Taking Good Care of Yourself in Mid-Life: Advice from Dr. JoAnn Pinkerton, In-Coming President of the North American Menopause Society

No one knows better than Dr. JoAnn Pinkerton just how complex medical problems can be for women in mid-life, even for those who live an exemplary, healthful lifestyle.  In addition to seeing patients in private practice, she is Director of Mid Life Health and Professor of Obstetrics and Gynecology at the University of Virginia. Dr. Pinkerton is also the incoming President of the North American Menopause Society, an organization whose mission is “promoting health and quality of life of women through an understanding of menopause.”In a recent conversation, I asked Dr. Pinkerton about the medical problems women in mid-life should be most concerned about and what, if anything, women can do to prevent them from occurring. Here is a transcript of our conversation: Dr. Pinkerton: Physicians usually focus on three main medical problems during this time; heart disease, breast cancer and osteoporosis/bone health.  However, midlife is a key time for women to take stock and improve their care of themselves. Perimenopausal and menopausal women are often involved in careers or care-taking for teenagers, aging parents or both.For overall health, women should work to limit the weight gain that happens with aging and hormonal changes due to menopause.  Specifically, not smoking, avoiding excess alcohol, regular aerobic exercise and strength training and improving response to stress will all help prevent major diseases. Regular checkups and discussions with providers regarding individual risks and need for preventive testings such as mammograms, bone densities, colonoscopy, lipid panels, pap tests remain important.

I also recommend taking 1000-1500 mg of calcium either through diet or supplements, and 1000 IU of Vitamin D. Additional supplements may be indicated for specific women. If you have a strong family history of heart disease, breast cancer, osteoporosis or other health issues, there may be more specific recommendations for diagnostic testing, or lifestyle changes or medications to decrease your risks.

It is never too late to work to get excess weight off, lose central abdominal obesity, build more muscle mass, and live a healthier, less stressful lifestyle. And stay active! We need to keep our bodies “humming” to maintain the pitch of our busy lives.

Wendy:  In contrast, what are your patients’ biggest complaints or concerns? 

Dr. Pinkerton: In our midlife health center, the major concerns that women want addressed center around their fear of breast or ovarian cancer, difficulty losing weight or persistent weight gain, changes in memory or concentration, mood changes which range from premenstrual syndrome to severe depression and loss of interest in sex or decreased responsiveness during sex. It is important to balance your health risks (heart disease, breast cancer, bone loss) with these additional concerns that you have.

Women’s health is much more complex because of increasing risks and concern for health issues as well as care-taking stress and changes occurring because of aging and hormonal changes. No single answer, regimen or medical treatment is right for everyone.

Wendy:  As a gynecologist specializing in mid-life health, a lot of women  look to you for advice and guidance for getting through this difficult phase.  What is your approach for tackling all of these complex medical issues that you mentioned?

Dr. Pinkerton: I believe in shared decision-making where the provider and you – the patient – identify individual risks and concerns and work together to make positive changes to decrease your health risks and increase your sense of vitality and well being. For example, instead of walking out of the office with an unreasonable goal of 50 pounds weight loss in the next year, it may be more reasonable to identify your current stressors, barriers to exercise and weight loss, and develop a plan that is workable. “I will lose 10 pounds in the next year (or at a minimum, not gain any more); I will find a friend and begin walking 30 minutes three days a week plus climb the stairs in my office or home. I will get my colonoscopy this year.”  Deciding that you “can” make a change (confidence) and are “ready” (the change is important) to make a change- are the first steps.

Wendy:  What about hormones? What do you advise your patients?

Dr. Pinkerton:  Decisions about whether to take hormones, when to start, when to stop, are complex and need to take into account what we know at this point:  for example, timing:  taking hormones before age 60 and within 10 years of menopause appear safe. Then there is the safety and efficacy of the products or alternatives that are being considered – whether they are prescription medications or over the counter products. Lastly, the woman and her provider need to develop a plan about what  is most important to treat, what strategies to start with- for example lifestyle changes first- and how and when to proceed with  medical therapy if it is indicated.<.p>

I also asked Dr. Pinkerton her opinion and experience with alternative therapies, such as Black Cohosh,  for easing menopausal symptoms.  I’ll post her response in my next blogpost.

Feel free to leave comments or questions for Dr. Pinkerton in the comment box below.