Definition

Menopause, or the permanent end of menstruation and fertility, is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss.

Hormonal changes cause the physical symptoms of menopause, but mistaken beliefs about the menopausal transition are partly to blame for the emotional ones. First, menopause doesn't mean the end is near — you've still got as much as half your life to go. Second, menopause will not snuff out your femininity and sexuality. In fact, you may be one of the many women who find it liberating to stop worrying about pregnancy and periods.

Most important, even though menopause is not an illness, you shouldn't hesitate to get treatment if you're having severe symptoms. Many treatments are available, from lifestyle adjustments to hormone therapy.

Symptoms

Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens about age 51, on average.
The signs and symptoms of menopause, however, often appear long before the one-year anniversary of your final period. They include:

• Irregular periods
• Decreased fertility
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Increased abdominal fat
• Thinning hair
• Loss of breast fullness

Causes

Menopause begins naturally when your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. The process gets under way in your late 30s. By that time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, perhaps partially due to these hormonal effects.

These changes are more pronounced in your 40s, as are changes in your menstrual pattern. Your periods may become longer or shorter, heavier or lighter, and more or less frequent. Eventually, your ovaries shut down and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. You're much more likely, though, to have a gradual tapering off.

Unfortunately, there's no way to know exactly which period will be your last. You have to wait until well after the fact — 12 months after, by official definition. In your final months before reaching menopause, it's still possible to get pregnant, but it's quite unlikely.
Because this process takes place over years, menopause is commonly divided into the following two stages:

Perimenopause. This is the time you begin experiencing menopausal signs and symptoms, even though you still menstruate. Your hormone levels rise and fall unevenly, and you may have hot flashes and other symptoms. Perimenopause may last four to five years or longer.

Postmenopause. Once 12 months have passed since your last period, you've reached menopause. Your ovaries produce much less estrogen and no progesterone, and they don't release eggs. The years that follow are called postmenopause.

Risk factors

Menopause is usually a natural process. But certain surgical or medical treatments or medical conditions can bring on menopause earlier than expected. These include:

Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But an operation that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any perimenopausal phase. Instead, your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms.

Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.

Premature ovarian failure. Approximately 1 percent of women experience menopause before age 40. Menopause may result from premature ovarian failure — when your ovaries stop working before age 40 — stemming from genetic factors or autoimmune disease, but often no cause can be found.

Definition

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones.
A common result of osteoporosis is fractures — most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density.
It's never too late — or too early — to do something about osteoporosis. You can take steps to keep bones strong and healthy throughout life.

Symptoms

In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include:

• Back pain, which can be severe if you have a fractured or collapsed vertebra
• Loss of height over time, with an accompanying stooped posture
• Fracture of the vertebrae, wrists, hips or other bones

Causes

The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.


The process of bone remodeling

Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.

A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later.


What keeps bones healthy

Three factors that you can influence are essential for keeping your bones healthy throughout your life:

• Regular exercise
• Adequate amounts of calcium
• Adequate amounts of vitamin D, which is essential for absorbing calcium

Risk factors

A number of factors can increase the likelihood that you'll develop osteoporosis, including:

• Your sex. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. The risk of osteoporosis in men is greatest from age 75 on.
• Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.
• Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.
• Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
• Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
• Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
• Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.
• Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
• Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.
• Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
• Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.
• Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.
• Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.
• Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.
• Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.
• Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.
• Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.
• Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.
• Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.
• Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).
• Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. However, these results don't necessarily mean that SSRIs cause bone loss or osteoporosis. More research is needed to fully understand the association between SSRI use and low bone density. Evidence does not currently indicate that you should stop using SSRIs because of concerns about bone loss.
• Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminum-containing antacids also can cause bone loss.
• Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen. This isn't true for women treated with tamoxifen, which may reduce the risk of fractures.
• Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.
• Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia nervosa and Cushing's disease — a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.
• Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.
• Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.
• Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.
• Depression. People who experience serious depression have increased rates of bone loss.

Tests and diagnosis

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density.

