[Music Plays] When they turn 40, Most American women stand at th halfway point in their lives.

On average they can look forward to living another 40 years.

Today, millions of wome who are part of the postwar baby boo are moving through their 40s.

They are headed for chang as their bodies begin the gradual transitio to menopause.

There are so many 40 something women that doctor offices are filled with women seeking answers help and understanding what's happenin to their bodies.

This is a program for the and for all the people who are getting read for menopause.

[Music Plays] Funding fo this program is provided by the Jewish HealthCar Foundation, a Pittsburgh based grant make reaching out to meet the needs of the region's women, children the aged and persons with chronic conditions and by Magee-Women's Hospital.

Because every woman is unique every woman deserves a hospital uniquely her own.

Magee-Women' Hospital, specializing in women care for over 80 year and by a grant from the Corporatio for Public Broadcasting.

Hello, I'm Elain Effort, and I'll be your host as we seek informatio for the millions of 40 something women who stand o the threshold to menopause.

It's a time physician call the perimenopause.

Now, if that term is new to you, you can think of the perimenopaus as the beginning of menopause, a transition period betwee the first signs of menopause and when your perio stop altogether.

Because knowledge is power we will bring you as much up to date information as possible.

We'll talk with doctor who will explain what's going on inside a woman's body.

We'll learn about health issues that become importan at the time of menopause, and we'll meet wome who will share their thoughts and feelings about the change they're experiencing.

And we'll find out what we ca be doing now to give ourselves the best chanc of being healthy and vital for the rest of our lives.

So let's start at the beginning.

[Crying This baby has all the eggs in her ovarie that you'll ever have.

About half a million.

Her body will never mak any more.

In about a dozen year at puberty, her ovaries will begi releasing one age each month.

Scientist think that about a thousand acres are used u each month, though usually only one egg ripen or matures.

By the time she's in her 40s, most of the egg will be used up.

At that time, regula menstrual cycles will stop.

It's important to understan that these changes are gradual.

They don't occur all at once.

And if you think abou all the changes at puberty, you'll remembe they didn't occur overnight.

Well, it' the same way with perimenopause.

The changes are very gradual.

At first you might not even b conscious of these changes.

Very often, the very first sig a woman has is a change in her menstrual cycle.

She might notice a shorte or longer time between periods.

She might skip a period.

Or, like for many women she might experience heavy menstrual bleeding.

Somethin very new and frightening.

We'll find that perimenopause takes on a differen meaning for each of three women who will share their experiences with their physician and with us.

51 year old Judith Frazier is a patien of Doctor Morris Turner.

Primarily, I have been no four months without a period, and in the past several week I've begun to have women.

Pretty sure hot flashes, ho flashes.

Can can you describe these?

These incidents?

Are ther just being being overcome by an enormous sensation of hea coming not from without, as usual in the environment but it's a furnace within.

You're burning from the insid out, right To the hair roots.

It's I've been very a very cold person all my life.

Always looking to up the thermostat, get a sweater another jacket, whatever.

Not doing it all in reverse.

Is this somethin that happens all the time, or does it go and come?

It's, It's fairly frequent.

It's daily.

At least 6 or 8 time a day wakes me at night.

How long does it last?

Several minutes.

Several minutes.

Each one.

And while it's there.

Tell me the symptoms again.

What does it feel like?

It's just an enormous sensatio of heat all over the body.

It seems primarily, I'm more aware of upper bod heat than I am the rest.

But I know that I'm war all over, sweating.

Just have to get air.

Just feeling that I had to roll u my sleeves, my pants, whatever.

And get to to some sorts of air.

Okay.

Open windows turned on thermostats where others in your compan doing the same thing?

No, no, certainly the only one.

Did you ask others if they felt.

Probably That was my first question.

Is anybody else in her to warm as they sat huddled up?

Yeah, there's sweater all covered.

Does aggravation or do pressure circumstance bring on these changes?

I'm not sure.

For instance if you if you're at work and and things are not quite going right or as you expect, does that ten to bring bring them on.

Not that as much as just movin at a real fast pace.

Really movin along to get things done.

And so as long as you'r relaxed, it does not happe or it just does not happen.

No, I can get the one.

I'm relaxed probably a little less.

Okay.

All right.

You'v never experienced this before?

No, this is my first time.

Linda Sanderson is a patien of Doctor Sarah Berger.

I'm only 44 years old and I'm getting a little bit worried about menopause.

I'm a little couple of thing that are happening to me that I. I don't kno if they should be happening.

It seems like I'm awful young.

And I just wonde could these things be menopause or is that like long wa down the road or is am I sick from something else.

Okay.

Give m a little bit more of a hint.

Okay.

Well, for one thing, sometimes I wake up at nigh and I'm all sweaty.

And it's not always.

But every no and then that happens.

And, I thought do I have a fever?

