to your dentist.
   
• See a dentist regularly. Twice per year is a good starting point, but some people who need extra attention could go four times per year.
   
• In between those appointments, watch your teeth and gums and let your dentist know if something doesn’t seem right.
   
• Avoid smoking.
   
• Eat a healthy diet that’s low in cavity-causing sugar and high in beneficial things like calcium.
  
  “Calcium and vitamin D deficiencies can affect calcium balance in the bones,” Dr. Splaingard adds
   
• And if you are diagnosed with osteoporosis, follow the medication plan outlined by your health care provider.

Learn more

Read more about how to maintain good oral health on the OSF HealthCare website.

Interview clips

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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

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.

Interview clips

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Say yes ma'am to the mammogram
FDA dense breast rule promotes earlier cancer detection
A woman's battle with breast cancer
Prevention of breast cancer starts with awareness