• Dual energy X-ray absorptiometry (DEXA) - This is the best test method and is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it's used to accurately follow changes in these bones over time.
• Ultrasound
• Quantitative computerized tomography (CT) scanning
  

Should you have a test?

If you're a woman, the National Osteoporosis Foundation recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:

• You're older than age 65, regardless of risk factors.
• You're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.
• You have a vertebral abnormality.
• You use medications, such as prednisone, that can cause osteoporosis.
• You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.
• You experienced early menopause.

Heart disease isn't just a man's disease.

Heart attack, stroke and other cardiovascular diseases are devastating to women, too. In fact, coronary heart disease, which causes heart attack, is the leading cause of death for American women. Many women believe that cancer is more of a threat, but they're wrong. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.

The American Heart Association has identified several factors that increase the risk of heart disease and stroke. The more risk factors a woman has, the greater her risk of having a heart attack or stroke. Some of these risk factors you can't control, such as increasing age, family health history, and race and gender. But you can modify, treat or control most risk factors to lower your risk.


What are the risk factors for heart disease and stroke that you can't control?

Increasing age — As women grow older, their risk of heart disease and stroke begins to rise and keeps rising with age.

• Sex (Gender) — Men have a greater risk of heart attack than women, and they have attacks earlier in life. Each year about 60,000 more women than men have strokes, and about 60 percent of total stroke deaths occur in women.
• Heredity (family history) — Both women and men are more likely to develop heart disease or stroke if their close blood relatives have had them. Race is also a factor. Black women have a greater risk of heart disease and stroke than white women. Compared with whites, African-American men and women are more likely to die of stroke.
• Previous heart attack or stroke or TIA — Women who've had a heart attack are at higher risk of having a second heart attack; 43 percent of women ages 40 and older who survive a first heart attack will have another heart attack or fatal coronary heart disease within five years, and 22 percent who survive a first stroke will have another within five years. A transient ischemic attack (TIA or "mini-stroke") also is a risk factor and predictor of stroke.

What risk factors can be modified, treated or controlled by focusing on lifestyle habits and taking medicine, if needed?

• Tobacco smoke — Smoking is the single most preventable cause of death in the United States. Smoking is a major cause of cardiovascular heart disease among women. Women who smoke have an increased risk for ischemic stroke and subarachnoid hemorrhage. Constant exposure to others' tobacco smoke (secondhand smoke) at work or at home also increases the risk, even for nonsmokers. Women smokers who use birth control pills have a higher risk of heart attack and stroke than nonsmokers who use them.
• High blood cholesterol — High blood cholesterol is a major risk factor for heart disease and also increases the risk of stroke. Studies show that women's cholesterol is higher than men's from age 55 on. High levels of LDL (low-density lipoprotein) cholesterol (the "bad" cholesterol) raise the risk of heart disease and heart attack. High levels of HDL (high-density lipoprotein) cholesterol (the "good" cholesterol) lower the risk of heart disease. Research has shown that low levels of HDL cholesterol seem to be a stronger risk factor for women than for men.
• High blood pressure — High blood pressure is a major risk factor for heart attack and the most important risk factor for stroke. Women have an increased risk of developing high blood pressure if they are obese, have a family history of high blood pressure, are pregnant, take certain types of birth control pills or have reached menopause. African-American women have higher average blood pressure levels compared to Caucasian women.
• Physical inactivity — Various studies have shown that lack of physical activity is a risk factor for heart disease and indirectly increases the risk of stroke. Overall, they found that heart disease is almost twice as likely to develop in inactive people than in those who are more active. When you're inactive and eat too much, you can gain excess weight. In many people overweight can lead to high blood cholesterol levels, high blood pressure, diabetes and increased risk of heart disease and stroke. The American Heart Association recommends accumulating at least 30 minutes of physical activity on most or all days of the week.
• Obesity and overweight — If you have too much fat — especially if a lot of it is located in your waist area — you're at higher risk for health problems, including high blood pressure, high blood cholesterol, high triglycerides, diabetes, heart disease and stroke.
• Diabetes mellitus — Adults with diabetes have have heart disease death rates that are two to four times those of adults without diabetes. People with diabetes often have high blood pressure and high cholesterol and are overweight, increasing their risk even more. 

