Heart disease is the number one killer of women today. Dr. Chrisandra Shufelt, assistant director of the Women’s Heart Center at the Cedars-Sinai Heart Institute, shares valuable information about heart disease during menopause.
Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center at the Cedars-Sinai Heart Institute.
1. Question: How can women approaching or experiencing menopause protect themselves from heart disease?
Chrisandra Shufelt, M.D.: The best protection is in knowing your heart health numbers. By that I mean you should know your blood pressure, LDL and HDL cholesterol, weight, body mass index (BMI) and fasting blood sugar level. If your numbers are out of whack, see your doctor, start exercising, change your eating habits, lose weight if you need to and stop smoking. You also need to be aware of your family medical history. Women who have a first-degree relative diagnosed with heart disease at an early age are at an increased risk of developing heart disease themselves. Heart disease is the number one killer of women so the first step in preventing it is to know your numbers.
2. Question: Does a woman’s heart disease risk increase during menopause?
Dr. Shufelt: One in seven premenopausal women die of heart disease compared to one in three postmenopausal women. We know that blood cholesterol levels can often change for the worse within six months to a year from the onset of menopause, which on average is the age of 51. The risk of high blood pressure triples with menopause; after the age of 55, more women have high blood pressure.
3. Question: Does hormone therapy increase a woman’s risk of developing heart disease?
Dr. Shufelt: Hormone therapy may be an effective way of controlling the moderate to severe night sweats, hot flashes and other menopause symptoms that can wreak havoc in a woman’s life. Start by seeking a certified menopause specialist who can weigh the risks and benefits for each patient. If your doctor considers hormone therapy safe for you, be sure to reevaluate annually. Starting hormone therapy many years after a woman has gone through menopause does increase the risk of heart disease. Women who are not good candidates for hormone therapy do not need to suffer in silence. There are many nonhormonal options to treat menopause symptoms.
4. Question: Are women who take oral contraceptives at an increased risk for cardiovascular disease?
Dr. Shufelt: Oral contraceptives are the most commonly prescribe hormones with approximately 80 percent of women in the U.S. using them at some point. In healthy younger women – young than 35 and nonsmokers – oral contraceptives do not increase a woman’s risk for heart disease. And we know that birth control pills can be helpful in controlling symptoms around perimenopause. That’s why you should re-read my answer to the first question and get to know your heart health numbers!
5. Question: Is it possible to treat menopause symptoms while simultaneously preventing heart disease?
Dr. Shufelt: Yes. That is exactly what we do at the Women’s Heart Center at the Cedars-Sinai Heart Institute. And it’s why menopause transition is such an important time for all women. I want women to know that when they reach menopause, it’s time to take stock of their health and their individual risk factors. Because when we know a patient’s numbers, we can help her assess the side effects and risks that come with all treatments and also help ensure that the second act of her life can be just as vibrant and active as the first.
6. Question: Does estrogen provide heart protection?
Dr. Shufelt: No, estrogen is not prescribed to prevent heart disease.
7. Question: What else should women know about heart disease?
Dr. Shufelt: When it comes to heart disease, women need to recognize that often, our symptoms are different from men’s heart disease symptoms. In addition to chest pain, women are more likely to have shortness of breath as a first sign of heart disease. Women more commonly experience extreme fatigue and persistent chest pain. Unlike men, women generally have major arteries that are clear of plaque, but the smaller coronary blood vessels cease to constrict and dilate properly, creating the lack of blood flow and oxygen to the heart.
I live in the land of angels, but in Los Angeles these guardians are nipped and tucked with crooked smiles and lopsided eyes frozen on a static expression.
At 52 I am really pissed off that aging — a thing that happens as soon as we take our first breath — is such a big deal! Why does a large part of our population struggle with aging?
Considering that the average lifespan in the early 1900s was 49, and now it’s 77, perhaps old age is a more recent phenomenon. Thanks to modern technology and medical advances, we have an easier life compared to our ancestors. A hundred years ago when the average person was dying by age 50, wrinkles were a badge of honor displaying wisdom and earning respect for a life long-lived.
My first signs of aging appeared as a growing colony of spider veins and brown spots that surfaced after years of sun damage. Witnessing these skin tone imperfections sent me running to the nearest celebrity dermatologist for a quick fix. Six months and $1,200.00 later, those spider veins and brown spots reappeared. Don’t they know I paid good money to banish them forever?
I revisited that famous dermatologist insisting the procedures did not work. She said, “Staness don’t you know? You have begun your journey chasing youth.” What? I have no intention of chasing youth, just fix it so I can move on with my life as I was — young with perfectly clear, tight skin.