I take my daughter I have a fever.

I wonder what's happening.

Is, is thi what hot flashes are.

Sounds like they may be.

Do you get a chil sometimes afterwards.

Sometimes I do yeah!

And sometimes I have to change my nightgow because Im really sweaty.

Right and, bu this isn't all the time.

No, no just now and then.

How about your menstrua periods?

How are they?

Well they used to be every 28 days.

And now I'd say it's 25, 26.

It's a little bit unpredictable.

It was a little nice when I knew pretty much exactly when I was going to have my period but I can't always depend on that anymore Okay.

Are there any heavie or lighter?

Really?

No, no they're not heavy or lighter.

And I hear a lot of time women do get very heavy periods but really haven't had that yet Okay.

Any other things?

Any other changes in you your menstrual period?

Anything that you've notice differently?

No, no.

That's why I thought, well maybe this isn't menopause.

Okay.

Because I hear you get, like big changes.

And I just wonder.

Well, maybe menopaus takes a long time.

I mean, does it just.

I hear some women say they just stopped one day and that was it.

And it doesn't look like that's what's going to happe with me if this is menopause.

40 year old Leigh Ann Paris talks with gynecologis Marianne Hugo.

A regular perio that now would be the first day.

Probably jus a little bit of spotting, but are probably the next three days are extremely heavy in that I may have to be near a restroom and have to change a pa every 15 minutes.

It can get very heavy.

How long does that usually g on during your cycles?

Just usually just 2 or 3 days.

One day in particular where it's that heavy, and then maybe the next two day will be, you know, you may change pads frequently but not every 15 minutes.

And does this interfer with your activities, your, getting out or.

Well, when it' when it's gushing like that.

Yes it tends ends to be very disturbing.

And you almost feel as thoug you need to stay home.

Do you have any other symptom during this heavy flow or heavy?

Well, cramping back aches and cramping.

Sometimes very heavy cramping.

Almost like all stages of labor.

It can get that bad.

And usually a very nast headache the first day or two.

And are you passing any clot at all?

Yes!

Sometimes.

I don't know, inch to tw inch around size clots.

Yes, And that's disturbing to because you're not sure what.

What is all of thi coming out of me?

It makes me worry.

From just these three women it's clear that the experienc of perimenopause is highly variable, but the different symptom are all related to what Marianne Hugo call a relative imbalance in hormone levels throughout your lif your estrogen and progesterone.

The two female hormones are kept somewhat in balanc by the events in the ovary.

The ovary is is sending ou the correct amounts of these two hormones that give yo a nice regular menstrual cycle.

In the 40s because of the age of the eggs of the ovaries and the, the depletion of the eggs were running out of eggs actually, in our 40s.

The the ovary doesn' do such a good job of regulating the hormone and the the estrogen and the progesteron get out of balance.

What tends to happe in the perimenopausal years is there's too much estroge and not enough progesterone.

Whereas after the menopause the symptoms after the menopause are usually du to too little estrogen.

Okay.

And let me show yo the menstrual cycle here.

And so maybe we can sometime it helps to see a picture.

These this is the ovar and this is the uterus.

And these ar the events in the ovary.

These are the event in the uterus.

And so in a normal cycl what is happening is one egg in the ovary is selecte to mature each month.

And as that egg matures it get larger and larger and larger.

Now the egg is in sack of fluid that's very rich in estrogen okay.

And as more and more estroge is produced and secreted, the lining of the uterus, this is what's happenin at the same time in the uterus.

The lining of the uteru responds to that and gets thicke and thicker and thicker on or about day 1 and our regular 28 day cycle, the sack of fluid containe the egg breaks open, the egg is released and that event is over.

Now, with ovulation, a new hormone has started to be secrete called progesterone.

And the sac.

This old sac that containe the egg and the estrogen reforms and takes on a differen look called a corpus luteum.

And that new sac now produce the second female hormone, which is progesterone.

Now progesteron does something to the uterine lining in that it stops th the increasing growth.

It kind of puts a lid on things puts a cap on things, and it sort of holds it stead and keeps it mature in case, fertilizatio or pregnancy occurs.

And after 12 or 14 days o no pregnancy, then the corpus luteu goes away, the progesterone levels dro and a woman has a period.

Now, what happens in the 40 because these eggs are getting old.

They're not respondin the way they should.

We, we star to see an egg begin to develop, and it gets to about here when it should ovulat and it just is not working right So obviously does not occur.

So what happens is, is this there' still plenty of estrogen.

The lining of the uterus get thicker and thicker and thicker and thicker and thicker.

And there's no progesterone no to put a cap on things.

And so it gets built u way up here and maybe on day 28 and maybe on day 58 it gets so thick.

That comes down as a heav flooding period full of clots.

ET cetera.

And so that's wh we get these short cycles, long cycles, floodin periods, light periods.