What other factors contribute to the risk of heart disease and stroke in women?

• High triglyceride levels — Triglyceride is a common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and increased risk of diabetes. But scientists don't agree that it's a risk factor for heart disease by itself. Research suggests that having high triglycerides may increase the risk for women more than for men.
• Excessive alcohol intake — The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women per day) is lower than in nondrinkers. However, it's not recommended that nondrinkers start using alcohol or increase the amount they drink. Excessive drinking and binge drinking can contribute to obesity, high triglycerides, cancer and other diseases, raise blood pressure, cause heart failure and lead to stroke. Pregnant women should not drink alcohol in any form.
• Individual response to stress — Research hasn't yet defined the role stress plays in the development of heart disease. People respond differently to situations they find stressful. Unhealthy responses to stress may lead to other risk behaviors like smoking and overeating.

For one reason or another many women seem to need a little push when it comes to having valuable health screenings performed. For this reason Lakeside Women’s Hospital is encouraging you to schedule a colonoscopy. As most people know, a colonoscopy is an evaluation of the lining of the colon to check for medical problems such as bleeding or the presence of cancer. It is the method of choice for screening patients at high risk for colon cancer. To schedule a “Gentle Colonoscopy” call: (405) 936-1065

KNOWING THE SCOPE OF THINGS
Are you nervous about having a colonoscopy?  You are not alone.  The thought of going through the procedure can be a little unsettling, even though you know it is for your own good.  Most people say it is the anticipation and preparation prior to the procedure that is worse than the procedure itself.  Colorectal cancer is the second leading cause of death in the United States for women and men combined, so it is imperative that we work together to intensify our efforts to inform you about the ways to proactively protect your
health against this largely preventable disease.

What is a colonoscopy?

A colonoscopy is a procedure that enables your doctor to examine the lining of the colon (large bowel) for abnormalities by inserting a lubricated flexible tube that is the thickness of your finger into the anus and advancing it slowly into the rectum and colon.

What Preparation is required?

The colon must be completely clean for the procedure to be accurate and complete. INSTRUCTIONS: For all colonoscopy patients:

1. Don’t eat food or drink with red or purple coloring three days prior to exam.
2. Bring your insurance card on admission to facility.
3. Do not wear or bring any jewelry on the day of your procedure.
4. Wear comfortable loose clothing, (pajamas, jogging suit, etc.).  Wear flat shoes.
5. Arrange to be accompanied by an adult who will accept responsibility for you and to drive you home.  We STRONGLY encourage that person to remain at the facility during your procedure and be responsible for discharge instructions.  Have an adult stay with you for about six hours after the procedure. IF YOU ARE ALONE, YOU ARE NOT ALLOWED TO TAKE A TAXI, BUS, AND OR WALK HOME ETC.  IF YOU DO NOT HAVE SOMEONE TO ACCOMPANY YOU HOME YOUR PROCEDURE WILL HAVE TO BE RESCHEDULED.
6. Do not drive a car, operate machinery, or make important legal decisions after the sedation.
7. PLEASE NOTIFY NURSE ON ADMISSION TO PRE-PROCEDURE AREA THE COLOR AND CONSISTANCEY OF BOWEL MOVEMENTS.

What about my current medications?

