Osteoporosis is a disease of the bones characterized by brittle and fragile bones. If you suffer from osteoporosis you are more likely to suffer a fracture if you fall. Even a small fall may cause a fracture in someone with osteoporosis which may not have in someone not suffering from osteoporosis.
We cannot modify some of the risk factors that cause osteoporosis, like sex, age, race, family history, and body frame size. But there are other risk factors that we can modify to decrease our risk of getting osteoporosis, like excessive alcohol consumption, tobacco use, low calcium intake, and a sedentary lifestyle.
Exercise is good for you and your health regardless of how old you are and whether or not you suffer from osteoporosis. Studies show that people who exercise regularly have lower rates of depression, heart disease, dementia, cancer, and diabetes.
Exercise is important to protect the spine, build muscle strength, slow the rate of bone loss, and prevent falls.
Good posture is essential for your bones. Always sit and stand as tall as possible. Poor alignment of the vertebrae, the bones that make up your spine, especially during activities that involve bending and twisting, can cause fractures. Spine fractures result from the compression of one vertebrae against another and can cause pain, disability, and deformity of the spine, like an excessively curved upper back, “hunchback” shape. Weak back muscles can also cause the spine to curve. Exercising the back muscles can help improve posture and decrease spinal fractures. It is easier to achieve good posture if you engage your core muscles by pulling your belly button towards your spine, lowering your shoulders, and gently drawing your shoulder blades, in your back, together.
Like muscles, bones also atrophy if not used. Exercise results in stronger muscles which in turn stimulate bone growth. Exercises aimed at increasing muscle strength, combined with weight-bearing aerobic physical activity, help to prevent bone loss.
According to the National Institutes of Health, “the best exercise for building and maintaining bone mass is weight-bearing exercise: exercise that you do on your feet and that forces you to work against gravity”. Examples are walking, jogging, step aerobics, dancing, stair climbing, and sports that involve running and jumping such as soccer, basketball, volleyball, tennis, and others.
Exercises that increase muscle strength involve performing movements against resistance and can be performed using equipment such as dumbbells, weight machines, or exercise bands.
The North America Menopause Society (NAMS) recommends:
- Target specific muscle groups (the large extensor muscles of the back, the hip flexors and extensors, muscles of the thigh, upper arm, and forearm) in order to affect areas of the skeleton most often involved in osteoporotic fractures.
- To strengthen your back, perform gentle spinal extension exercises while seated (sit tall, look up toward the ceiling, and arch your back) and lift the lower ribs off the pelvis.
Swimming and cycling are not weight-bearing exercises but are aerobic physical activities good for your heart.
Good balance is needed to prevent falls which in turn prevents fractures.
NAMS says that “balance work should begin with a chair for support, especially if you already have osteoporosis. While holding the chair, practice standing on one foot at a time. Gradually, work up to balancing on one foot without using the chair. Advanced activities include tai chi and yoga, which improve muscle strength, flexibility and balance. Note that yoga can be both beneficial and risky in women with osteoporosis. There is controversy regarding the safety of some of the spine-twisting positions in yoga. Toe touches and sit-ups should be avoided because they increase the weight placed on the spine, which may result in spine fracture in high-risk women”.
During the menopausal transition:
*the levels of estrogen decrease and that blunts the desire to be physically active
* estrogen regulates the amount and distribution of fat
*estrogen decreases the level of energy we spend at rest
*women lose a lot of bone mass
This predisposes menopausal women to gain weight, particularly in the abdomen, muscular atrophy, and losses in muscle strength, functional decline and high risk for osteoporosis. It is very important that women become aware of these risks and take the time and effort to look after their bones, muscle and health by exercising regularly.
The Canada’s Physical Activity Guide “suggest that ALL adults (including those over 65 years of age) participate in at least 30 minutes of moderate to vigorous intensity physical activity on most days of the week (5 days a week or more)”.
Spring is coming, enjoy the outdoors and exercise your menopausal bones!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Exercise For Your Menopausal Bones
/in Osteoporosis, Exercise, Menopause/by Teresa IsabelOsteoporosis is a disease of the bones characterized by brittle and fragile bones. If you suffer from osteoporosis you are more likely to suffer a fracture if you fall. Even a small fall may cause a fracture in someone with osteoporosis which may not have in someone not suffering from osteoporosis.
We cannot modify some of the risk factors that cause osteoporosis, like sex, age, race, family history, and body frame size. But there are other risk factors that we can modify to decrease our risk of getting osteoporosis, like excessive alcohol consumption, tobacco use, low calcium intake, and a sedentary lifestyle.