It's as though, the body is just, it's jus lost its natural rhythmic to help restore that natural rhythmi hormone pattern.

More and more doctors have been prescribing low dos birth control pills, and a woman can continue on the pill all the way through menopause.

Heavy bleeding and dramati hot flashes give clear evidence that the female hormone are out of balance, but the signs of perimenopaus in its timetable are not always that clear, leaving women wit lots of unanswered questions.

And do you think this i menopause and and how long is thi going to take?

And we'll get worse.

It sounds as if you've still go some hormones being made, and it isn't very clear what' going on for certain right now.

What do you think, then that since I'm starting to have these hot flashes that means I might be getting a little lo in estrogen that I might.

Well, you might.

And the the thing to do is t keep track of what's going on.

Typically the hormone level fall right at the end of the cycle, righ as the menstrual period is beginning.

So typicall people may get hot flashes then.

And if they occur in one mont and then go away the next month that might be a sign that one month the is workin well, in one month it's not.

But not everybody gets ho flashes.

And s and they can be very subtle.

Not everyone will clinically be able to say oh yeah, that was definitely a hot flush.

So you can only use hot flashes.

So much to tell what's going on.

Other symptoms that peopl sometimes complain about is a chang in their vaginal lubrication, the complaint of itchiness or vaginal drynes or pain within a course.

Have you any problems like that Yeah, I had that.

Okay.

Do I get to look forwar to that?

Well, it doesn't have to happen.

The symptoms of menopaus are highly variable, and you can never predic who's going to get which symptoms win.

But the tissues in the bod all respond to hormone in both good and bad ways.

And yes, we worry that as the hormone levels change, tha your body is going to complain.

And one of the complaint might mean that you get hot flashe or vaginal dryness.

And we worry about thinnin of the of the bones.

And basically when you get right down to it almost every tissue in the body is dependent on hormone to some degree or another.

Classicall we think about the heart and the cardiovascular tre and the bones, but also the brain notice the changing hormone levels and that is what cause hot flashes.

So it sounds like yours.

When you get the some pretty profound.

Yeah, they sort of are.

And sounds like they'r premature, too.

If I'm only 44.

Well, 44.

Isn't that early?

We think something is premature in terms of menopaus if it occurs below age 40, but between 40 and 50 you may get signs of menopause.

And if you have complete menopause in that age range, we still consider i in the normal range.

So, as I said, half of wome will reach menopause by age 50 and 4 is not that far away from that.

Does it take that long?

I coul I be starting now and you could.

Well, basicall it's not an on off switch.

So you could have some change now and they could stay that way for the next six year or two months from now.

You could have complet cessation of your periods, since your period are pretty regular right now.

And they're hot flashes sound very intermittent.

I'm not sure that we really nee to do any testing, but if anything changes I think should let me know and be happy to see you back.

I can probably have mor hot flashes or my periods would star to be absolutely more frequent.

Right.

And sometimes peopl will have periods and hot flashes at the same time.

And so you don't have to wait till you miss your perio and have hot flashes or have hot flashes, and havin periods is still okay to call.

And we'd like to see you bac because again, I don't have a crystal bal and I can't tell you if this is going to be somethin that occurs tomorrow or in six years.

And I don't want yo to feel like, that these symptom aren't important or real.

They aren' always very easy to read.

I hope talking to these doctors has helpe you understand what's going o in a woman's body in the years leading up to menopause but a lot of women want more.

They want the reassuranc and support that they get from talkin to other women.

In many communities, hospital and health care facilities sponso menopause support groups, making the step you want to take to help yourself in this wonderfu second half of life.

The unique experience and thir skills that.. Doctor Jane Ben Stock is the facilitato for the support group that meets at Magee-Women' Hospital.

So we're a self-hel group, right?

Okay.

Look at what they cal the symptom checklist.

Can we start those aroun the symptom checklist?

Let's take a loo at those for a minute.

See if those begi to look familiar.

And these are what our what us ladies talk about abou what we call these symptoms, these body changes, these thing we feel ladies we can feel these for 30 years, 80 years, three years or never.

15 to 20% of women float through this stopping of the eg manufacture and release.

And they feel nothing.

And they said I don't know what happened.

I don't kno what you're talking about, but the rest of people sa irritability, less fatigue, depression, headaches hot flashes is the number one.

If somebody wanted to know am I starting?

It might be hot flashe when you're 40 or 35.

What about other here, Forgetfulness.

Weight gain.

Gene I think something also that's not on this lis that I found is really anxiety.

Waking up in the middle o the night with anxiety attacks.

And that was probabl the first sign that something was changing in me.

And that's something peopl really haven't talked about.

But found that very, very strong.

And the when that happened to you, how di what did you do about it?

I got up, I walked around, told mysel that's what was happening.

I was having an anxiety attac and just sort of tried to pass through it.

And that's exactl what happened.