Most medications must be continued as usual, but some can interfere with the preparations or the examination.  It is best to inform the physician of your current medications and allergies to food and/or medicine.
1. STOP any diet or herbal supplements 2 weeks prior to exam.
2. STOP taking iron and multivitamins containing iron 5 days prior to exam.
3. STOP taking anti-inflammatory pain medications 5 days prior to exam.  (Ibuprofen or Motrin, Naproxen or Alieve, Aspirin or Aspirin containing products such as Alka-Seltzer etc.) IF IN DOUBT ABOUT ANY OF YOUR MEDICATIONS ASK YOUR PHARMACIST ABOUT ANY PRESCRIBED OR OVER THE
COUNTER MEDICATIONS.
4. If you are on anticoagulant (BLOOD THINNERS) therapy such as COUMADIN, PLAVIX, WARFARIN etc. please consult your PRIMARY PHYSICIAN to see if you are able to stop this medication for 5 days prior to the procedure and notify Lori at 405-936-1546 IMMEDIATELY.
5. If you are adiabetic, please let us know when scheduling your procedure with Kathy Vogt.  Contact your PRIMARY PHYSICIAN for specific instructions for monitoring your blood sugar and dosing instructions for your medications and notify Lori at 405-936-1546 IMMEDIATELY.
6. FROM YOUR GROCERY STORE PURCHASE:
     a. Clear liquids, such as water, tea, coffee, 7-Up, ginger ale, apple or white grape juice, Jell-O and/or Popsicles (NOTHING WITH RED OR PURPLE COLORING), clear soup or broth.  DRINK LOTS OF CLEAR FLUIDS.  THE KEY TO A SUCCESSFUL PREPARATION IS DRINKING PLENTY OF CLEAR LIQUIDS TO STAY HYDRATED AND PREP YOUR BOWEL.
     b. Use hemorrhoid ointments or creams on your skin to create a barrier to minimize irritation from frequent bowel movements and wiping.   Flushable hemorrhoid wipes are available for use instead of toilet paper.

What to expect during the preparation?

For a colonoscopy, you need to clear your colon of all obstructions and we do mean all.  The key to a successful bowel preparation for a colonoscopy is following the clear liquid diet and medication dosing instructions.

What can be expected during a Colonoscopy?


Once you arrive at our center, a nurse will greet you, ask you to change into a hospital gown, ask you to sign a consent form, and start an IV.  Next, the doctor will meet with you to answer any questions and to review the procedure with you. When you are ready, the nurse will bring you to a private procedure room and have you lie on your left side. We will make sure you are comfortable with a pillow and warm blanket. The nurse will place nasal oxygen and several monitoring devices on your body.  This equipment will allow us monitor your heart rate, blood pressure, and oxygen level during the colonoscopy. This is routine for all patients. Once you are ready, you will receive sedative and pain medication through the IV. This medication will bring you into a state called “conscious sedation: which means you should not feel or remember the procedure. This should be the last moment you will remember for a while.  You will need to remain at our facility for approximately one hour after the procedure or until the sedative wears off. While you are in this relaxed sleepy state the doctor inserts a thin, flexible tube, about the size of your little finger into your rectum and gently eases it into your colon. The tube is equipped with a tiny video camera that transmits a clear picture to a TV monitor, allowing the doctor to visualize the inside of your colon. Imagine your colon as flat as an empty balloon; the doctor inflates it enough to visualize the wall of your colon for abnormalities or polyps.   The colonoscopy takes approximately 20 to 60 minutes on average, time could vary depending on the success of the bowel prep or if any specimens are obtained.

If any abnormal tissue or small polyps are detected the doctor can remove all or part or it by using a tiny instrument that is passed through the scope.  The biopsy or polyp (specimen) is sent to a lab for evaluation.  You should not feel any pain, the inner lining of the colon does not contain any pain sensors.

What happens after the Colonoscopy?


After the exam, you are taken to our recovery area where you monitored until you awaken and tolerate fluids. Most people feel well rested after waking up; some stay drowsy for several hours after discharge.  You may experience some bloating, passing gas, and cramping intermittently through out the day. This should disappear quickly after you start ambulating, we encourage you to pass the gas and not hold it in.

The doctor will visit with the person who accompanied you to the hospital and the nurse will review discharge instructions with them.

A copy of your colon report and discharge instructions will be given to you at discharge.

AGAIN, you many not remember anything for several hours after being medicated. Most patients do not remember the recovery area at all and very few remember the ride home.

RESULTS OF BIOPSIES WILL BE AVAILABLE IN 7 TO 10 BUSINESS DAYS.   The total time at our facility is approximately 2-3 hours. REMEMBER THIS IS AN ESTIMATE


What are the possible complications of a colonoscopy?