A few martinis later, I decided to cover up those spider veins and brown spots with a spray on tan. Living in Los Angeles this is a perfectly acceptable treatment. Ahhhh, with just one spray tan session for $36.00 I felt much better with those brown spots and spider veins artificially covered. But, this trick only lasted a few months. Self-tanning is a time consuming job with sketchy results. This last ditch effort to conceal brown spots and spider veins, left orange evidence around my elbows, fingers, and ankles. Now what?
When the elasticity of my skin started to relax, the anti-aging battle seemed hopeless. I was now wearing a permanent suit styled with a draping midsection, accessorized with paisley spider veins, and finished off with a set of droopy boobs and a deflated tush to match. It wasn’t pretty! An aging alien was trying to squeeze into my body and take over.
Keeping up with aging was a full time job without any benefits. My self-esteem was being tested daily. No one prepares us for this transition of fading youth.
Thou shalt not lose your youth and beauty in Los Angeles. Breaking this unwritten commandment can contribute to job-related age discrimination, result in a divorce or secure a spot in the never-married line.
Men and women in Los Angeles have an unusual attraction to altering their looks, and demanding flawless skin. They are willing to give up their human right to have natural expressions by electively going “under the knife.” We have many versions of Angelina Jolie living in Los Angeles with perfectly plump lips, high check bones, full breasts and tight butts. People in their 20s, 30s and 40s casually chat about who did their implants, and where to get the best price for Botox injections.
Don’t get me wrong, having surgical and non-surgical cosmetic options available can change someone’s life for the better. A nose job can promise better self esteem, removing a scar can boost confidence, and reconstructive procedures can give hope after devastation.
Botox, fillers, and plastic surgery can relax, plump or pull a wrinkle out of existence – temporarily. These technologies can be helpful, but don’t depend on them to deliver everlasting youth.
Personally, I refuse to rely on cosmetic procedures to cling onto my youth. It was time to investigate how the beneficiary of youth — beauty — was defined in my life.
Growing up an Air Force brat, we moved almost every year. I learned at an early age that if I was the helpful girl, not the pretty girl, I had friends. My worth was not defined by my looks. That changed when I moved to Los Angeles where beauty was a cloak of power. When that cloak wears out after years of use, people will do anything to keep it looking youthful.
Do I miss my youth? Yes, a little now, probably even more later. I miss having joints that don’t ache when I exercise. I miss the ease of not working hard to be healthy. I miss the days my purse was not full of reading glasses. I miss the cheaper health insurance. But, those inconveniences are nothing compared to knowing who I am.
I feel some sadness as my youth leaves center stage and a more wrinkled version of myself claims the spotlight. In another decade I become an official cast member of Cocoon. Fortunately with good nutrition, exercise, and a few beauty products my aging process will hopefully be a graceful one.
The good news — I am not alone. According to the 2005 U.S. Census report, by 2030 there will be 72 million Americans aged 65 or older. That is more than double the 35 million in 2000. Our population is getting older.
If the youth of America sees a generation of baby boomers ashamed to age, what message does that send? Twenty year olds are having Botox parties, plumping their lips and changing their body shape. Is this obsession with body altering the result of our fear of aging?
We see our local newscasters come back from vacation “refreshed” with tighter skin, and that wide-eyed surprised look. Networks pressure newscasters to stop aging after 40, studios hire the 20 and 30 year-old actors for the lead parts, and magazines completely retouch their covers and editorial spreads.
Why are we not obsessing about being older and wiser? I applaud Kaiser Permanente for having the right attitude in their commercial campaign When I grow up I want to be an old woman.
Mother Teresa spent her life dedicated to helping the poor and helpless. Do people look at her and say, “Check out those wrinkles, that girl needs some Botox?”
As I try to make peace with my own signs of aging, it was challenged when I visited a dermatologist for an irritating skin condition and at the end of the appointment the doc said, ” I can make you look 10 to 15 years younger with some Botox and fillers.” Ouch, I thought I looked OK. After the blood from my face started flowing back to the rest of my body, I proudly said, “I love my wrinkles, dammit!”
After our 40s and 50s aging isn’t necessarily pretty. Can there be beauty in age? Most definitely. Those permanent crinkles between my eyebrows are the result of fun times in the sun riding horses and sailing boats. The lines that cradle my eyes are a reminder that I have had a life full of smiles. I invite those surprise lines in my forehead to stay forever. They remind me of the unexpected moments I learned great lessons.
When I was 10, anyone over the age of 30 was ancient. When I was 30, anyone over the age of 50 was a dinosaur. Now that I am in my 50s, being 60 isn’t looking so bad.
