Nurse Practitioners Look At Women’s Health Issues

By Kaaren Valenta

Osteoporosis and menopause, words that evoke concern in the minds of many women, were the topics of a program sponsored by the Parish Nurse Ministry at St Rose Church recently. Lisa Haut and Diana Rackey, nurse practitioners with Community Health Associates in Newtown, were the guest presenters.

While both men and women can develop osteoporosis, it is much more common in women, particularly after menopause. But many preventative measures can be taken, the two nurse practitioners said.

Osteoporosis is the gradual loss of bone mass. While bone cells are constantly in a process of building and breaking down, as estrogen decreases during menopause, bones lose more than they gain. The result shows in the statistics.

“White women have a 16 to 18 percent likelihood of having a hip fracture over their lifetime; white men have a five to six percent likelihood,” Diana Rackey said. “In the United States there are 1.5 million fractures annually, mostly spine, hip, and wrist. This is expected to increase as the population ages.”

While people don’t die of hip fractures, the fractures often lead to secondary problems – pneumonia or blood clots from being confined to bed – and these decrease the survival rate by 10 to 20 percent, she said.

Compression fractures of the spine are not obvious when they occur but they lead to reduction in daily activities, which leads to more osteoporosis.

“The risk factors are being female, being white, having a family history of osteoporosis, having a tiny frame, smoking cigarettes, having a low body weight, drinking more than three alcoholic drinks a day, experiencing menopause before age 35, drinking five or more cups of coffee a day, having low calcium intake, and having no or minimal physical activity,” Ms Rackey said.

There are some medications available for persons who suffer from osteoporosis, but prevention is by far the best alternative, she said.

“Any woman over the age of 65 should have a bone density scan, as should any woman under that age who has risk factors and is past menopause. It has been shown that estrogen replacement can reduce the risk of osteoporosis by more than 50 percent over three years. It slows down bone loss and may help create new bone. It also helps prevent heart disease,” she said. “However, it may increase the risk of cancer.”

Some of the drugs available to treat menopause include the one-a-day pill Fosamax; Calcitorin (miacaicin) nasal spray, and Raloxifene (Evista), a drug which also sometimes reduces cholesterol and hot flashes.

“The nice thing is that there are options. But nothing is perfect,” Diana Rackey said.

One of the easiest preventative measures is to get an adequate amount of calcium every day. Post-menopausal women need 1,500 mg a day. Dairy products and dark green leafy vegetables are among the best sources, but for those who have lactose intolerance, there are other options.

“Calcium carbonate – Tums – is easy and inexpensive,” Ms Rackey said. “Calcium citrate – Citrucel – is better absorbed. Recent research suggests calcium is best absorbed at night, and it should be taken with adequate amounts of Vitamin D.”

To reduce the risk of osteoporosis, increase weight-bearing exercises such as walking, bike riding, and weight training. Stop smoking. Fall-proof your house by removing scatter rugs and electrical cords from the floors, and increasing lighting, especially in hallways and stairs. Wear supportive shoes. Let someone else do the heavy lifting.

Osteoporosis is linked to menopause, a natural process that all women must go through, said nurse practitioner Lisa Haute.

“In the United States most women experience menopause between the ages of 45 and 60, with the mean age of 51, not including those who have had surgical procedures,” she said. “Anything before age 45 is considered premature menopause.”

The term menopause means that menstruation has stopped, a process that can go on for 10 years, she said. During that time women can experience irregular periods, heavy flow and clotting, hot flashes, night sweats, dizziness, vaginal atrophy, more yeast and bladder infections, changes in the skin, and sexual dysfunction.

The hormonal changes can bring on other symptoms as well: depression, insomnia, palpitations, exhaustion, irritability, crying jags, memory loss, lack of concentration, and decreased sexual desire.

Hormone replacement therapy (HRT) is the most common way to treat the symptoms of menopause. “Most patients tolerate it well if [the health practitioner] finds the right kind – there are about 20 different kinds on the market including pills, skin patches, and vaginal creams,” she said.

HRT may be synthetic, plant-based, or, in the case of Premarin, derived from the urine of pregnant mares. Some versions of HRT have the male hormone testosterone added.

There are other alternatives, too, Ms Haut said. “There are soy-based replacements, and herbs such as black kotasch and red clover, which seem to help with hot flashes. Having soy with skim milk in a shake provides estrogen and calcium. Eating well is important – reduce fats and salt, increase fruits and vegetables and complex carbohydrates.”

All women of menopause age should have an annual physical examination including an EKG, Pap test, mammogram, bloodwork, bone density scan, and colon-rectal cancer screening. They should participate in weight-being exercise regularly and do a self-breast exam on a monthly basis.

“It is important to spot potential problems early before they become problems,” Ms Haut said.

Women who have a family history of breast cancer, or who have fleabites, clotting disorders, or are smokers, often are advised not to take HRT. For others it is a personal decision.

“There is no right or wrong,” said Dr Jeffrey Friedman of Community Health Associates, who observed the program. “There is no choice in life without risk. You have to evaluate each choice and ask whether the good outweighs the potential bad.”