One possible complication is a perforation or tear through the bowel wall that could require surgery. Death is a remote possibility with any interventional procedure. Bleeding may occur from the site of a biopsy or polypectomy. It is usually minor and stops on its own or can be controlled through the colonoscope. Rarely blood transfusions or surgery is required. Other potential risks include a reaction to the sedatives used and complications from heart or lung disease. Localized irritation of the vein where medications were injected may cause a tender lump lasting for several weeks, but this will go away eventually. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complications.  Please contact the doctor who performed the procedure if you notice any of the following symptoms:

• Severe abdominal pain, to touch or movement
• Fever over 101F and/or chills
• Rectal bleeding of a half a cup of more (bleeding can occur several days after the polypectomy)

Colonoscopy and polypectomy are generally safe when performed by doctors who have been trained and are experienced in
these endoscopic procedures.

During menopause, your ovaries decrease production of the female hormones estrogen and progesterone. This decline in hormones puts a permanent end to menstruation and fertility, but it can also cause hot flashes, mood swings, vaginal dryness and urinary problems. The solution? For decades, doctors routinely eased these symptoms with hormone replacement therapy — medications containing female hormones to replace the ones the body is no longer making. And it was widely believed that boosting estrogen levels after menopause could also ward off heart disease and osteoporosis, while improving quality of life and keeping women young.

Then, in 2002, a large clinical trial called the Women's Health Initiative (WHI) reported that hormone therapy actually posed more health risks than benefits for women in the clinical trial. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And up to two-thirds of women on the therapy discontinued its use, often without talking to their doctors.


Today, there's plenty of confusion about hormone replacement therapy, which is now commonly called hormone therapy. The truth is that hormone therapy is not the magical cure for aging that it was once believed to be, but it's still the most effective treatment for unpleasant menopausal symptoms for most women. If you're facing menopause, learn more about the benefits and the risks of hormone therapy.


What are the benefits of hormone therapy?


Estrogen remains the most effective treatment for relief of troublesome menopausal hot flashes and night sweats. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. Long-term hormone therapy for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against the following conditions:

• Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures.
• Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.
• Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your postmenopausal years. A randomized, controlled clinical trial — the Kronos Early Estrogen Prevention Study (KEEPS) — exploring estrogen use and heart disease in younger postmenopausal women is under way, but it won't be completed for several years.

For women who undergo menopause naturally, estrogen is typically prescribed as part of a combination therapy of estrogen and progestin. This is because estrogen without progestin can increase the risk of uterine cancer. Women who undergo menopause as the result of a hysterectomy can take estrogen alone.

What are the risks of hormone therapy?

The Women's Health Initiative found that women taking the combination estrogen-progestin (Prempro) used in the study had an increased risk of developing certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin compared with a placebo might experience:

• Seven more cases of heart disease
• Eight more cases of breast cancer
• Eight more cases of stroke
• 18 more cases of blood clots

Based on these numbers, the increased risk of disease to an individual woman is small. However, the overall risk to menopausal women as a group became a substantial public health concern. In addition, researchers found that women taking combination estrogen-progestin had an increase in abnormal mammograms. The higher number of false-positives — signs of possible breast cancer that ultimately prove inaccurate — was probably due to estrogen, which increases breast tissue density.


For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. But researchers did find that over one year, 10,000 women taking estrogen compared with a placebo might experience 12 more cases of stroke and six more cases of blood clots in the legs, plus an increase in mammography abnormalities. This last point is important, because women who take estrogen or combination estrogen-progestin therapy may need more frequent mammograms and additional testing.


Who should consider hormone therapy?

Despite the inherent health risks, estrogen is still the gold standard for treating menopausal symptoms. For women who experience moderate to severe hot flashes or other menopausal symptoms, the benefits of short-term therapy outweigh the potential risks.
Data surrounding hormone replacement therapy can be scary and confusing. But the absolute risk to an individual woman taking hormone therapy is quite low — possibly low enough to be acceptable to you, depending on your symptoms. Talk with your doctor about your personal risks.

Who should avoid hormone therapy?