Exercise is good for you and your health regardless of how old you are and whether or not you suffer from osteoporosis. Studies show that people who exercise regularly have lower rates of depression, heart disease, dementia, cancer, and diabetes.
Exercise is important to protect the spine, build muscle strength, slow the rate of bone loss, and prevent falls.
Good posture is essential for your bones. Always sit and stand as tall as possible. Poor alignment of the vertebrae, the bones that make up your spine, especially during activities that involve bending and twisting, can cause fractures. Spine fractures result from the compression of one vertebrae against another and can cause pain, disability, and deformity of the spine, like an excessively curved upper back, “hunchback” shape. Weak back muscles can also cause the spine to curve. Exercising the back muscles can help improve posture and decrease spinal fractures. It is easier to achieve good posture if you engage your core muscles by pulling your belly button towards your spine, lowering your shoulders, and gently drawing your shoulder blades, in your back, together.
Like muscles, bones also atrophy if not used. Exercise results in stronger muscles which in turn stimulate bone growth. Exercises aimed at increasing muscle strength, combined with weight-bearing aerobic physical activity, help to prevent bone loss.
According to the National Institutes of Health, “the best exercise for building and maintaining bone mass is weight-bearing exercise: exercise that you do on your feet and that forces you to work against gravity”. Examples are walking, jogging, step aerobics, dancing, stair climbing, and sports that involve running and jumping such as soccer, basketball, volleyball, tennis, and others.
Exercises that increase muscle strength involve performing movements against resistance and can be performed using equipment such as dumbbells, weight machines, or exercise bands.
The North America Menopause Society (NAMS) recommends:
Swimming and cycling are not weight-bearing exercises but are aerobic physical activities good for your heart.
Good balance is needed to prevent falls which in turn prevents fractures.
NAMS says that “balance work should begin with a chair for support, especially if you already have osteoporosis. While holding the chair, practice standing on one foot at a time. Gradually, work up to balancing on one foot without using the chair. Advanced activities include tai chi and yoga, which improve muscle strength, flexibility and balance. Note that yoga can be both beneficial and risky in women with osteoporosis. There is controversy regarding the safety of some of the spine-twisting positions in yoga. Toe touches and sit-ups should be avoided because they increase the weight placed on the spine, which may result in spine fracture in high-risk women”.
During the menopausal transition:
*the levels of estrogen decrease and that blunts the desire to be physically active
* estrogen regulates the amount and distribution of fat
*estrogen decreases the level of energy we spend at rest
*women lose a lot of bone mass
This predisposes menopausal women to gain weight, particularly in the abdomen, muscular atrophy, and losses in muscle strength, functional decline and high risk for osteoporosis. It is very important that women become aware of these risks and take the time and effort to look after their bones, muscle and health by exercising regularly.
The Canada’s Physical Activity Guide “suggest that ALL adults (including those over 65 years of age) participate in at least 30 minutes of moderate to vigorous intensity physical activity on most days of the week (5 days a week or more)”.
Spring is coming, enjoy the outdoors and exercise your menopausal bones!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Food For Menopausal Bones
/in Osteoporosis/by Teresa IsabelDuring menopause you need to think about food for your menopausal bones.
Bones aren’t static, they have cells that make bone and cells that dissolve bone. When we are young we make more bone than we lose but around the menopause years bone loss speeds up due to decreasing levels of estrogen. Osteoporosis is a disease of the bones characterized by brittle and fragile bones. If you suffer from osteoporosis you are more likely to suffer a fracture if you fall. Even a small fall may cause a fracture in someone with osteoporosis which may not have in someone not suffering from osteoporosis. Another possible symptom of osteoporosis is loss of height and a bent-forward posture, which is caused by small fractures in the vertebrae of your spine affecting your posture.
We cannot modify some of the risk factors that cause osteoporosis, like sex, age, race, family history, and body frame size. But there are other risk factors that we can modify to decrease our risk of getting osteoporosis, like sedentary lifestyle, excessive alcohol consumption, tobacco use, and low calcium intake.
Calcium is important to maintain healthy bones. The heart, muscles, and nerves also use calcium. According to Dieticians of Canada “women between 51-70 years of age should aim for an intake of 1000 milligrams (mg)/day and stay below 2000 mg/day. This includes calcium from food and supplements”.
