Introduction to Menopause

What is menopause?

When a woman permanently stops having menstrual periods, she has reached the stage of life called menopause. Often called the change of life, this stage signals the end of a woman’s ability to have children. Many healthcare providers actually use the term menopause to refer to the period of time when a woman’s hormone levels start to change. Menopause is said to be complete when menstrual periods have ceased for one continuous year.

The transition phase before menopause is often referred to as perimenopause. During this transition time before menopause, the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the big drop in estrogen levels that causes most of the symptoms of menopause.

When does menopause occur?

Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to have an earlier menopause, while women who are overweight often have a later menopause. Generally, a woman tends to have menopause at about the same age as her mother did.

Menopause can also happen for reasons other than natural reasons. These include:

  • Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40. It may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.

  • Surgical menopause. Surgical menopause may follow the removal of one or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often have more severe menopausal symptoms than if they were to have menopause naturally.

What are the symptoms of menopause?

These are the most common symptoms of menopause. However, each woman may experience symptoms differently. Some have few and less severe symptoms, while others have more frequent and stressful ones. The signs and symptoms of menopause may include:

Hot flashes

Hot flashes or flushes are, by far, the most common symptom of menopause. About 75% of all women have these sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman’s last period. For 80% of women, hot flashes occur for 2 years or less. A small percentage of women experience hot flashes for more than 2 years. These flashes seem to be directly related to decreasing levels of estrogen. Hot flashes vary in frequency and intensity for each woman.

In addition to the increase in the temperature of the skin, a hot flash may cause an increase in a woman’s heart rate. This causes sudden perspiration as the body tries to reduce its temperature. This symptom may also be accompanied by heart palpitations and dizziness.

Hot flashes that happen at night are called night sweats. A woman may wake up drenched in sweat and have to change her night clothes and sheets.

Vaginal atrophy

Vaginal atrophy is the drying and thinning of the tissues of the vagina and urethra. This can lead to pain during sex, as well as vaginitis, cystitis, and urinary tract infections.

Relaxation of the pelvic muscles

Relaxation of the pelvic muscles can lead to urinary incontinence and also increase the risk of the uterus, bladder, urethra, or rectum protruding into the vagina.

Cardiac effects

Intermittent dizziness, an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity, cardiac palpitations, and fast heart rhythm may occur as symptoms of menopause.

Hair growth

Changing hormones can cause some women to have an increase in facial hair or a thinning of the hair on the scalp.

Mental health

While it is commonly thought that mental health may be negatively affected by menopause, several studies have indicated that menopausal women suffer no more anxiety, depression, anger, nervousness, or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia, and nervousness may be related to both the lack of estrogen, the stress of aging, and a woman’s changing roles.

What can I do about hot flashes?

Hot flashes occur from a decrease in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your healthcare provider have evaluated your risk versus benefit ratio.

To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative (WHI) in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.

The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.

These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy may be effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take nonestrogen medicines. The FDA recommends that hormone therapy be used at the lowest doses for the shortest time needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their healthcare providers.

Practical suggestions for coping with hot flashes include:

  • Dress in layers, so that you can remove clothing when a hot flash starts.

  • Avoid foods and beverages that may cause hot flashes, like spicy foods, alcohol, coffee, tea, and other hot beverages.

  • Drink a glass of cold water or fruit juice when a hot flash starts.

  • Reduce your stress level. Stress may worsen hot flashes.

  • Keep a thermos of ice water or an ice pack next to your bed during the night.

  • Use cotton sheets, lingerie, and clothing that allow your skin to breathe.

  • Keep a diary or record of your symptoms to find what might trigger your hot flashes.

Treatment for menopause

Several therapies that help to manage menopause symptoms including:

Hormone therapy (HT)

Hormone therapy (HT) involves the taking a combination of the female hormones estrogen and progesterone during perimenopause and menopause. HT is most commonly prescribed in pill form. However, estrogen can also be given by using skin patches and vaginal creams.