I didn't really.

It's like you're sayin to yourself, I'm having an anxiety attac here.

This is not real, because they were really ver imagined kind of things and really tried to walk literally walk out of it.

I wanted to say again could we keep in mind tonight menopause and aging because it's easy to slip into saying everythin happening to me is hormones.

You look at your age you look at these unusual moods that might be happening, bu they're not always menopause.

And I feel okay with that that they can be something else.

Like the aging, like aging, like something like hey, sometimes older women don't think they have to kind o be a nice girl anymore.

You can kind of show it.

We were talking about tha the other day.

Is that is that hormon or is that something about I've lived long enoug to know that you can't always be a nice girl that I'm still lovable, even though I kind of.

Well, you know I think that has to do with developing a securit in the sense of oneself.

I've been very activ all my life.

I've been like an athlet all my life, and I just never dreame that my body would ever change.

I was going to sprint and jum hurdles the rest of my life.

Being tol that I was perimenopausal suddenly made me think about the first half of my life and and assessing i and having some morning, going throug some real morning and losses.

I mean, it's the los of some of one's self-image.

And there' going to be a change.

I was not going to be the person that was going to go ou and have any plastic surgery or anything like that.

And now that I have to admi that I am at this space, I'm not so sure about i anymore.

And I'm not so sur I like the weight gain, and I'm not so sur I like how puffy my eyes look in the mornin when I wake up, and how my skin is getting drie and things like that.

It's it's it's a little more difficult to cop with when it was a theory than now it's a reality.

I helped educators like Jean are working hard to give wome the kind of information they need to make informe choices during their menopause.

Information about menopause ha been exploding in recent years as the baby boomers approac the change of life to help provid real information, researcher at the University of Pittsburgh launched a landmark stud on menopause ten years ago.

It's called the Healthy Wome Study.

More than 500 women were randomly chosen for this experiment from the list of license drivers in Allegheny County.

That random selection is important becaus what previously passed is hard.

Data on women and menopause was written by doctor who were treating women with the most severe symptoms.

Let's face it, women who had no problem didn't seek medical treatment.

The Healthy Women Stud will provide real information, hard facts on what it's lik for most women during menopause.

The study followed women from their early 40 all the way through menopause.

Principal investigator are epidemiologist Louis color, psychologist Karen Matthews an epidemiologist Elaine Millan.

Doctor Millan is focusin on the physiological changes that take plac during this period.

Well, we have so much to lear about menopause and heart disease in wome that we proposed in the study and have done a wid array of measurements, and that includes bringing wome into a clinical setting, which is dedicate to this study, I guess, on my appointment.

Your name, please, Pierre.

Healthy women like Pierre Cos have been coming to the clinic several times a yea for the last decade.

Okay.

And I just need to ask yo a few questions.

Are you currently taking an prescribed medications for.

In addition to physical test and measures the study participant complete questionnaires about psychologica and lifestyle issues.

When we asked the wome what they thought menopause was going to be like we asked it in two parts.

We said, what do you think it's goin to be like for other women your ag going through menopause?

And what do you think it's goin to be like for you?

And we asked it in terms of no only health related questions, but issue about psychological well-being.

And in fact, women in the main said, boy, I think it's bee pretty tough on other women.

I think it's a tough experience.

But for me I think I'm going to be okay.

And they were all righ about themselves.

They were mostly wrong abou everybody else.

Almost all of the health women in the study are now through the menopause.

About 80% of the women, when they were stil premenopausal and entered our study, thought women would ge depressed during the menopause.

And, you know I would say 5 or 10% actually did get a littl depressed during the menopause, but at 5 or 10 actually felt much better.

So they balanced each other out.

About 75% of the wome thought they'd experienced hot flashe during the middle class.

And in fact, that turned ou to be pretty accurate.

About 70% of the wome thought that women became irritabl or anxious during the menopause.

And in fact, that didn't happen.

Okay, what I'd like to do firs is get your blood pressure.

And for your blood pressure we'd like you to sit with your feet flat on the floo and your legs and crossed.

You could just put your righ arm up here on the table for me.

The medical data collected ove the last ten years has reveale some startling facts.

Heart disease is absolutel the biggest killer of women after menopause, even amon women who don't gain weight.

There i a minority of women who does not do not gain weight durin the time of the menopause.

Even among those women they're experiencing an increase in their blood levels of what we call lo density or LDL cholesterol.

And it's the ba kind of cholesterol.

Regular blood testing has reveale that for the menopausal woman, a dramatic health risk lie ahead.

The fact that your bloo cholesterol goes up doesn't mean that tomorro you're at higher risk.

This all takes time to develo because it relates to the atherosclerosi in our vessels.

So we're not talking about a immediate increase jump in risk, but we are talking about changes in factors that will dow the road lead to increased risk.

All right Pierre, I need yo to get up on the scale.