Women with breast cancer, heart disease or a history of blood clots should not take hormone therapy for relief of menopause symptoms. Women who don't suffer from menopause symptoms should not take hormone therapy for preventing memory loss or strokes. Instead, talk to your doctor about other medications you can take or lifestyle changes you can make for long-term protection from these conditions.

If you take hormone replacement therapy, how can you protect yourself from the added risks?

Recent analysis of the WHI data and other trials suggests that there are several ways to reduce the inherent risks of hormone therapy. Talk to your doctor about these strategies:

1. Time it right. The risk of hormone therapy causing heart disease is not significantly raised in women under age 60. In fact, some studies suggest that estrogen may protect the heart when taken early in your menopausal years.
2. Minimize the amount of medication you take. Use the lowest effective dose for the shortest amount of time needed to treat symptoms. On the other hand, don't be scared to continue treatment as long as you have debilitating menopausal symptoms.
3. Find the best delivery method for you. You can take estrogen in the form of a pill, patch, gel, vaginal cream or slow-releasing suppository or ring that you place in your vagina. If you experience only isolated vaginal symptoms, estrogen in a vaginal cream, tablet or ring is usually a better choice than a pill or a skin patch. That's because estrogen applied directly to your vagina is more effective at a lower dose than is estrogen given in pill or skin patch form.
4. If you haven't had a hysterectomy and are using oral or skin patch hormone therapy, you will also need progestin, which is available in a pill, combination pill, vaginal gel, intrauterine device or combination skin patch. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

What can you do if you can't take hormone therapy?

Women shouldn't have to suffer through menopause. You may be able to manage your menopausal symptoms by making healthy lifestyle choices. In fact, your doctor may recommend that you change your exercise or eating habits before you try medication. If lifestyle changes aren't providing enough relief from bothersome symptoms, there are many medications besides hormone therapy to relieve discomfort.

Sleep Disorders in Women

Women are twice as likely as men to have difficulties falling asleep or staying asleep. Younger women have sounder sleep with fewer disturbances. Some women, however, are prone to sleep problems throughout their reproductive years. Only recently has the medical community focused on women's sleep disorders.  

A number of factors may affect women’s sleep. Changes in hormonal levels, stress, illness, lifestyle, and sleep environment may impact sleep. Pregnancy- and menstrual-related hormonal fluctuations may affect sleep patterns, mood, and reaction to stress. Many women have premenstrual sleep disturbances. Difficulty falling asleep, nighttime waking, difficulty waking up, and daytime sleepiness all are linked to premenstrual changes. Insomnia (sleeplessness) is one of the most common symptoms of premenstrual syndrome (PMS).

Psychosocial stress may threaten sleep more than hormonal changes. Many young women reduce sleep to cope with work and their roles as mothers and wives. They ignore fatigue and other effects of inadequate sleep. About 30% of employed women report sleep problems. Sleep problems are more common in women older than 40 years. Getting enough sleep improves job performance, concentration, social interaction, and general sense of well-being.  Pregnancy may also disturb sleep. During the first trimester, women need more sleep and feel sleepier during the day. During the second trimester, sleep improves. During the third trimester, women sleep less and are more awake. The most common reasons for sleep disturbances are frequent urination, heartburn, general discomfort, fetal movements, low back pain, leg cramps, and nightmares. Swelling in nasal passages may cause snoring and sleep apnea during pregnancy.  As women age, physical and hormonal changes make sleep lighter and less sound. Sleep disturbances become more common during menopause. Women wake up more often at night and are more tired during the day. Hot flashes and night sweats linked to lower levels of estrogen may contribute to these problems. During the menopausal years, snoring becomes more frequent. After menopause, women get less deep sleep and are more likely to awaken at night than during menopause.   

Pain, grief, worry, certain medical conditions, medications, and breathing disorders may disturb sleep in menopausal and postmenopausal women.

The most common sleep problem in women is insomnia. This includes trouble falling asleep, staying asleep, or early awakening, and inability to resume sleep. Other common sleep disorders are sleep-disordered breathing, restless legs syndrome, periodic limb movement disorder, and narcolepsy. 

