WoMEn’s hEalthdoc.mediaplanet.com/all_projects/5489.pdf · are unique. The type of advice you get for yourself might not fit the situa-tion of your friend or neighbor. That’s

AN iNdepeNdeNt SUppLeMeNt FROM MediApLANet tO tHe NAtiONAL pOSt

Dr. Marla Shapiro speaks out about embracing menopause: Accepting it as a part of aging gracefully and recognizing we’re all diff erent

KEEP FRESH, FIT AND FULL OF LIFE

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no.1/august 2010

WoMEn’s hEalth

MenopauseWhat you need to know

Hello sunshineHow Vitamin d helps preventosteoporosis

Heart disease and strokeit’s the leading killer of women

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AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt2 · AUgUSt 2010

challEngEs

Your change. Your life. take charge.

Menopause is a natural part of aging for every woman.It is also an ideal time to put a renewed focus on you, especially if you are experiencing menopause symptoms.

taking care of yourself and refocusing on your overall health is now more important than ever. Growing evidence suggests that paying careful

attention to diet, exercise, weight and stress, as well as limiting your consumption of alcohol, cigarettes and caff eine will help to ward off some of the health issues that arise with menopause and perimenopause.

Stay strong, prevent diseaseThe best advice for every woman during the menopause transition is to include some form of exercise in your daily routine. Exercise is the key to not only making you feel stronger, but it also helps to prevent certain diseases that come with aging. Even a moderate increase in your fi tness level can help to protect you against heart disease and diabetes. Regular physical exercise can reduce stress levels, help you sleep better and reduce the severity of troublesome menopausal symptoms such as hot fl ashes. And with osteoporosis a major concern for women as they age, exer-cise is very important to minimize

bone loss and improve balance and strength.

How much exercise? And what kinds? Thirty minutes of moderate aerobic exercise (even in 10-minute sessions) is recommended for its cardio-protective effects. A minimum of 20 to 30 minutes of weight-bearing exercise on most days (e.g. walking, dancing), along with muscle-strengthening exer-cise involving the arms, legs, abdomen and back for 30 to 60 minutes three times per week, will improve bone mass and decrease back pain. And if you haven’t tried yoga yet, this low impact form of exercise provides excellent fl exibility training which can improve balance and help to prevent falls and protect against fractures. And if you are starting to have those “senior’s moments” you’ll be glad to know that exercise can even help preserve memory and cognition.

A walk a day to keep cancer awayExercise and a healthy lifestyle can even protect you from can-cer. It has been estimated that 30 to 40 percent of all cancer could be prevented with a healthy diet, regular

physical activity, and maintaining an appropriate body weight. Isn’t it great to know that by taking a brisk walk every day after supper, you may be protecting yourself from developing breast cancer!

Keep informedEveryone should live in a healthy way to protect themselves from dis-ease and enhance their quality of life. Women entering menopause today have had the advantages of growing up with access to better nutrition, a greater focus by society and by health care professionals on preventive health care, and much improved access to information about healthy living. This menopause report is one of these. Take time to read through it today. It covers a range of topics that may be top of mind as you experience the meno-pause transition. You’ll fi nd advice, encouragement and support, as well as recommendations for trusted educational online resources such as menopauseandu.ca, where you can research topics of interest to you.

The SOGC is a member of the Canadian Menopause Coalition.

Dr. Vyta SenikasAssociate executive Vice-president,the Society of Obstetricians andgynaecologists of Canada (SOgC)photo: Creative Concepts photography

■■ Hot fl ashes■■ Night sweats■■ Poor memory■■ Disturbed mood■■ Irritability■■ Depression■■ Poor concentration■■ Fatigue■■ Urinary frequency and urgency■■ Vaginal dryness■■ Joint and muscle ache■■ Diminished sex drive

MeNoPaUSe SYMPtoMS

“it’s all about education and information, not anecdotes. it’s about recognizing that all women are unique.”

Living with menopausedr. Marla Shapiro advises how women can age gracefully.

We reCoMMeNd

pAge 3

Hormone therapy p. 21. Margery gass, Md clarifi es what information you can trust.

Staying sensual p. 52. Who says menopause means losing your libido?

