Complications:

After a woman reaches menopause, her average life expectancy is 30 - 40 years. During those years, however, her risks for serious disorders are estimated at 46% for heart disease, 20% for stroke, and 15% for hip fracture. In addition, about 8% of people over 75 have dementia, with postmenopausal women having 1.4 - 3 times the risk for Alzheimer's disease compared to men.

Menopause and Heart Health

Heart disease is the number one killer of women. Although young women have a much lower risk for cardiovascular disease than young men, after menopause women catch up. After age 51, women’s risk of dying from heart disease is very close to that of men. Estrogen loss is believed to play a major role in this increased risk. Woman who reach menopause before the age of 35 have a significant increase in risk for heart disease as they age. This increase is primarily due to a rise in levels of the harmful low-density lipoprotein (LDL) cholesterol. [For more information, see In-Depth Report #3: Coronary artery disease.]

Women who take hormone replacement therapy are at risk for thromboembolism -- blood clots that block a vessel. This action may explain the higher rates of adverse heart events now observed in women with heart disease who take HRT.

Menopause and Bone Density

Osteoporosis is a disease of the skeleton in which bones become brittle and prone to fracture. In other words, the bone loses density. At age 65, about 30% of women have osteoporosis, and nearly all of them are unaware of their condition. After age 80, up to 70% of women develop osteoporosis. Osteoporosis is a major risk factor for fracture in the spine and hip. The lifetime risk of spinal fracture in women is about 1 in 3 and that for hip fracture is 1 in 6. Furthermore, 10 - 20% of women who break their hip die within a year, and about 25% need nursing home treatment.

Experts are still puzzled by the extreme speed-up of bone breakdown (resorption) after menopause. Estrogen may have an impact on bone density in various ways:

• Estrogen's most important effect on osteoporosis appears to be prevention of bone break down (resorption). Some research suggests that estrogen may control the lifespan of osteoclasts, the cells responsible for bone breakdown.
• Part of estrogen's beneficial actions may involve maintaining normal levels of vitamin D, an important nutrient in bone protection.

Risk factors for osteoporosis include:

• Being tall and thin
• Being Caucasian
• Smoking
• Taking thyroid hormone
• Being sedentary
• Early menopause or surgical menopause (removal of ovaries)

Women at risk for osteoporosis should have a bone density test to measure their bone mass and then make a decision about treatment after consulting their doctor. [For more information, see In-Depth Report #18: Osteoporosis.]

Menopause and Depression

Depression may occur as a woman transitions into menopause (perimenopause), even among women with no history of clinical depression. Hormonal changes and declines in estrogen levels are probably involved in this process. Research suggests that a depressive disorder is 2.5 times more likely to develop during perimenopause than premenopause. Women who reach menopause at a younger age are at increased risk of a first episode of depression.

Symptoms of clinical depression include:

• Loss of interest or pleasure in activities once enjoyed
• Persistent (longer than 2 weeks) sad mood
• Decreased energy
• Sleep problems (insomnia or oversleeping)
• Feelings of guilt, worthlessness, and hopelessness
• Difficulty concentrating

Some of these symptoms may overlap with other symptoms that typically accompany perimenopause. Women who have these symptoms should talk to their doctor. Depression is treatable. [For more information, see In-Depth Report #8: Depression.] For many women, depression eases once they reach menopause.

Estrogen Loss and Mental Decline

Estrogen, the primary female hormone, appears to have properties that protect against the memory loss and lower mental functioning associated with normal aging. About 40% of women who are either perimenopausal or menopausal complain of forgetfulness.

Gum Disorders and Tooth Loss

Estrogen therapy has been associated with reduced gum bleeding and with decreased bone loss around the teeth, and women who take estrogen are less likely to lose their teeth. Thus, the same principle that helps prevent bone loss in osteoporosis is also at work in preventing bone loss in the mouth.

Eye Disorders

Estrogen, progesterone, or both appear to protect against cataracts.

Studies also indicate that estrogen helps prevent glaucoma and macular degeneration.

Urinary Incontinence

The drop in body estrogen levels brought on by menopause may contribute to both urinary stress and urge incontinence.

Urinary Tract Infections

Women are at increased risk for recurrent urinary tract infections after menopause. Research suggests that estrogen may prevent infection by increasing the number of lactobacilli, a microorganism that fights infection by preventing bacteria from adhering to vaginal cells.

Wrinkles

Estrogen may help prevent slackness and dryness in the skin and reduce wrinkles.

Sleep Disorders

Menopause is associated with more sleeping problems, including inability to fall asleep and nighttime wakefulness.