Sleep-disordered breathing occurs with loud snoring, interrupted breathing during sleep, disrupted sleep, and daytime sleepiness. Sleep apnea increases in women older than 50 years.  

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) can disturb sleep profoundly. The causes of these conditions are unknown. RLS occurs before sleep starts and causes calf discomfort and restlessness in the legs that is relieved by movement. PLMD causes periodic leg movements that may awaken the person from sleep. RLS may cause insomnia. PLMD may cause excessive sleepiness. Both conditions are more common in older people.

Narcolepsy causes excessive daytime sleepiness. The major features of narcolepsy are sleep attacks and cataplexy. Sleep attacks are an irresistible urge to sleep. Cataplexy is a sudden loss of muscle tone typically preceded by emotional states. Other narcolepsy symptoms are sleep paralysis and hypnagogic hallucinations. Patients with narcolepsy often have disrupted sleep.

Discuss any sleep problems you have with your physician. Your doctor may recommend that you see one of the physicians at Lakeside Women’s Hospital’s Sleep Center.
Kellie R. Jones, M.D.
Azhar Khan, M.D.

Sleep Center (405) 606-2727

Definition

Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time.
Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex.

If you're having enough trouble with bladder control that it affects your day-to-day activities, don't hesitate to see your doctor. In many situations, urinary incontinence can be stopped. Even if the condition can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.

Symptoms

Urinary incontinence is the inability to control the release of urine from your bladder. The problem has varying degrees of severity. Some people experience only occasional, minor leaks or dribbles of urine. Others wet their clothes frequently. For a few, incontinence means both urinary and fecal incontinence the uncontrollable loss of stools.
Types of urinary incontinence include:

• Stress incontinence. This is loss of urine when you exert pressure - stress - on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It has nothing to do with psychological stress. Stress incontinence occurs when the sphincter muscle at the bladder is weakened. The problem is especially noticeable when you let your bladder get too full. Stress incontinence is one of the most common types of incontinence, often affecting women. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to this type of incontinence.
• Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. Some people with urge incontinence have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" — it's contracting even when your bladder isn't full. In fact, urge incontinence is often called an overactive bladder.
• Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, leading to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase the risk of developing overflow incontinence.
• Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence. Usually one type is more bothersome than the other is.
• Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. Someone with Alzheimer's disease may not plan well enough to make a timely trip to the toilet. This type of incontinence is called functional incontinence.
• Gross total incontinence. This term is sometimes used to describe continuous leaking of urine, day and night, or periodic large volumes of urine and uncontrollable leaking. The bladder has no storage capacity. Some people have this type of incontinence because they were born with an anatomical defect. It can be caused by a spinal cord injury or by injury to the urinary system from surgery. An abnormal opening (fistula) between the bladder and an adjacent structure, such as the vagina, also may cause this type of high-grade urinary incontinence.

The ins and outs of bladder control.

Except when you're urinating, your bladder muscle stays relaxed so that it can expand to store urine. The relaxed bladder gets support from increasing contractions of your pelvic floor muscles. Your bladder and pelvic floor muscles communicate with each other to help hold urine in the bladder without leaking.
When your bladder is full, it sends nerve signals to your brain. In response, and at an appropriate time and place, you relax your pelvic floor muscles and your bladder contracts, allowing urine to pass through the urethra and out of your body.

Causes

Urinary incontinence isn't a disease, it's a symptom. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.

Causes of temporary urinary incontinence. Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.

• Alcohol. Beer, wine and spirits are all diuretics. They cause your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate and act on that need in a timely manner.
• Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.
• Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.
• Caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly andhold less than usual so that you suddenly and perhaps uncontrollably need to urinate.
• Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.
• Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.
• Other illnesses or injuries. Any serious illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence.
• Easily treatable medical conditions also may be responsible for urinary incontinence.

• Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
• Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and trigger urine frequency.