WOMeN’S HeALtH1St editiON, AUgUSt 2010

Country Manager: Gustav [email protected] Manager: Jackie [email protected]

responsible for this issue:Publisher: Kelsey [email protected]: Penelope [email protected]:Famida Jiwa, osteoporosis CanadaMargery Gass Md, NaMSdr. Vyta Senikas , SoGCSuzanne WintrobCanadian Continence Foundationovarian Cancer Canadathe Heart truth Campaign

Distributed within: National Post, august 2010this section was created by Mediaplanetand did not involve the National Post orits editorial departments.

Mediaplanet’s business is to create newcustomers for our advertisers by providing readers with high-quality editorial contentthat motivates them to act.

The North American Menopause Society (NAMS) is an international leader in menopause. Our review of the research indicates there is solid evidence indicating HT is safe for most women who are experiencing troublesome menopause symptoms, especially those women in the fi rst fi ve years of menopause. Your fi rst step is to see a healthcare practitioner you trust. After assessing your symptoms and medical history, your clinician may recommend HT in the lowest eff ective dose of estrogen alone (for women without a uterus) or estrogen plus progestogen (for women who still have their uterus). Evidence shows that the risks of taking HT are very low compared to the benefi ts you may gain during the fi rst fi ve years after menopause. HT is commonly prescribed for hot

flashes and vaginal atrophy. Hot fl ashes are the No. 1 complaint of menopausal women, often leading to sweats at night that disturb sleep and cause fatigue. Vaginal atrophy can cause burning, itching, dryness, and pain during sex. This condition happens during the menopause transition when hormone levels decrease causing loss of the lubri-cating eff ect that comes from our estrogen. If this is the only symptom troubling you, your practitioner may recommend an estrogen you insert in the vagina. Putting the HT directly where it is needed, and using a smaller amount is very low risk because little of the medication is absorbed into your body.

What is BHT?One area of confusion for women thinking about HT is the issue of “bioi-dentical hormone therapy” (BHT). This term refers to many government-approved HT products containing hormones that are chemically-identi-cal to those in the body. However, the term is often used to describe formu-lations prepared by certain pharma-

cists according to a healthcare prac-titioner’s prescription, thus the term, custom-compounded.

NAMS has concerns about custom-compounded hormone preparations:

■■ Custom-compounded formula-tions have not been tested for eff ec-tiveness or safety as other HT has been tested.

■■ Safety information is not always provided to women with their pre-scription, as required with govern-ment-approved HT.

■■ Batch standardization and purity may be uncertain.

Recently the U.S. Food and Drug Administration ruled that compound-ing pharmacies have made claims about the safety and eff ectiveness of BHT that are not supported by clinical trial data. NAMS recommends govern-ment-approved HT for most women; it will provide appropriate therapy without the risks and cost of custom preparations. The NAMS is a member of the Cana-dian Menopause Coalition.

are you thinking about hormone therapy?If you’ve been following the media stories about hormone therapy (HT) and menopause, you may be confused about whether HT is right for you. Here are some facts to help you make your decision.

Mammograms

1 Talk to your doctor about scheduling a mammogram if

you haven’t had one done.

Heart health

2 Have your blood pressure and cholesterol checked regularly.

Be careful about weight gain around your waist; this is associated with increased risk for heart problems.

PAP test

3 All women should have PAP tests to check for cervical

cancer, even as you get older; sched-MARGERY GASS, MD, NCMPexecutive director, the North american Menopause Society; Consultant, Cleveland Clinic Center for Specialized Women’s Health

Debunking the menopause myth

Source: Society of Obstetricians and Gynaecologists of Canada

3aPPoINtMeNtS YoU SHoULd MaKe

EVERY WOMAN COPES WITH MENOPAUSE DIFFERENTLY

EVERY WOMAN

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Debunking the menopause myth

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Night sweats, hot flashes and vaginal dryness are just some of the common symptoms experienced by menopausal women. But that doesn’t mean all menopausal women should receive the same treatment. On the contrary, says Toronto family physician Dr. Marla Shapiro, what’s appropriate for one woman might be completely wrong for another.