Good sources of calcium include
Fortified soy beverages and calcium-fortified orange juice and cereals are sources of calcium but keep in mind the calcium in these products is added, so it falls into the calcium supplement category.
Osteoporosis Canada “strongly recommends that everyone obtain their calcium through nutrition whenever possible. Even if you take excess calcium from your diet that is not harmful.… getting more calcium than you need from supplements can be harmful. Excess calcium from supplements has been associated with kidney stones, heart problems, prostate cancer, constipation and digestive problems. Do not take extra calcium from supplements if your diet is already giving you enough calcium”.
According to Osteoporosis Canada:
to know whether or not you need to take a calcium supplement, you really need to figure out how much calcium you are getting in your diet. Here is a very simple way to calculate this.
First, give yourself a baseline of 300 mg of calcium simply for eating anything at all. This is because there is a small amount of calcium in a variety of foods such as breads, muffins, oranges, etc. At the end of the day, even without eating any high calcium foods, you can’t help but get about 300 mg of calcium in your daily diet.
Now, add another 300 mg for any of the following high calcium foods:
Vitamin D helps your body absorb and use calcium and improves muscular function. Vitamin D is a hormone synthesized in our skin by sunlight. We can also get vitamin D through fortified foods and supplements. Osteoporosis Canada says that “it is impossible for adults to get sufficient vitamin D from diet alone, no matter how good their nutrition. Therefore, Osteoporosis Canada recommends routine vitamin D supplementation for all Canadian adults year round”.Adults over the age of 50 should aim for a daily intake of vitamin D between 800-2000 IU. Taking more than 2,000 IU of vitamin D daily should be done only under medical supervision. Too much vitamin D can cause kidney stones, nausea, constipation and other health problems.
Best Food Sources of vitamin D:
The Osteoporosis Canada website offers a calcium calculator that’s very easy to follow:
Three servings of any of the above will give you about 900 mg of calcium, and if you add the 300 mg of baseline calcium for eating anything at all, this will ensure the 1200 mg of calcium you need if you are over 50. Don’t forget to add in any calcium you might be getting from a multivitamin tablet .
Prevention is the best remedy, so think about your bones and eat wisely to prevent osteoporosis.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
HPV Immunization In Menopause
/in Cancer, Immunization, Menopause, Sexual Health/by Teresa IsabelHPV immunization in menopause? Yes! I am a firm believer that prevention is better than treatment. So obviously that makes me a believer in vaccination to prevent disease.
Vaccinations seem to be a hot topic in the media these days. There’s the “victimization” of the M-M-R vaccine that prevents measles, mumps and rubella and has been wrongly associated with autism, and last week there was a lot of print in Canadian newspapers about the HPV vaccine.
I will focus on the latter since HPV immunization in menopause is something that menopausal women should know more about.
Various types of HPV can lead to different infections. Some infect the skin on the hands and feet while others target the anogenital area. Throat cancer can also be caused by HPV infection.
Human Papillomavirus (HPV) is the most common sexually-transmitted infection (STI) in Canada and elsewhere. There are many types of HPV and about 13 of those can cause cervical cancer. Even more astonishing is the fact that 80% of sexually-active people may be infected but don’t even know it. That’s because symptoms may not be felt, or may take weeks, months, or even years to develop.
The most common symptom that women experience is cervical warts. Some 70-90% of infections are cleared by the immune system but some, if untreated, can cause changes in the cervical cells and lead to cancer.
In Canada the vaccine Gardasil is indicated for girls and women 9 through 45 years of age for the prevention of infection caused by HPV types 6, 11, 16, and 18, and the diseases associated with these types:
It’s easy to see why we should vaccinate young women, before they get sexually active and contract the virus, but why should women get HPV immunization in menopause as well?
According to the North American Menopause Society, “A study released early in 2013 of women 35 to 60 years old found that HPV in women at or after menopause may represent an infection acquired years ago. Think of it like chickenpox—that virus can lie dormant in the bodies of people who were infected as children, then come raging back as shingles later in life when the immune system weakens. It’s the same with HPV. The reactivation risk may increase around age 50. This is dangerous because of HPV’s link to head and neck, cervical, vulvar, vaginal, penile and anal cancer. It is the most common sexually transmitted disease in the US. Women who started having sex during and after the sexual revolution of the 1960s and 1970s have a significantly higher risk of HPV infection compared to women who did so before 1965. This is because the risk of HPV is related to the number of sexual partners women have. Baby boomer women, and all women who have had multiple partners, should not stray too far from their Pap smear or HPV test at menopause until we know more about the increased risk of HPV flare up at menopause.”