The decision to start using these hormones should be made only after you and your healthcare provider discuss the risks and benefits.

Estrogen therapy (ET)

Estrogen therapy (ET) involves taking estrogen alone, which is no longer being made by the body. ET is often prescribed for women who have had a hysterectomy. Estrogen is prescribed as pills, skin patches, and vaginal creams.

The decision to start using this hormone should be made only after you and your healthcare provider discuss the risks and benefits.

Non-hormonal treatment

This type of treatment often involves the use of other types of medicines to relieve some of the symptoms associated with menopause.

Estrogen alternatives

Estrogen alternatives are the so-called “synthetic estrogens,” like ospemifene, improve symptoms of vaginal atrophy without affecting endometrial cancer risk.

Alternative therapies

Homeopathy and herbal treatments, often called bioidentical hormones, may offer some relief from some symptoms of menopause. However, there are concerns about potency, safety, purity, and effectiveness.

Fibroids

What You Need to Know Fibroids: What You Need to Know

  • Uterine fibroids are an extremely common condition in which solid tumors develop in the uterus.
  • Fibroids are not cancerous and do not increase the risk for uterine cancer.
  • It is not known what causes fibroids, but studies suggest genetics and prolonged exposure to estrogen may increase your risk of developing fibroids.
  • Symptoms can include heavy and prolonged periods, bleeding between periods, pressure in the abdomen and pelvic pain.
  • Fibroids are most often found during a routine pelvic exam or incidentally noted on imaging. If treatment is needed, it may include medications or surgery.

What are fibroids?

Fibroids are growths made of smooth muscle cells and fibrous connective tissue. These growths develop in the uterus and appear alone or in groups. They range in size, from as small as a grain of rice to as big as a melon. In some cases, fibroids can grow into the uterine cavity or outward from the uterus on stalks.

An estimated 20% to 50% of women of reproductive age currently have fibroids, and up to 77% of women will develop fibroids sometime during their childbearing years. Only about one-third of these fibroids are large enough to be detected by a health care provider during a physical exam, so they are often undiagnosed.

In more than 99% of fibroid cases, the tumors are not cancerous and do not increase the risk for uterine cancer.

What causes fibroids?

The cause of fibroids is not known. Research suggests each tumor develops from an abnormal muscle cell in the uterus and multiplies rapidly when encountering the estrogen hormone, which promotes the tumor’s growth.

Who is at risk for fibroids?

Women in their reproductive age are most likely to be affected by fibroids.

Other risk factors may include:

  • Family history of fibroids
  • Obesity
  • Diet high in red meat
  • High blood pressure

Black women are more likely to develop fibroids than other women, they are diagnosed at younger ages and they more often require treatment. It is not clearly understood why fibroids disproportionately affect Black women.

Fibroids Symptoms

It is common that women who have fibroids do not experience any noticeable symptoms. Other women with fibroids experience severe symptoms that interfere with their daily lives. Common fibroid symptoms include:

  • Heavy or prolonged periods
  • Bleeding between periods
  • Abdominal discomfort and/or fullness
  • Pelvic pain
  • Lower back pain
  • Bladder symptoms, such as frequent urination or difficulty emptying the bladder
  • Bowel symptoms, such as constipation or excessive straining with bowel movements

Women with fibroids can also experience:

  • Infertility
  • Complications during pregnancy
  • Pain during intercourse

Emergency Fibroid Symptoms

In rare cases, women with fibroids need emergency treatment. You should seek emergency care if you have sharp, sudden pain in the abdomen that is unrelieved with pain medication, or severe vaginal bleeding with signs of anemia such as lightheadedness, extreme fatigue and weakness.

How are fibroids diagnosed?

Fibroids are most often found during a routine pelvic exam. During this exam, your health care provider will press on your abdomen and may feel a firm, irregular mass that might indicate a fibroid.