These days I am committing my life to things more important than wrinkles. Maybe the only one who cares about my wrinkles is moi. Maybe the only one who cares about your wrinkles is you. Maybe it is time to get on with things that really matter.
Do I love my wrinkles? I am trying to, dammit!
Speroff, L. and M.A. Fritz. Clinical Gynecologic Endocrinology and Infertility. Philadelphia: Lippincott Williams & Wilkins; 2005.
One of the first symptoms you may notice during perimenopause is irregular periods.
I was on birth control pills so I did not experience irregular periods. But for those of you not on birth control pills, noticing a change in your period may be an indication you are perimenopausal.
Interview with Dr. Wendy Klein, leading menopause expert and co-author of The Menopause Makeover
Staness: What is one of the first symptoms of perimenopause?
Dr. Klein: The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.
What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.
Staness: Why does this happen?
Dr. Klein: Prior to menopause your periods are usually very regular. The amount of hormone that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.
Staness: How long does period irregularity last?
Dr. Klein: How long that lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.
Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.
Staness: How does a woman know her periods are irregular?
Dr. Klein: You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.
Staness: What should a perimenopausal woman with irregular periods do?
Dr. Klein: Well the easiest thing to do is keep track of your periods. Write them down in the your calendar and track them. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.
If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.
One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.
Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.
Happiness and exercise may seem like an odd combination of words. Shouldn’t we just be happy or not be happy?
During menopause I discovered happiness was going to be an exercise. I had to practice being happy. Being consumed by hourly hot flashes, cranky moods, itchy skin and sleepless from night sweats, being happy was not on my to-do list. It was a full time job just managing these menopause symptoms. Additionally, I had to learn how to eat and exercise differently, and adjust my skin care regime. I was definitely NOT happy about these changes. As I developed the Menopause Makeover 8-step, 12-week plan I had to add “happiness” to the menopause checklist.
According to NationMaster.com, Americans ranked number 13 on the national scale of happiness, and Canada ranked number 17. Iceland, Sweden and Denmark ranked the top three happiest nations. Hmm, what does that say about women in the United States and Canada? Perhaps, we are too busy taking care of our home, family, finances and career. Maybe the new world of instant communication moves too fast? With emails, the inter-net, and cell phones is there any down time?
For the many, happiness is the ultimate goal.
How do you find happiness?
1. Slow down and think about it! 2. Ask yourself what makes me happy, and make a list. 3. Look at your list and ask yourself why are these things missing from my life? 4. Make a commitment to work on the things you can change that have blocked your happiness. 5. Every week take one “happiness item” from your list and set a goal to make it happen.
Before you know it, you the things that make you happy will be happening!
Just like exercise, you must incorporate it into your life daily! You must exercise your happiness muscle!
Finding happiness requires a commitment to change. It isn’t always easy incorporating change into your life, but with practice it will get easier – just like exercise.
Over 60 percent of divorces are initiated by women in their 40s, 50s or 60s — the menopause years — according to a recent survey conducted by AARP Magazine. Why are women running away from marriage?
I wasn’t even married when I slammed into menopause months before my wedding day at the age of 47. Despite being completely in love, I almost ran away and my fiance almost married bridezella!
Experts say the number one reason for divorce is lack of communication. My response from the ladies corner, “When everything you know to be normal is being kidnapped by changing hormones, communication may be last on the list. Throw in lifestyle changes, health and aging issues, and you are left in a small evaporating puddle of low self-esteem feeling hopeless.”
Many men blame lack of sex as the leading reason for midlife divorce. But is it? AARP poled 1,682 adults ages 45 and older on the importance of sex. Two-thirds of men (66 percent) and about half of women (48 percent) agreed that a satisfying sex life was important to their quality of life. That is only an 18 percent difference. So is it lack of sex, or a breakdown in communication chasing the women away?
Navigating a course in uncharted territory can test any relationship emotionally and sexually. It can also bring a couple closer — it did for me.
Purchasing midlife marriage insurance can help combat the unforeseen hazards during the menopause transition. How do you qualify for this love insurance? The first step is to understand how menopause can affect your love life.
Menopause is a life transition that can affect you physically and emotionally. Your body is experiencing fluctuating hormones that can cause hot flashes, night sweats, itchy skin, migraine headaches, breast tenderness, vaginal dryness and irregular periods. Eighty percent of women will experience uncomfortable symptoms, and the majority struggle with midlife weight gain.
Many women feel unattractive going through so many uninvited changes. Some suffer from exhaustion, depression and moodiness leaving them feeling isolated and confused.