Even if you have already been infected with HPV you should still get the vaccine. That’s because, according to Health Canada, “If you are infected with one type of HPV you can still benefit from the HPV vaccine. It can protect you against other strains of the virus. Unfortunately, even if you are vaccinated, you are still at risk for some types of HPV not covered by the vaccine. It is important that women who receive the vaccine still have regular Pap tests and practice safer sex.”
Minimizing your risk of infection includes getting vaccinated, regardless of your age, and learning about and practicing safe sex methods, which includes using a condom correctly and consistently. See your doctor regularly for a Pap test, even if you have been vaccinated.
Prevention is the best remedy…..
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Bones And Menopause
/in Osteoporosis, Menopause/by Teresa IsabelWe build our bones in our younger years, up to around age 30, at which point we generally reach a plateau, but in menopause women lose a lot of bone mass due to hormonal changes. After menopause the rate of bone loss decreases.
If we didn’t make enough bone in our younger years the risk of osteoporosis is higher.
Osteoporosis is a disease of the bones that causes the bone to lose mass and become weaker and easier to fracture.
A Bone Mineral Density (BMD) test can tell you whether or not you have osteoporosis and how likely you are to develop it in the future.
Who should have a BMD test? According to Osteoporosis Canada:
In BMD test results your bones are compared with the bones of an average young adult. A score (called a T-score) is calculated that describes the density of your bones (usually at the spine and hip) and tells you how strong your bones are compared with this average. While some bone loss with aging is normal, making such comparisons helps to determine whether you are losing bone more rapidly than expected for someone your age.
According to World Health Organization (WHO) classifications, “a T-score below 2.5 SDs indicates osteoporosis and a score between 1 and 2.5 SDs indicates osteopenia or low bone density. Normal bone density is no more than 1 SD below the young adult normal value”.
Besides being assessed by the health care provider for their risk of osteoporosis, women can also determine their fracture risk. Major risk factors for fractures from osteoporosis are:
The Fracture Risk Assessment tool (FRAX) calculates a woman’s 10-year probability of hip fracture or other major osteoporotic fracture (spine, forearm, upper arm). If you are over the age of 40 you can calculate your risk of fracture by visiting FRAX website.
Select the “Calculation Tool” and your geographic location and follow the directions.
Among the factors that increase a women’s risk of osteoporosis are heredity, smoking, lack of exercise, and certain medications (steroids).
There are also several things women can do to avoid osteoporosis and resulting fractures:
If you live in Ontario, you can call EatRightOntario, toll free, for more information on diet to help prevent osteoporosis 1-877-510-5102.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Supplements For Hot Flash Management
/in Hot flashes, Menopause/by Teresa IsabelMany women experience hot flashes during the menopause transition, but supplements can help.
The best-known treatment for hot flashes is hormone therapy but some women, for health or personal reasons, prefer other options like non-hormonal therapies. These include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others.
To help healthcare providers deliver the best information and care to women suffering from hot flashes, in 2015 The North American Menopause Society (NAMS) issued a Position Statement on Non-Hormonal Management of Menopause-Associated Vasomotor Symptoms (VMS), also known as hot flashes or night sweats.
Herbal supplements are non-hormonal therapies, available over-the counter (sold without a prescription), and used widely in the treatment of hot flashes by women all over the world.
Businesses have realized the commercial potential and have come up with a vast array of products to treat menopausal symptoms.
Women should understand what products work safely and effectively, how to use them properly, and how to avoid inappropriate and unhealthy therapies. Consult a healthcare provider, knowledgeable in the treatment of hot flashes and menopause, before taking any supplements.
It is important to note that when women take medication to treat their hot flashes, 50% is placebo* effect. In my opinion that’s not necessarily a bad thing, and it may even be beneficial, as long as the treatment is safe and doesn’t cause any undesirable adverse effects or interactions with other medications.
There are few studies done by manufacturers on the efficacy and safety of herbal supplements.
Canadian regulations require that all natural health products**, including herbals, have a product license.
Herbals like black cohosh and dong quai have not shown benefits in trials, and may be unsafe for women with certain medical conditions like liver disorder or for those taking anticoagulant medications.
Supplements like evening primrose oil, flaxseed, ginseng, hops, maca, omega-3 fatty acids, pine bark, pollen extract, and siberian rhubarb, have not been proven effective for the treatment of VMS and may worsen certain conditions and/or interact with certain medications women are already taking.