To diagnose uterine fibroids, your doctor may order one of the following tests:

  • Pelvic Ultrasound. A procedure during which a small instrument, called a transducer, is either inserted into the vagina or pressed over the abdomen to produce pictures of the internal organs using sound waves. The doctor can see the size, shape and texture of the uterus and evaluate any growths.
  • Magnetic resonance imaging (MRI). This is a form of advanced imaging technology that provides highly detailed images of internal organs. These images help your provider determine the exact location and characteristics of fibroids and, if needed, plan minimally invasive treatments.
  • Hysterosalpingography. This is a type of X-ray exam of the uterus and fallopian tubes. Your doctor will use a special dye to more easily visualize these organs and determine if the fibroids have blocked your fallopian tubes.
  • Hysteroscopy. This is a visual exam of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Woman speaking with her gynecologist

How are fibroids treated?

Since the growth of most fibroids slows as you approach menopause, your health care provider may simply suggest “watchful waiting” if your symptoms are tolerable. With this approach, the health care provider closely monitors your symptoms with frequent follow-up visits and ultrasounds to make sure there are no significant changes in your condition.

Treatment may be necessary if your fibroids cause significant symptoms. Treatment options include medicinal and surgical approaches. Your doctor will recommend treatment based on your symptoms, location and size of the fibroids, your age and medical history, and your health goals such as a desire for pregnancy.

In some cases, women also require treatment for iron-deficiency anemia due to heavy or prolonged periods, or because of abnormal bleeding between periods.

The best form to permanently get rid of fibroid is herbal treatment.

Medicinal Treatment Options

Anti-inflammatory painkillers such as ibuprofen or naproxen may reduce menstrual bleeding caused by fibroids and provide pain relief. This is the most conservative treatment method and is recommended for women with occasional pelvic pain or discomfort due to fibroids.

Hormonal treatment can include:

  • Gonadotropin-releasing hormone agonists (GnRH agonists). This treatment lowers your estrogen level and triggers a temporary “medical menopause.” GnRH agonists are used to shrink the fibroid(s). They are also used to stop your period in preparation for surgery or to improve your blood count. Doctors will not typically administer this medication for longer than a year — and the medication’s effects are reversed once it leaves your system.
  • Oral contraceptive pills (or a patch or vaginal ring) can help reduce bleeding associated with fibroids.
  • Progesterone-containing agents — pills, implant, injection or intrauterine device (IUD) — may also control bleeding.

Procedural Treatment Options

Conservative surgical therapy. Myomectomy is a procedure during which the fibroids are removed but the uterus stays intact. This approach is recommended for women who want to preserve their fertility. There are three primary myomectomy methods:

  • Traditional open myomectomy. The procedure is performed via an abdominal incision and carries some risks, including bleeding and scar tissue formation at the incision site and a longer recovery. This approach may be necessary depending on the size and number of fibroids.
  • Laparoscopic or robotic myomectomy. This outpatient procedure uses small “keyhole” abdominal incisions and a laparoscope. This minimally invasive approach often results in less bleeding and a faster recovery, but it is not suited for all patients. Most patients go home the day of surgery and recover within a few weeks. Your doctor will determine if you are a good candidate for this procedure.
  • Hysteroscopic myomectomy. During this outpatient procedure, your doctor uses a camera inserted through the vagina to shave off visible portions of the fibroid tumors. This method only treats fibroids that have formed inside the uterine cavity.

Uterine artery embolization (UAE), also called uterine fibroid embolization, is a newer technique. This minimally invasive procedure shrinks fibroids by cutting off their blood flow. An interventional radiologist performs UAE, using X-rays for guidance. Health care providers are looking at this procedure’s long-term implications regarding fertility and regrowth of the fibroid tissue.

Magnetic resonance guided focused ultrasound, also a newer technique, focuses sound waves on fibroids that are at the front of the uterus. The potential effects on fertility are not yet understood.