Finding your fit “Just as in shoes–even Jimmy Choos–one size doesn’t fit all,” explains Dr. Shapiro, a leading authority on menopause. “It’s all about education and information, not anecdotes. It’s about recognizing that all women are unique. The type of advice you get for yourself might not fit the situa-tion of your friend or neighbor. That’s absolutely critical for women to understand.” Dr. Shapiro, 54, has dedicated her

career to helping women embrace their bodies and age gracefully. She is particularly vocal about breast can-cer and menopause, both of which she has personally faced head on. Six years ago she was diagnosed with breast cancer and had a complete hysterectomy that brought on meno-pause. She was unable to take estro-gen due to the cancer so managed her night sweats and hot flashes with diet and exercise.

Busting the myth Today, as a director with SIGMA (Special Interest Group in Meno-

pause and Aging) Canada Menopause Society, Dr. Shapiro continues to pro-mote healthy living and dispel the common menopausal myths. For instance, she says it’s true that 75 percent of women will experience hot flashes but only nine percent will find it disrupts their life. Vaginal dryness can be effectively combated with vaginal or oral hormone therapy yet many women are embarrassed to ask their doctor for treatment. But the biggest myth is that hormone therapy causes breast cancer in all women users. Conversely, she says, it’s the “gold standard” for

those with intractable menopausal symptoms. Depending on the time of initiation and length of hormone use, there can be no increased risk of breast cancer or heart disease. In fact, women who start hormones in their 50s, a window of opportunity for treatment, (hormones should not be initiated in the 60s) may have a protective effect on their heart and a reduced risk of Alzheimer disease.

Make it your lifestyle“It’s never too late to get fit and address your lifestyle,” she says. “Women who smoke are likely to go through menopause earlier, so quit smoking. Information gleaned from TV or the Internet is often not based on science or evidence. So talk to your doctor, get informed, and take an active role in aging well.”

Suzanne Wintrob

[email protected]

Leader to Leader

Dr Marla Shapiro■■ Family physician and specialist

in community medicine■■ Board Member of SIGMa Cana-

dian Menopause Society■■ recipient of the North american

Menopause Society’s 2005 Media award from her work in expanding the understanding of menopause

■■ recipient of the Society of ob-

stetricians and Gynecologists of Canada/Canadian Foundation for Women’s Health award for excel-lence in Women’s Health Journal-ism, 2006, for her documentary run Your own race

■■ author of Life in the Balance: My Journey with Breast Cancer, CtV Medical Contributor Canada aM, Medical Consultant, CtV.

ProFILe

Weight gain is not directly re-lated to menopause, however during perimenopause women gain an average of five to nine pounds. Our metabolism slows and our bodies begin to burn fat at a reduced rate. A healthy diet and moderate exercise can help prevent unwanted weight gain.

The Canada’s Food Guide encourages Canadians to focus on vegetables, fruit, and whole grains, to include

milk, meat, and their alternatives, and to limit foods that are high in calories, fat (especially trans fats), sugar, and salt. The new enhanced, interactive web site, My Food Guide, helps you personalize the information according to your age, sex, and food preferences. It even includes culturally relevant foods from a vari-ety of ethnic cuisines. You can use this tool to build a customized plan for healthy choices in both nutrition and physical activity after menopause. Start by choosing “Female” and age

“51 to 70.” The Guide will tell you how many servings per day of vegetables and fruits, grain products, milk and alternatives, and 2 of meat and alter-natives you’ll need to stay healthy and maintain a good weight. You can even print off your personalized profile and keep it handy in the kitchen to keep you on track. Also on the Canada Food Guide website is My Food Guide Servings Tracker, a tool developed by the Dietitians of Canada to provide even more detailed nutritional

information and guidance for you as you make healthy changes in both your eating and physical activity. The tool helps you keep track of the amount and type of food you eat each day and makes comparisons with recommendations. A recent research study has shown that people trying to lose weight who use a dietary log will lose twice as much weight as those who do not keep track of their food intake. By increasing your level of physical activity, improving your eating hab-

its, and achieving and maintaining a healthy weight, women at midlife can help ensure good health and prevent many chronic diseases, including some cancers, type two diabetes, and cardiovascular disease and stroke. If you’re having trouble managing your weight, talk to a health-care pro-vider familiar with your health and medical history.

healthy eating can help you cope with a changing metabolism

“Just as in shoes–even Jimmy Choos–one size doesn’t fit all.”