Causes of persistent urinary incontinence. Urinary incontinence can also be a persistent condition caused by some underlying physical problem — weakened pelvic floor or bladder muscles, neurological diseases, or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:

• Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.
  Women produce less of the hormone estrogen after menopause, a decrease that can contribute to incontinence. Estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues lose some of their ability to close — meaning that your urethra can't hold back urine as easily as before.
• Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — runs the risk of damaging the supporting pelvic floor muscles, which can lead to incontinence.
• Painful bladder syndrome (interstitial cystitis). This rare, chronic condition can be associated with an inflammation of the bladder wall. It occasionally causes urinary incontinence, as well as painful and frequent urination. Interstitial cystitis affects women more often than men, and its cause isn't clear.
• Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
• Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
• Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Urinary obstruction can also occur after overcorrection during a surgical procedure to correct urinary incontinence, leading to more urine leakage.

Risk factors
With so many possible causes, it's not surprising that urinary incontinence is common. These factors increase your risk of developing this common condition:

• Sex. Women are more likely than men are to have stress incontinence. Pregnancy and childbirth, menopause, and normal female anatomy account for this difference. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.
• Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release. However, getting older doesn't necessarily mean that you'll have incontinence. Incontinence isn't normal at any age — except during infancy.
• Obesity. Being overweight increases the pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze.
• Smoking. A chronic cough can cause episodes of incontinence or aggravate incontinence that has other causes. Constant coughing puts stress on your urinary sphincter. Longtime smokers often experience stress incontinence for this reason. Smokers are also at risk of developing overactive bladder.
• Vascular disease. People with extensive vascular disease that can occur with aging are at increased risk of overactive bladder.
• Participating in high-impact sports. High-impact sports — such as running, basketball and gymnastics — can cause episodes of incontinence in otherwise healthy women. These vigorous activities put sudden, strong pressure on your bladder, allowing urine to leak past your urinary sphincter. However, no data links high-impact sports to an increased risk of chronic stress incontinence.

Other diseases. Having kidney disease or diabetes may increase your risk of urinary incontinence.

Definition

Vaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable. A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture.

Symptoms

Signs and symptoms of vaginal dryness include:

• Dryness
• Itching
• Burning
• Pain or light bleeding with sex
• Urinary frequency or urgency

As many as four in 10 women who have reached menopause experience signs and symptoms related to vaginal dryness.

When to see a doctor

Make an appointment with your doctor if you have vaginal burning, itching or soreness or painful sexual intercourse that doesn't improve with self-care measures, such as using a vaginal moisturizer or water-based lubricant. Most vaginal lubrication consists of clear fluid that seeps through the walls of the blood vessels encircling the vagina. When you're sexually aroused, more blood flows to your pelvic organs, creating more lubricating vaginal fluid. But the hormonal changes of menopause, childbirth and breast-feeding may disrupt this process.

Causes


A variety of conditions can cause vaginal dryness. Determining the cause is key to helping you find an appropriate solution. Potential causes include:

Decreased estrogen levels -Reduced estrogen levels are the main cause of vaginal dryness. Estrogen, a female hormone, helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. These factors create a natural defense against vaginal and urinary tract infections. But when your estrogen levels decrease, so does this natural defense, leading to a thinner, less elastic and more fragile vaginal lining.
Estrogen levels can fall for a number of reasons:

• Menopause or perimenopause
• Childbirth
• Breast-feeding
• Effects on your ovaries from cancer therapy, including radiation therapy, hormone therapy and chemotherapy
• Surgical removal of your ovaries
• Immune disorders
• Cigarette smoking

Medications - Allergy and cold medications, as well as some antidepressants, can decrease the moisture in many parts of your body, including your vagina. Anti-estrogen medications, such as those used to treat breast cancer, also can result in vaginal dryness.

Sjogren's syndrome -In this autoimmune disease, your immune system attacks healthy tissue. In addition to causing symptoms of dry eyes and dry mouth, Sjogren's syndrome can also cause vaginal dryness.

Douching - The process of cleansing your vagina with a liquid preparation (douching) disrupts the normal chemical balance in your vagina and can cause inflammation (vaginitis). This may cause your vagina to feel dry or irritated.