To Supplement or Not to Supplement

Do you take calcium and vitamin D supplements? If you’re a woman over 60, chances are you do. More than half of women in this age range take these dietary supplements, and for good reason. Fully 80% of the 10 million people in the US with osteoporosis—a debilitating disease marked by porous, fragile bones—are women. Another 37%–50% of women over 50 have osteopenia (low bone mass). Both conditions put sufferers at risk for bone fractures, which can take longer to heal as you age and can cause major mobility problems, and sometimes death.

So when the US Preventive Services Task Force (USPSTF) recently recommended that postmenopausal women should stop taking calcium and vitamin D supplements, it caused some confusion. The USPSTF concluded that the small risk of kidney stones associated with taking calcium and vitamin D outweighs the protection against bone fractures that most postmenopausal women receive from the supplements.

ACOG and the Institute of Medicine recommend that women over 50 get 1200 mg/day of calcium and 600 IU/day of vitamin D (800 IU/day in women 71 and older). The National Osteoporosis Foundation has similar recommendations.

While the debate continues, there are a few facts we can all agree on:

  • Calcium is a nutrient that’s vital to bone health and vitamin D helps the body to use it efficiently
  • It’s important that women get enough of these bone-protecting nutrients
  • Supplements can help you reach optimal levels, but they don’t replace the need for eating a variety of foods with calcium and vitamin D

The average American only gets 500 to 750 mgs of calcium each day, far short of the recommended daily intake. You can increase your daily levels by eating calcium-rich foods such as lowfat dairy (yogurt, cheese, milk), dark leafy greens (kale, collards, spinach), and canned fish with soft bones (salmon and sardines). You can get more vitamin D by eating fortified foods such as milk or cereal, or aiming for 15 minutes of sun exposure on your hands and face or arms a few days each week. Weight-bearing exercise, such as walking, tennis, dancing, yoga, or tai chi, can help strengthen bones, too.

For some women, certain types of hormone therapy and other medications containing bisphosphonates, estrogen, and calcitonin can also help prevent fractures. Talk to your doctor. He or she can determine whether you’re getting enough calcium and vitamin D, suggest a supplement to make up for what you’re missing in diet alone, or help choose a medication that may work for you.

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Keeping It Sexy during Menopause

While hot flashes typically top a woman’s list of menopausal concerns, they are not the only disruptive symptom of menopause. For some women, menopause also brings unpleasant and unexpected sexual changes—such as a decreased sex drive or pain during sex.

It is not uncommon for women to occasionally encounter problems with sex throughout their lifetime. Studies suggest that 35%–45% of women believe they have sexual problems that make sex difficult. While sexual function can be affected by many things, hormone fluctuations are often the culprit. During menopause, loss of estrogen leads to increased vaginal dryness, thinning of vaginal tissue, decreased interest in sex, and more difficulty reaching orgasm. These complications can make sex painful or cause women to avoid intimacy. But here’s the good news: menopause is no sentence for a sexless life.

If you are experiencing sexual troubles, talk to your doctor. He or she can assess what may be causing the problem and suggest changes for you and your partner, such as trying a water-soluble lubricant to combat vaginal dryness. Hormone therapy may also be a good solution for some women.

A healthy sex life can have a positive impact on a woman’s quality of life. Don’t ignore problems in the bedroom. Speak up and get your groove back.

A Guide to Midlife Health

“Keeping women healthy for a lifetime.” This may sound like a marketing tagline for ob-gyns, but it’s really more like a job description. It’s what we try to do in our practices day in and day out. We see our patients through transitions big and small—among these, adolescence, pregnancy, and menopause.

The changes that occur during the time surrounding menopause rival those experienced during puberty. Raging hormones, physical changes, bone concerns, and a menstrual cycle that is more like a rollercoaster in some cases, can seemingly turn the world upside down. It’s enough to throw a normally pulled together and in-control woman into a tailspin.

As a doctor, I try to provide my patients with helpful resources that they can use to educate themselves and complement the conversations we have during our routine health visits. One fantastic resource is pause magazine. The publication, along with its website—menopause.acog.org—is dedicated to maintaining and improving health leading up to, during, and following menopause.

The newly released spring/summer issue covers a range of health concerns most important to women in midlife, from advice on dealing with hot flashes, maintaining bone health, and keeping the brain sharp to tips on losing weight, saving money on health care, finding the right bra, and keeping the love alive in your marriage.

If you’re approaching menopause or know someone who is, this is a resource too valuable to miss. I invite you to take a look.

Heart Month Pop Quiz: Which is Better, HDL or LDL?

Quick—which type of cholesterol do you want more of, HDL or LDL?

Answer: HDL, or the “Happy” or “Healthy” type.

A lot of people can’t remember which type of cholesterol is the “good” one and which is the “bad” one, but it’s an important distinction. High cholesterol is one of the main culprits in heart disease, the leading killer of women in the US.

LDL (low-density lipoprotein) is the “bad” cholesterol that causes buildup and blockages in the arteries, which leads to heart attacks and strokes. The healthiest LDL level is less than 130 mg/dL.

HDL (high-density lipoprotein) is the “good” cholesterol that helps keep the “bad” LDL cholesterol from sticking to your arteries. You want a high HDL number (60 mg/dL or higher) to help lower your heart disease risk. Your ideal goal is a total cholesterol level (HDL+LDL combined) of less than 200 mg/dL.

As women move past menopause, their overall cholesterol level tends to rise. Estrogen levels prior to menopause raise HDL cholesterol; this benefit is lost after menopause. But there are things you can do to raise your HDL level and lower your bad LDL cholesterol: Lose weight, reduce foods with saturated fats in your diet, stop smoking, and exercise regularly. Medication may also be needed to lower your cholesterol levels.

Know your cholesterol levels and get tested every five years. Do it for your heart.

Increased Health Risks for DES-exposed Women

Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.

Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.

Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).

Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.