Put your feet together, arm at your side.

The study indicates tha for mental Paul's of women, gaining weight affect more than your waistline.

The weight gain is 2 or 3 pound a year on average.

But there is 10% of our population ha gained about 20 pounds or more.

And that' a lot of weight to gain because your bloo sugar goes up.

You have a greater propensity for diabetes which is very dangerous for wome in terms of heart disease.

Weight gain lead to higher blood pressure.

We know thos those things about weight gain.

We shouldn't gain that muc weight around this time.

It can lead to advers consequences.

Okay.

So this would be thre ounces of chicken.

And what we would want to kno is if that three ounces was cooked or raw, was it with or without the skin with or without the bone.

Was it the breas or the dark meat?

And then how did you prepare it?

Did you batter a food log enable the researchers to study women's eating patterns.

So one of the things that you probably know that we'r very actively involved in is the effectivenes of dietary change in both breast cancer, ovarian cancer colon cancer and heart disease.

And that may be the next importan major breakthrough is to show that some of these dietar changes will actually reduce or prevent these disease rather substantially.

The evidence shows that wome who smoke face additional health risk during menopause.

First of all, women who smok have their menopause earlier.

We're not quite sur why that is, but it apparently affects estrogen production.

So you women who smok have their menopause about 1 to 2 years younge than women who don't smoke.

Let's start with that.

We have observe in our longitudinal study that women who quit smoking really they gain they tend to gain weight, whic is theoretically a problem.

But in spite of that weigh gain, on average, those women who manage to qui smoking show an improvement in their bloo cholesterol levels in the face of the weigh gain in the face of menopause, as as compared with wome who continue to smoke, wome need to be absolutely aware that for them, smoking cause heart disease.

It it exasperated osteoporosis.

It has all the bad effect on all the diseases that we're talking about post-menopausal and the wome who are just entering their menopausal years now, who are in their late 40 and early 50s, are the first group of wome who have come up over the years who smoke like men So I think we're going to see, potentiall enormous public health impact of thi in terms of chronic disease.

And I think part of wha we've learned is, in fact, there are very importan biological changes that do occur that set the stage for later disease, and that there's lots of thing that women can do during the menopausal transitio to prevent those changes.

The dangerous declin in the strength of bones after menopause is another aspec of the healthy Women study.

Normally, the curve would firs occur up here.

Osteoporosis is one of th special concerns of Doctor Michelle Roberts.

Vivien Enfield who's 53, experienced menopause 14 years ag at the age of 39.

Recent magazine article have alerted her to the fact that early menopaus puts her at increased risk for osteoporosis, osteoporosis, or brittle bone disease, is a more commo disease than most women realize.

Half of all women ove the age of 50 will have some type of fractur due to osteoporosis.

That's one out of tw and three fourths of all women between 65 and 7 have the disease.

When women go through menopause, they lose the protective effec of estrogen on bone.

Now normally bone is continuall turning over.

The bone is not just a stati tissue that just sits there.

Bone is continuall being reabsorbed and formed.

In fact, the cycle occur in a very orderly pattern.

Normally, bone is reserve by certain cells known as osteoclasts, and these osteoclasts come along and dig little pit in the surface of the bone, and those pits ar then filled in by other cells known as osteoblasts, the bon forming cells.

Now, before menopause, bon formation keeps up with this process, and bone mass remain essentially stable.

But when wome go through menopause and lose the protectiv effect of estrogen, they begin to dig deeper cavities than they might otherwise do and they don't fill them in all the way.

So as a result, bon mass is lost at a muc greater rate after menopause than before menopause and bone mass can actually declin quite dramatically.

Now, not all wome lose bone at the same rate, but we estimat that women can lose between 1 and 3% of their bon mass each year in the ten year period following menopause, so that the rang can be anywhere from 10 to 30% of total bon mass being lost in the ten year period following menopause.

So this can be quit significant.

Now, the impact of this depend in large part upon where the woman i starting from.

Did she have a high peak bon mass to start with, in which case losing a certain percentag may not place her at high risk?

Or did she start with a lowe peak bone density, and losing this amount of bon will place her at high risk.

It's the bones of the spine called the vertebral bodies, that are the most vulnerabl to the effects of osteoporosis.

These are the vertebral bodie here, normally nice square structure here that support the spine.

Now, when these vertebral bodies are affected by osteoporosis they can become extremely weak.

Now inside these is a nic latticework of bone that provide stability.

Now when that support syste thins it becomes much more fragil so that with any kind of minimal trauma these were tibia bodies can collapse.

And I tell my patients it' like squeezing a marshmallow just completely flattens.

But unfortunately once that happens, they don't ever regai their shape.

Doctor Roberts explains tha this is what a vertebral body looks like in cross-section.

This photo shows the outline of the bon with the bone marrow removed.

The thin lattice like structures provide internal support.