During menopause a woman’s brain also goes through changes. Dr. Louann Brizendine (author of The Female Brain) says, “The mommy brain unplugs. Menopause means the end of the hormones that have boosted communication circuits, emotion circuits, the drive to tend and care, and the urge to avoid conflict at all costs.”
There are additional factors on top of fluctuating hormones that may contribute to a lack of communication and interest in sex.
Dr. Wendy Klein, co-author of The Menopause Makeover and leading menopause expert, informed me, “If a woman is taking medications, such as antidepressants, mood stabilizers, contraceptive drugs, antihistamines, sedatives, antihypertensives and/or medications for blood pressure, this can also decrease sexual desire.”
Midlife stresses brought on by career change, the loss of a loved one, empty nest syndrome or caring for elderly parents can contribute to a declining libido.
Throw in aging issues and the last thing on a menopausal woman’s mind is communicating. This woman is in self-survival mode, and may be in no mood to connect or make whoopi.
If she is in an unsupported relationship while managing this collection of changes, leaving the marriage may appear like her only salvation.
Gentlemen — your turn.
How many factors listed above is your partner experiencing? It is no surprise why men are afraid of menopause. His woman is changing in front of his eyes.
Women are not alone suffering from changes. Men also have midlife challenges, both physically and emotionally. Declining testosterone can affect libido, moods and sexual performance. Generally a man’s hormones change gradually compared to the woman’s experience during menopause, so it may not be obvious to the man that he too is changing. Some of these unwelcomed changes may include midlife stress, as well as health and aging issues. If both partners are experiencing change, the relationship may be on an emotional roller coaster.
Approximately 47 percent of women experience sexual difficulties with a decrease of sexual desire being the most common, according to the National Health and Social Survey and the Global Study of Sexual Attitudes and Behaviors.
It is no surprise that most men associate menopause with having less sex. But, it does not have to be this way. The man can actually help save a shaky midlife marriage with some handy tools to power charge the relationship. Women who have a supportive partner often have a smoother transition through menopause. When she is happy, he is happy.
Acquiring midlife marriage insurance takes action to make a difference.
Midlife Marriage Insurance For Him
1. Listen to her; don’t criticize or try to fix her.
2. Go with the flow; be prepared for mood swings.
3. Be compassionate, and validate her experience (that means agree with her, don’t try to fix her).
4. Be romantic. Bring her flowers for no reason. Make her dinner. Give her a massage. Make it about HER.
5. Cuddle more. Tell her you love her and that she is beautiful. You may just get lucky. If not, do not take it personally.
6. If YOU are not in the mood, keep her company shopping, she will love the company
7. Support healthy eating and exercise choices. Join her for a walk or go on a hunting expedition at the grocery store to find new healthy foods.
8. Don’t ignore her menopause symptoms. Talk about it. Ask her what she needs to feel better.
9. Offer support if she needs to visit her healthcare provider to discuss menopause symptoms, a low libido or depression.
10. If numbers one through nine fail – disappear for a while. She may be seriously cranky and need space to focus on herself.
Success depends on going through this transition as a team! Both partners must contribute to have a successful marriage.
Midlife Marriage Insurance For Her
1. Track menopause symptoms and discuss treatment options with your healthcare provider.
2. Make a commitment to a healthy lifestyle. Exercise most days of the week. Eat nutritious meals. Watch portions.
3. Update your beauty regimen.
4. Build a support group.
5. Communicate with your partner. Don’t shut him out – let him know what you need. Understand he may be confused by your changes.
6. If you are not happy in your current relationship, discuss counseling.
7. Be receptive to creative adjustments in lovemaking activities.
8. If your libido is low and/or you are suffering from vaginal dryness, discuss your treatment options with your healthcare practitioner. There are hormone and non-hormone options available.
9. Pamper yourself.
10. Try to stay positive.
Communicate, support each other’s needs, get counseling if needed, add romance, adjust lovemaking activities, and your odds increase that your marriage will survive menopause. Being on the same team will nourish a healthy, loving relationship that can last a lifetime.
Life is constantly changing, and marriage is no different. Have real expectations, and acknowledge that your relationship goes through transitions. This will help you weather difficult times.
Midlife is an opportunity for both men and women. If you are prepared, informed and willing, your marriage can survive menopause. A loving relationship supported with good communication can strengthen your love life at any age.
This menopausal bride made it down the aisle of love. Both my partner and I said “I do” to communication and romance during menopause. We are still happily married five years later and ready to leap over the seven-year itch together.
Montenegro, X. The Divorce Experience: A Study of Divorce at Midlife and Beyond. AARP, May 2004.