Radiofrequency ablation of fibroids is another newer technique, during which — under laparoscopic and ultrasound guidance — heat is applied into the fibroids to make them smaller and softer. The potential effects on fertility are not currently well understood.

Hysterectomy for Fibroids

During a hysterectomy, the entire uterus is removed. Fibroids are the #1 reason for hysterectomies in the U.S.

The procedure can be performed vaginally or abdominally via a large incision, laparoscopically or robotically, depending on the size of your uterus, location of the fibroids and your medical history.

Because a hysterectomy is a major surgery, it is only recommended to treat fibroid cases for women who are not interested in preserving their fertility. It is the most effective method of fibroid treatment because it eliminates the possibility of recurrence.

Fibroids and Pregnancy

Uterine fibroids can affect fertility in a variety of ways. If fibroids grow and block the uterus or fallopian tubes, they may make it harder to become pregnant. They may also have other negative effects on pregnancy including:

  • Increased risk of miscarriage and preterm labor
  • Abnormal attachment of the placenta
  • Increased likelihood of delivery by cesarean section
  • Postpartum hemorrhage

If you have fibroids and are experiencing infertility, consult a reproductive endocrinologist who specializes in treatment of women with fibroids. A fertility specialist can develop a treatment plan that maximizes your chances of a successful pregnancy. If surgery to treat fibroids is needed before pursuing fertility treatment, myomectomy is likely your best option.

Why Cholesterol Matters for Women

Ah, cholesterol and triglycerides. We hear about them all the time. Even foods that might seem good for you on the surface, like fruit-filled yogurt or bran muffins, can contribute to abnormal levels if they contain too much saturated fat or refined sugar.

cholesterol, HDL and LDL in block letters

What’s more, many women are at risk for high cholesterol and don’t realize it. “Approximately 45 percent of women over the age of 20 have a total cholesterol of 200 mg/dl and above, which is considered elevated — but a survey by the American Heart Association found that 76 percent of women say they don’t even know what their cholesterol values are.

Scarier still: Triglycerides, a type of blood fat typically measured alongside cholesterol, are even more risky in women compared with men. This is a problem because women’s cholesterol levels can fluctuate quite a bit after menopause and tend to increase with age, putting us at greater risk of heart disease and stroke. Knowing your cholesterol numbers and how to control them is a big step toward staying healthy.

Understanding the Highs and Lows of Cholesterol

You know that too much is dangerous. But what is cholesterol, anyway? Where does it come from? And is it all bad?

Cholesterol is a waxy substance that is found in every cell in the body. It’s either made by the body or absorbed from food. Your body needs cholesterol to make important steroid hormones such as estrogen, progesterone and vitamin D. It’s also used to make bile acids in the liver; these absorb fat during digestion.

So some cholesterol is necessary — but bad cholesterol is something you can do without. Excess bad cholesterol in the bloodstream can deposit into the body’s arteries. These deposits are called plaques and result in atherosclerosis, or hardening of the arteries. This is the major cause of heart attacks, strokes and other vascular problems.

Your total cholesterol level is a measure of the total amount of cholesterol circulating in your bloodstream, which includes several components:

  • LDL cholesterol: LDL stands for “low-density lipoprotein.” This is known as the “bad” cholesterol, which directly contributes to plaque buildup in the arteries. Very low density lipoprotein, or VLDL cholesterol, is another type, which is a precursor to LDL.
  • Total cholesterol is VLDL cholesterol plus LDL cholesterol plus HDL cholesterol.
  • HDL cholesterol: HDL stands for “high-density lipoprotein.” Experts think at optimal levels (around 50 mg/dl) it might help the body get rid of LDL cholesterol.

So bits of this stuff circulate through your system, and here’s what happens: The bad parts – the LDL particles – like to stick to the lining of your arteries, like soap scum in pipes. As it sticks there, it generates an inflammatory response and your body starts converting it into plaque. Plaque in your blood vessels makes them stiffer and narrower, restricting blood flow to vital organs such as your brain and heart muscle, leading to high blood pressure. Additionally, chunks can break off and cause a heart attack or a stroke.