They're called to Beckley.

There are horizonta and vertical trabecular, and many of the horizonta supports are gone and the vertical one are starting to break, especially at the edges.

This is what Doctor Roberts calls a moderate degre of osteoporosis.

Now, if we were to take out th whole spine and look at it, this might be what we would see.

You can see here.

This is a cross-section of a spinal colum with severe osteoporosis.

Now these dark area are the bone and the only ones that loo normal are the ones up here.

All the rest of thes are completely collapsed.

And the white space are the disks.

And with the collaps of the bones, the disks have herniated it up into the space formerly occupied by bone.

But these were tw bodies are completely collapsed.

The bone is compressed.

And if you'll notice this is the anterior portion.

Or if the patient was standing sideways her nose would be pointing.

This way the anterior portion are more collapsed than the posterior portions, and that's what leads to tha progressive forward flexion, otherwis known as the dowager's hump.

So this is osteoporosis at its most sever with complete collapse of vertebral bodies.

To help determine Mrs.

Enfield's risk of developin severe osteoporosis, Doctor Roberts has ordere a test called a Dexa.

It's a kind of X-ra study of the spine and hip that measure the density of the bone.

The test is relatively eas to do.

It's not even necessar to undress, and it can be don on an outpatient basis.

It involve very little radiation exposure, so that even the technologis doesn't have to be shielded by shining an X-ra through the bones.

The Dexa is abl to measure their density.

Following the examination the computer generates a report that compare the subject's bone density with that of othe women her age.

This is an image of your spin right here, and this graph here shows you where you fal relative to other women.

Now the dot right here is you.

And what this tells me is that you'r just about average for other women your age.

Now, you'll notic that you're lower than you probably wer when you were younger.

Say peak bone mass around ag 20 to 25.

So you're lower than you wer when you were aged 25.

But you're about averag for other women your age now, even though your averag for your age, if you continue along that curve by age 80 you will be at risk for fracture because essentially all women, by that age have had a tremendous amount of bone loss and are at ris for fracture at this time.

Doctor do you prescribe SD gen for me?

Well, it's not completely clear cut.

You're not at hig risk for fracture, and you're in good health.

You'l it would be important for you to try to preserv as much bone mass as you can.

But you're not at such high ris that I would sit here and attempt to convince you over and over to use estrogen.

I think it would be importan for you.

I think on balanc it will be helpful for you, and it will certainly preven the continued bone loss that will undoubtedly occur in taking calcium tablets.

It's just not the sam as the estrogen is correct.

That's true.

I mean, calciu is very important because bones are made of calcium.

But calcium alone is not enough.

You need the estrogen to hel put the calcium back into the bone to keep them stronger.

Here's the grub.

Here's what we di to kind of play a game with you.

Learning how to increas calcium consumption is one of the activities of the Menopaus Support Group I put together.

If you took this amount of food, it would give you all th calcium you need for the day.

If you took three glasses of 2 and I'll let, I'll ask you to come up clos in a minute.

Three yogurts.

You could get your 100 three ounces of Swiss cheese.

Most American women consum less than half the recommende daily amount of calcium, and almost everyone agree that an adequate amount of calciu is important to bone health.

But when it comes to hormon replacement therapy or HRT, it's hard to find consensus.

Look at how much broccol you'd have to eat to get to get 100%.

According to recent statistics, only about 20% of American wome who've gone through the menopause are taking hormon replacement therapy.

Costs may be a factor.

It costs $35 a month but it's covered by health insuranc and medical assistance.

Now, researchers at the University of Pittsburg have found that where you live may play an important rol in determining whether or not you take hormon replacement therapy.

Freema is the most widely dispensed drug in the United States.

In California more than 60 to 70% of postmenopausal women are on HRT.

But in New England, the percentage drop to around 20%.

So clearly, not all doctor agree on the risks and benefits of hormon replacement therapy.

Many see the drug's advantages.

The first one, an especially if you have symptoms of of hot flashes restlessness, sleeplessness, personality changes whereby yo you aren't as tolerant of your family member or surroundings.

I have seen.

Where a hormone replacemen therapy can certainly eas these symptoms.

And often that's all that' necessary for patients.

This is what they are intereste in doing.

Secondly they have other symptoms related to this lack of hormone namely if they are bothere with painful intercourse, drive vagina susceptibility increase susceptibility to things like yeast infections.

They would gai from the hormone replacement, whether they applie locally to the vagina or whether they take i by mouth.

Estrogen therapy has a very beneficial effec on the blood lipids.

So if your LDL goes up and you take estrogen it tends to normalize it.

So for women who have a ver great whopping increase in their bad cholestero at the time of menopause, taking estrogen will certainl be beneficial for that.

Well the use of estrogen will prevent the accelerated bone loss tha normally occurs with menopause.

So using estroge can actually increase bone mas a small amount and stabilize it.