Brizendine, L. The Female Brain. New York: Broadway Books; 2006.
Jonekos, S. and W. Klein. The Menopause Makeover. Ontario, Canada: Harlequin Enterprises; 2009.
Once you commit to an exercise regime, your secret weapon is utilizing your target heart rate ensuring an effective workout. The target heart rate (THR) is your pulse rate per minute, and it can guide you through safely exercising while maximizing your routine.
Wear a heart rate monitor when exercising to track your target heart rate. During cardio sessions your target heart rate range should be between 60% (fitness zone) and 80% (aerobic zone) of your maximum heart rate. Monitoring your target heart rate is a great way to make sure you are pushing yourself hard enough to get the fat burning and cardio results you want.
Set goals using your target heart rate. Pace yourself if you have been inactive. If you are not at 60% of your target heart rate, push a little harder and watch your fitness level improve. Within six months of regular exercise you may be able to exercise at 80% of your maximum heart rate.
Always discuss your exercise choices with your healthcare provider. Click here for more information.
Mirror, mirror on the wall, who’s the fairest of them at? Well lately – NOT ME!
With the list of menopause symptoms getting longer each month, now my make-up is making me look older. The one time in my life that I want to “hide” behind a full face of make-up hoping age won’t find me, just isn’t working any more. The fine lines on my face and neck are just getting deeper, no thanks to the lower levels of estrogen in my body. Applying make-up and light powder just makes the lines just look worse. It has gotten so bad that my husband suggested I not wear make-up at all. This story has a happy ending, and it doesn’t involve going to a plastic surgeon. Theresa, a dear friend and beauty consultant, suggested exfoliation. Once I started a weekly program of exfoliation, I immediately looked years younger.
Every 28 days skin renews itself leaving your skin with a fresh layer of baby cells. As we get older this shedding process, called desquamation, slows down leaving us with fine lines, dry areas and an uneven skin texture. Make-up can really accentuate this dilemma.
Exfoliation stimulates new cell growth by removing the cells your body is no longer shedding. It helps your body with the desquamation process by stripping the dead epidermal cells on the outer surface of your skin and exposing a fresher layer of living cells. It takes a few days for a noticeable amount of dead cells to accumulate. It is best to exfoliate once or twice a week. You don’t want to irritate your skin or remove healthy living cells by doing it daily.
Benefits of Exfoliation
• Removes the top layer of dead cells, so the cells turn over at a faster rate revealing softer, smoother skin • Improves the texture of your skin • Helps reduce fine lines and wrinkles • Un-clogs pores • Makes your skin look healthier, fresher and more radiant • Gives your skin a good base to absorb moisturizers and other skin products • Boosts your circulation from the friction
Exfoliation can benefit the skin on your face, around your lips, neck, elbows, knees and feet. Lately I have noticed the skin on my heels starting to crack and the skin on my elbows seems thicker. This dilemma has improved as a result of exfoliating. For those of you who love self-tanning, exfoliation will be your new best friend. It is a great technique to blend around the feet, elbows and knees.
There are three different exfoliating methods.
Manual Chemical Enzyme
Manual exfoliation is moved across your skin’s surface using your fingers or buff puff. You are removing the dead cells by scraping off the top surface with physical friction. Many manufacturers use natural products such as seeds, apricot pits, or crushed oyster shells as the ingredient that causing friction. Some products use round beads or poly spheres that can be easier on the skin.
Chemical exfoliates are a topical bio engineered ingredient that can dissolve the glue like substance that holds the dead cells together. Most chemical exfoliates use either Alpha Hydroxy Acids or Beta Hydroxy Acids. This type of exfoliation is applied to the skin then rinsed off. You do not “scrub” to enjoy the benefits. The “chemical” does the work.
Enzymes work by dissolving the dead tissue. The enzymes are molecules that catalyze chemical reactions of other substances. The product is applied then washed off. You do not manually “scrub” your skin. The enzyme does the work for you. You have three choices: manually scrub off the dead cells, dissolve the glue like substance that holds the dead cells together with chemicals or dissolve the dead tissue with enzymes. They all work equally well. I prefer to exfoliate manually because it feels good to scrub my face.
I was absolutely amazed at the results of such an inexpensive and simple process. Not only is my facial skin benefiting, but my elbows and feet are too. Exfoliation is my new anti-aging weapon.
I am a fifty-something baby boomer who has recently reinvented everything about my life. Changed careers, got married, changed residence and adopted a dog-- all before my 50th birthday. After three decades of success I have finally found happiness staring at an empty canvas. If you are a baby boomer going through changes - let's chat.