And guess what? This buildup can start as early as your 20s.

What to Know About Triglycerides

In addition to cholesterol, you might hear about your triglycerides, another kind of fat found in the bloodstream. Women should pay particular attention to this. “A high level of triglycerides seems to predict an even greater risk for heart disease in women compared with men.

When you take in more calories than you need, your body converts the extra calories into triglycerides, which are then stored in fat cells. Triglycerides are used by the body for energy, but people with excess triglycerides have higher risk of medical problems, including cardiovascular disease. Drinking a lot of alcohol and eating foods containing simple carbohydrates (sugary and starchy foods), saturated fats and trans fats contributes to high triglycerides. High levels may also be caused by health conditions such as diabetes, an underactive thyroid, obesity, polycystic ovary syndrome or kidney disease.

Triglycerides also circulate in the bloodstream on particles that may contribute to plaque formation. Many people with high triglycerides have other risk factors for atherosclerosis, including high LDL levels or low HDL levels, or abnormal blood sugar (glucose) levels. Genetic studies have also shown some association between triglycerides and cardiovascular disease.

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High Cholesterol: Prevention, Treatment and Research

Cholesterol is a natural component in everyone’s blood. However, when you have too much of this fatty substance, it’s considered hyperlipidemia, hypercholesterolemia or high blood cholesterol—a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.

What’s your cholesterol level, anyway?

A standard lipid blood test usually measures the concentration of total cholesterol, HDL cholesterol, and triglycerides levels. The LDL-cholesterol level is typically estimated from these numbers using a well-established formula that has been more recently revised and improved by researchers at Johns Hopkins.

So what are your target numbers?  an ideal LDL cholesterol level should be less than 70 mg/dl, and a woman’s HDL cholesterol level ideally should be close to 50 mg/dl. Triglycerides should be less than 150 mg/dl, total cholesterol levels well below 200 mg/dl are best.

Why Cholesterol Affects Women Differently

In general, women have higher levels of HDL cholesterol than men because the female sex hormone estrogen seems to boost this good cholesterol. But, like so much else, everything changes at menopause. At this point, many women experience a change in their cholesterol levels — total and LDL cholesterol rise and HDL cholesterol falls. This is why women who had favorable cholesterol values during their childbearing years might end up with elevated cholesterol later in life. Of course, genetics and lifestyle factors can play big roles, too.

How to Lower Your Cholesterol

If you’ve been told that you have high cholesterol — or you just want to prevent it — what can you do?

There are several ways to manage it, including:

Medication: Depending on your overall cardiovascular disease risk, you might be treated with a cholesterol-lowering medication, such as a statin. The decision to use a statin is based on a woman’s overall risk for heart attack and stroke including all these factors and the LDL cholesterol value.

If you already have vascular disease or evidence of atherosclerosis, or if you are at high risk for cardiovascular disease, a statin for prevention is strongly recommended because this treats the plaque in the arteries, and lowers LDL cholesterol.

Diet and lifestyle: “Diet and lifestyle are very important to help maintain healthy cholesterol levels. Even for women who are recommended to take cholesterol-lowering medications, a healthy lifestyle helps these drugs work better.

Here’s how to maintain a lifestyle that promotes healthy cholesterol levels:

  • Maintain a healthy body weight
  • Don’t smoke.
  • Exercise for at least 30 minutes five or more days per week.
  • Eat a diet rich in fruits, vegetables, lean protein and high amounts of soluble fiber such as beans and oats, which can reduce LDL.
  • Avoid sugar-sweetened drinks and fruit juices — opt for water and unsweetened tea instead — and minimize your intake of other simple carbohydrates like baked goods and candy.
  • Drink alcohol in moderation, especially if you have elevated triglycerides.
  • Consider the Mediterranean diet, which is rich in fruits, vegetables, grainy breads and fish. Use olive oil (instead of butter) and spices (instead of salt).
  • Eat monounsaturated and polyunsaturated fats — such as those found in olive oil, nuts and fatty fish like salmon. They can actually have a positive effect on cholesterol, by reducing the amount of LDL in the blood and reducing inflammation in the arteries, especially when they replace saturated fats in the diet.