If we're talking about estroge therapy as a prevention for coronary heart disease because we think it doe prevent coronary heart disease.

We know from the dat that we have that you have to take i the rest of your life.

You probably have to take it from the tim you become menopausal to the to the end to the finish of the race, which gives us about 3 to 40 years of taking a drug.

Oftentimes a woman will be very concerned about her risk for cancer.

There have been a number of cancer scare associated with estrogen.

A lot of them will say I never take pills.

I hate to take pills.

Hormones will cause cancer.

I'm afrai my sister has breast cancer.

My aunt had ovarian cancer.

My mother had uterine cancer.

And I can reassure the on every front.

I can only tell the with breast cancer that w don't feel that the risk is greatly increased.

We feel there may be at mos a slight increase, but most of us fee that the risk of taking hormones is completely outweighe by the benefits.

It is wrong to to tell wome that there is no increase in risk of breast cancer.

On the other hand there's quite logical to say that at the present tim when not certain what that risk might be and whether the risk is of any importance it may well be that the risk is really relatively minimal.

But it would be totally wrong to tell women that we're certai that estrogens don't increase the risk of breast cancer.

It is gambling from a medica point of view in terms of we think of all the things that estrogen may be beneficial for, but I don't think it's wron to not take hormones, but I like to have some reaso not to give hormones as oppose to the other point of view, which would be to have a reaso to give hormones.

The big thing to remember tha it's drug treatment.

It's not replacement.

When you take oral estrogens it does a lot of funny things which natural estrogen don't do.

And it's not basicall a replacement.

It's a drug which is use just like any other drug.

Truly, women come in a vas spectrum of sizes as well, from 80 pounds to 320 pound or something like that.

And it's somewhat odd to think that the same size hormon pill would fit all women.

So I usually say that one siz pantyhose don't fit all, and probably one siz hormone pills don't fit all.

So I think we always nee to be alert to the possibility that if someone's not doin well on an estrogen or a progestin, that they'r getting over or under dosed.

Our level of informatio is still in its infancy on on women and long term risk and how estrogens and taking progesterone is going to affec that risk of heart disease and breast cancer, tw of our major killers of women.

We have to get it across tha we are always every day making decision on imperfect information.

And it's unfortunate that we don't hav perfect information, but we still have to mak some decisions based on what we know today, and then modify those decision as new information emerges.

The pros and cons of hormon replacement therapy prompt a lively discussio in the menopause Support group.

I've been on them off and on to my choice, but now I don't thin I have a choice because I had a heart attac last year and I no longer have a choice.

I told my doctor, I said you told me to take the hormones that this would, like prevent me from having a heart attac after I, like, got the menopausal stage in all thi and I said I had it anyway.

So what he's telling me and it's probably true that it would have been wors had I not been taking hormones.

So now I'll just stay on them.

The bad part is I'll be 61 in Jul and I get a period every month, but that's okay.

You know, I deal with that.

It's like, that's okay.

I chose to take i because I had seen two of my mother's sisters di within four days of each other.

My mother had tripl bypass surgery.

I had a very hard decisio to make about that because one I also had a breast biopsy done, but I chose to take the therapy because I just really fea coronary artery disease also.

And I think the best thing that I can d for myself is to kee my regular appointments, keep up with my mammograms, an put my mind at ease that way.

Why should you have to conside these choices?

Heart disease, cancer heart disease, or breast cancer?

Shouldn't ther be some research, some better way of pinpointin where your risk are and what would be best for yo and what course you should take?

One of the things I thin is women as a group that we need to do is make sure that the research continue as to what we can do, what can pinpoin these symptoms, what are the bes courses of treatment.

And I feel very very strongly about that because I was one of the individual that was first on the pill, as you can remember.

And we had went throug all those symptoms.

And here I am again the next stage.

But I think it's reall important that we remember we also have a voice to talk about researc and research on women's issues.

So that's what I thin we have to do.

What really concerned m was the longevity of using hormon replacement therapy.

And you had starte to get on that a little bit.

I didn't know whether you just continued the rest of your lif or, or you could stop it.

And, you know, I wasn't sure.

It's very common to sto and rest and start again.

It is for some reason, though, for some reason and that doesn't affect your.

What you're doin is building your own case for what you need to d because of your symptoms, because of your family history and because of of.

If you are someone who can us HRT because you're interested in along the wa to check all of your health, your bloo chemistries, your bone density, because you want to say hey, am I at risk for bone thinning and bon breaking, pneumonia, death or heart disease?

But it's your persona collection, your own diary of your own personal history, your family history your own patterns.

Some of us are not eligibl for hormone replacement therapy because of medical reasons.

I can't take the hormon replacement, mainly because I've had Hodgkin's diseas and they don't want me to take the hormone cancer kidney gallbladder, liver, heart.