Soy supplements are widely used. Soy contains isoflavones, a phytochemical that mimics estrogen in a woman’s body. According to NAMS “the relative amounts of isoflavones vary, depending on the portion of the soybean from which the material is obtained”. Therefore the therapeutic effect of soy supplements varies greatly from product to product. To complicate matters further, different women metabolize isoflavones differently depending on their genetics. Asian women seem to benefit more from isoflavones supplementation but only 30% of North American women can change isoflavones in their gut into a form that can be used by their bodies and be beneficial. With this in mind, a new supplement S-equol, has been developed but NAMS says: “additional research is needed to determine whether the supplement may be effective for these women”.
Remember, just because it’s natural doesn’t mean it is safe…
*placebo
** According to Health Canada: “To be licensed in Canada, natural health products must be safe, effective, of high quality and carry detailed label information to let people make safe and informed choices. You can identify products that have been licensed for sale in Canada by looking for the eight-digit Natural Product Number (NPN) or Homeopathic Medicine Number (DIN-HM) on the label. A NPN or DIN-HM means that the product has been authorized for sale in Canada and is safe and effective when used according the instructions on the label.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Menopause Is Not A Joke!
/in Uncategorized/by Teresa IsabelLet’s talk about menopause…and why not? Menopause is too often, if not always, treated as a taboo or a joke. For any of you reading this blog and who’ve experienced interrupted sleep due to hot flashes or night sweats, it is anything but!
Here are a few things you should know about menopause:
For starters, October is World Menopause Month and October 18 is World Menopause Day. Yes, menopause is that important and it should be talked about. After all, thousands of women experience menopause; a completely normal and natural occurrence.
But what is menopause? It is in fact a retrospective diagnosis 12 months after a women’s last menstrual period. Menopause is a natural, spontaneous, and permanent cessation of menstruation that occurs on average in most North American women around 51 years of age. However, smokers may reach menopause two years earlier, and induced menopause can occur at any age when both ovaries are damaged due to surgery or chemotherapy.
The timespan (usually several years) leading up to menopause when hormonal changes start to happen is called perimenopause. The day after menopause and thereafter, a woman is in post-menopause. Hormone tests are usually not very helpful because the levels of hormone fluctuate throughout a menstrual cycle.
Women may start experiencing symptoms such as irregular periods, hot flashes, sleep disturbances, mood swings, and memory changes during perimenopause due to changes in ovarian hormones. The most commonly reported symptoms are hot flashes, also known as night sweats (when they occur during sleep). According to the Society of Obstetricians and Gynecologists of Canada (SOGC), hot flashes or night sweats affect 60-80 per cent of women entering menopause. Besides an intense heat that seems to rise from the belly up, hot flashes can be accompanied by sweating, palpitations, apprehension, and anxiety.
Menopausal women report mood swings, lack of energy, impaired memory, depression, and anxiety. According to the North American Menopause Society (NAMS), “43 per cent of midlife women complain to have loss of energy throughout the menopause transition and two years post-menopause.”
During midlife, besides hormonal changes, some women also experience other challenges such as relationship difficulties, grown children returning home, ill parents, loss of partner, medical conditions, and career and financial changes. Aging alone can be a factor of change and difficult to face in a society that values youth. Women’s self-esteem, self-worth, and body image change and may also contribute to feelings of anxiety, “feeling blue”, and even depression.
It is important to be aware of what to expect during this time of change and to report any physical changes to your healthcare provider, pharmacist or physician, because they may be caused by other conditions such as thyroid disorder, depression, or even the side-effects of certain medication.
The myth that menopause is something women “must put up with” is just that- a myth.
Not all women experience the same symptoms to the same degree. Some women breeze right through menopause, while for others menopause symptoms wreak havoc on their lives. Unfortunately, many women find lifestyle modifications (avoiding hot flash triggers, exercising, dressing in layers, etc.) insufficient.
Pharmacists can provide information on available treatments for your symptoms. Besides prescription medication- hormonal and non-hormonal, there are some complementary and alternative treatments available at the pharmacy which may help reduce symptoms. Although Natural Health Products (NHPs) may not be as rigorously studied compared to prescription treatment, some women prefer this as an option. I can provide information on their use and potential side-effects and interactions with other medication and medical conditions.
Talk to me about menopause, learn about your symptoms, and get informed on what to expect from midlife. Break the taboo and take this opportunity to implement or continue a healthy lifestyle, during peri, menopause, and beyond.
Ask me, I’m not joking!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.