Add these to your shopping list:

  • Fatty fish such as salmon, trout, mackerel, sardines and albacore tuna
  • Nuts, including walnuts, pecans, almonds and hazelnuts
  • Olive oil to drizzle lightly over your salads and vegetables

While nobody wants to have high cholesterol, there are plenty of ways to keep it in check.  “With regular checkups and attention to what you eat, it’s possible to manage your cholesterol and blood fats to keep your heart healthy.

Osteoporosis

Your body regularly replaces the components of your bones. When those components are lost too rapidly or not replenished quickly enough (or both), osteoporosis occurs. Osteoporosis affects more than 10 million Americans. While women are at higher risk for the disease, men can develop it, too. Studies suggest that among those 50 and older:

  • Up to 1 in 2 women will break a bone due to osteoporosis — equal to the risk of breast, ovarian and uterine cancer combined.

  • Up to 1 in 4 men will break a bone due to osteoporosis — a risk greater than prostate cancer.

Fortunately, osteoporosis is preventable. When it does occur, your doctor can diagnose and treat it before it causes a broken bone. Even after a fracture, further problems are avoidable with the right steps.

What are the symptoms of osteoporosis?

Osteoporosis is often called the silent disease because it may not cause symptoms. Some patients experience:

  • Broken bones (mainly hips, spine or wrists), even from minor falls or bumps

  • Collapsed vertebrae — leading to severe pain, a decrease in height or a spine deformity

Such symptoms can also come from other bone disorders or medical problems. Always consult your doctor for a diagnosis.

What are the risk factors for osteoporosis?

Several factors appear to increase the risk of developing the disease:

  • Age. Risk increases after 50

  • Gender. Women are 4 times more likely to develop osteoporosis

  • Race. The disease can affect anyone, but white and Asian women are most at risk.

  • Menopause. Estrogen deficiency causes bone loss

  • Family history of osteoporosis or fractures

  • Low body weight, or being small and thin

  • Not getting enough calcium or vitamin D

  • Not eating enough fruits and vegetables for other nutrients (magnesium, potassium, vitamins C and K)

  • Not getting enough protein

  • Consuming too much alcohol, sodium or caffeine

  • Having an inactive lifestyle

  • Smoking

Certain medications (prednisone, e.g.) and diseases can also cause bone loss and increase the risk of osteoporosis.

How is osteoporosis prevented?

To protect their skeleton, men and women of all ages should ensure they are:

  • Consuming adequate amounts of calcium and vitamin D

  • Following national nutritional guidelines for protein, fruit and vegetable intakes.

  • Increasing weight-bearing activity

  • Limiting alcohol intake to moderate use or less

  • Stopping smoking if you smoke

If you’re a woman who has gone through menopause or a man older than age 50, your doctor should follow National Osteoporosis Foundation guidelines and:

  • Talk to you about your risk of osteoporosis and related fractures

  • Recommend a diet rich in fruits and vegetables that includes adequate vitamin D and calcium, with supplements prescribed as necessary

  • Recommend regular weight-bearing and muscle-strengthening exercises

  • Assess fall risk and offer appropriate preventions

  • Ask whether you smoke and how much alcohol you drink

  • Measure your height each year

Osteoporosis Diagnosis

A bone density test (also called bone densitometry or DXA) involves a special X-ray machine and is the only way for doctors to determine whether you have osteoporosis. Such scans are recommended for:

  • All women 65 and older

  • All men 70 and older

  • Certain postmenopausal women, depending on risk factors

  • Certain men ages 50-69, depending on risk factors

  • Certain patients who have fractured a bone, depending on their background

  • Individuals on medications or with medical conditions that can affect bone density

Bone density tests can also identify patients with osteopenia — decreased bone mass that has not yet reached the level of osteoporosis. Ask your doctor if you should get tested.