But I do live with the symptom and I get hot flashes and I fan and I, I have the people around m train to roll down the window.

She's having another flash.

So I just liv with the symptoms that I have.

But I there's something just live with and I just that's just part of everyday life.

I also want to say something about the hormone replacemen that when you're doing hormone replacement, remembe that it's not going to be regulated within a mont or two months or six months.

And make sure you ask the questions that it' a very delicate balance, because I forgot to as that question.

And things were happenin with hormone replacement that I didn't like very well.

But it is.

It's a question of balancing, and you have to keep in touch with your docto and let them know what you're doing.

I'm still, as my friend know, weighing whether we're goin to stay with this regime or not.

But I think after tonigh I probably will because my family has a histor of coronary heart disease, the women in particular.

And, I think I'll go the ris to have them try to balance it ou a little bit better.

The bottom line is, long term knowledge of hormone replacemen therapy is not known.

It won't for many years but thank God the initiatives on is Roz talke so you can start ten years after menopaus or some people start before.

But the reason you want to begi to explore is for two reasons you got symptom you can't stand, and hormone replacemen therapy, your brand of it, your simulation of your hormone story has to be delicately balanced.

And the doctor patient relationship is vital her because you've got to be going go in ther and be allowed to complain.

All right.

And you take time when you wan to stop and say stop already.

Let me look at this again.

Let's do some blood measur and bone measure.

What do I want to put up wit this or or I want to continue.

Remember you can take the hormon replacement therapy because you have the symptom or you dog on.

No.

Well you are a candidat possibly for heart attack or bone thinning.

And you want to sa I want a quality of life.

I don't want to take that risk.

[Music Plays] For most of us, quality of life after menopause become the most important issue.

On average, we can expec to live another 40 years.

But what wil those years be like?

If you're like me, you're hopin that you'll be this vigorous and activ when you're in your 60s and 70s.

Today, health professional recognize that when a woman is in her 40s.

This is a critical time to mak changes in diet and lifestyle with half of their live ahead of them.

40 something women have a chanc to maximize their chances of being healthy fo the second half of their lives.

Women are being aske not to think of menopause as the end of something, bu as the beginning of something.

A time when a woman can mak time to give priority to her own health needs.

A time to take care of her body.

Well, for the woman in her 40s, she should be focusing he efforts on preserving the bone mas that she already has.

And ways of preserving bon mass include getting enough calcium getting regular exercise, and avoiding risk factor that we know will damage bones.

Things like smoking, exces alcohol, use of glucocorticoids such as prednison those will all lower bone mass.

We can watch our intake of fa because currently the American die is about 38% fat on average.

That's what we're seeing i healthy women in other studies.

That's a normal amoun of fat in the diet.

So there's lots of roo for improvement.

Is is what I'm getting at.

And about a third of America women don't exercise much at all.

There's no regular exercis in their daily life.

There's a lot of roo for improvement there.

So there are thing within our grasp that don't cost anythin that we can do early on to start preventing some of thos changes that we're seeing.

And I think that's importan for women to understand, because heart disease is absolutely the bigges killer of women after menopause.

I think it's an important tim to take stock to figure out what are your risk factors what screening tests should you be gettin on a regular basis?

What should you be taking?

How much calcium do you need?

What should your cholesterol b and your blood pressure and your blood sugar?

You know, is there any risk for diabetes?

All these are important thing to check.

And menopause is a logical time It's a signal.

It's a signa that you're passing into a different phase of lif and a time to begin regular contac with the physician, to ensure that you're doin everything you can to have the remainder of your lif be as healthy as possible.

It is, unacceptable for any physicia and particularly gynecologist, who's treating wome not to be compassionate, not just in menopause but throughout the life, but especially at the time of the Men of Pause which means patients taking the time the opportunity to sit and listen t what the patients are saying.

So if you don't get that, you're at the wrong place.

We need to make tim for ourselves.

And this is almost becom a cliche now, but I'm saying it because it needs to be said.

And if from the standpoin of a Dutch uncle talking, take care of yourself.

I mean, put yourself in that circle of care that you already hav for your family and friends and everybody else.

I mean, women I think are very, very we have this traditional rol and it's a good role just expande to our to ourselves.

If you're a 40 something woma or know and care about one of the 20 millio women of protein menopause, then I hope you've gained some informatio and insight from this program, and I hope you've learne about things you can do now to enhance the qualit of the second half of your life.

So if you're heade for a change, make it a change for the better.

[Music Plays] Funding fo this program is provided by the Jewish Health Car Foundation, a Pittsburgh based grant make reaching out to meet the needs of the region's women, children the aged and persons with chronic conditions and by Magee-Women's Hospital.

Because every woman is unique every woman deserves a hospital uniquely her own.

Magee-Women' Hospital, specializing in women care for over 80 year and by a grant from the Corporatio for Public Broadcasting.