Other tools and tests include:

  • FRAX score. combines your bone density test with other factors to estimate your risk of a fracture within the next 10 years

  • Personal and family medical history

  • Physical examination

  • Additional scans with other machines

  • Blood and urine tests

Osteoporosis Treatment

Early treatment of osteoporosis and osteopenia can ease pain, limit or halt bone loss, and prevent fractures. Appropriate treatment can also help fracture patients avoid another injury. Our doctors recommend treatments based on:

  • Your age, overall health and medical history

  • Your gender

  • The extent of the disease and your anticipated rate of bone loss

  • Your tolerance for specific medications, procedures or therapies

  • Your opinion or preference

Many osteoporosis treatment tools are similar to prevention methods, such as recommending changes to diet and lifestyle.

The FDA has also approved a number of injections, IV infusions, tablets, nasal sprays and patches — all shown to reduce fractures in randomized studies. Make sure to discuss possible side effects with your doctor.

Parathyroid Hormone

Side effects: Possible calcium increases in the blood and urine and reactions at the injection site like itching and redness.

Drug: Teriparatide (a form of parathyroid hormone)
Use: Treats postmenopausal women and men who are at high risk for fractures
Form: Daily injection administered by the patient at home

Estrogen

Side effects: Risks vs. benefits should be discussed with a doctor. Typically used for a short period of time earlier in menopause, due to long-term risks of breast cancer and blood clots.

Drugs: Estrogen Therapy (ET) and Hormone Therapy (HT)
Use: Increases bone density in the spine and hip and decreases fractures at both sites. Typically used for prevention in postmenopausal women.
Form: Commonly available as tablets or skin patches

Bisphosphonates

Side effects: Oral bisphosphonates can cause upper stomach issues like heartburn. Patients can get flu-like symptoms after the first dose of intravenous bisphosphonates. With all bisphosphonates, there are rare side effects: Difficulty healing after dental work like a root canal or implant that involves the jaw bone (approximately 1 in 50,000 patients), and stress fractures after long term, continuous use (approximately 1 in 75,000 patients). Most doctors will prescribe these medications for 5-8 years, then consider taking their patients off the treatment as fracture risk remains low even after stopping the medication. After stopping the medication, bone density and blood testing annually can help determine when and if more medication would be helpful.

Drug: Alendronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and treats the disease in men, while reducing the risk of spine, hip and other broken bones
Form: Weekly pill

Drug: Risedronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and treats the disease in men, while reducing the risk of spine and hip fractures
Form: Weekly or monthly pill

Drug: Ibandronate Sodium
Use: Prevents and treats osteoporosis in postmenopausal women and reduces the risk for spine fractures
Form: Monthly pill or IV infusion every 3 months

Drug: Zoledronic Acid
Use: Prevents and treats osteoporosis in postmenopausal women, treats the disease in men and prevents additional broken bones for fracture patients with low bone density. It reduces the risk of fractures of the hips, spine and other areas like the wrists and arms.
Form: Annual IV infusion

Selective Estrogen Receptor Modulators

Side effects: Possible hot flashes and a small increased risk of blood clots

Drug: Raloxifene
Use: Prevents and treats osteoporosis in postmenopausal women while reducing the risk of spinal fractures
Form: Daily pill

Calcitonin

Side effects: Approximately 6 percent of patients will have some mild nose irritation. The FDA reviewed the medication in 2013 because there may be a 1 percent increase in skin cancers. The agency determined it should remain available, but you should discuss the risks and benefits with your doctor.

Drug: Calcitonin-Salmon
Use: Treats osteoporosis in women who are at least 5 years past menopause and reduces the risk of spine fractures.
Form: Nasal spray or injection