Dr. Marla ShapiroPhoto: CtV

There are more women in their 50s in Canada today than at any other time in history. Many are working, raising children and caring for elderly parents and don’t have time for menopause to slow them down. Dr. Marla Shapiro explains how to alleviate the symptoms while aging gracefully.

Source: Menopauseandu.ca administered by the SOGC

AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt4 · AUgUSt 2010

Question: How can you raise your survival rate of ovarian cancer?Answer: Catch it as soon as possible by knowing the signs and visiting your doctor.

First, it was cancer. then, it was menopause.

ProFILe

Cynthia Bradburn

■■ Age: 34■■ to give back to

her cause, Cyn-thia has been ac-tively involved in ovarian Cancer Canada’s Winners Walk of Hope for several years. the Walk raises money to fund research, raise awareness and support women who are living with the disease. on September 12, the Winners of Hope is taking place in cities across the country. Visit www.winnerswalkof-hope.ca to learn more about registration.

When Cynthia Bradburn becomes a mother, she will be well into menopause.

Cynthia was prematurely thrown into menopause in 2009 at the age of 33 after she had surgery to remove a tumour that was over 20-centimeters large and her reproductive organs, followed by chemo-therapy for Stage II ovarian cancer. The pathology report also showed that Cyn-thia had early stage uterine cancer.

Her doctor had thought that Cynthia’s rash of symptoms—persistent bloating, gas, frequent urination, and menstrual pain and bleeding—was caused by an ovar-ian cyst. Even before attending an ovarian cancer awareness presentation at her work, Cynthia had a gut feeling that her symptoms were more than just a cyst and “those intuitive feelings were just made stronger after hearing the presentation,” explains Cynthia.

Her diagnosis was a devastating blow to the newlywed, who was trying to start a family with her husband Jay. Before the surgery, Cynthia and Jay were fortunate to complete a cycle of in vitro fertilization.

“We are extremely lucky to have embryos waiting for us when we are ready

to use them,” says Cynthia. When the time is right for the Bradburns to begin their family, a close friend has off ered to carry the couple’s child.

“It means the world to us that our friend and her husband have kept our dream alive of one day being a mom and dad to our own child. They truly are our angels.”

Although ovarian cancer is most com-mon among women over 50, the disease can occur at any age, according to Fran Turner, national program director at Ovarian Cancer Canada.

“Unfortunately, there is no screening test for the early detection of ovarian can-cer, so women need to know the signs and symptoms of the disease and have per-sistent symptoms investigated. Women also need to know that the Pap test is an important test for cervical cancer but is not related to ovarian cancer.”

Women who have one or more of the following symptoms that persist for three weeks should see their family doc-tor or health professional: swelling or bloating of the abdomen; pelvic discom-fort or heaviness; back or abdominal pain; fatigue; gas, nausea or indigestion; changes in bowel habits; frequent urina-tion; menstrual irregularities; weight loss

or weight gain.Each year, approximately 2,600 women

in Canada are diagnosed with ovarian cancer and 1,750 women die of the disease. When diagnosed in its early stages, as many as 90 per cent of women will sur-vive. However, due to the lack of a screen-

ing test, most diagnoses occur in the late stages, when the survival rate can be as low as 30 per cent.

Cynthia considers herself one of the lucky women with an early stage diagno-sis.

“Ovarian cancer may have changed my life but I am determined not to let it ruin my life,” she says. “I’ve learned that life has no guarantees, so I’m living each of my days to the fullest and I’m living without regrets. Anything that’s within my con-trol, I’m going to take it and run with it.”

September is National Ovarian Cancer Awareness Month. For further informa-tion on ovarian cancer and other gyneco-logic cancters, and for event information across the country, visit the website of Ovarian Cancer Canada at www.ovarian-canada.org.

Ovarian Cancer Canada is a member of the Canadian Menopause Coalition.

InspIratIon

Source: Ovarian Cancer Canada

Keep it fun: how to stay sensual at any age

Cynthia and Jay Bradburn at Ovarian Cancer Canada’s 2009 Winners Walk of Hope

Menopause is a normal occurrence in a woman’s life;Urinary Stress Incontinence should not be!

Urinary stress incontinence caused by pelvic fl oor weakness is common in women entering menopause. However, many of them believe that there is nothing they can do about it and feel too embarrassed to address the problem with their physician.

During the menopause stages, a decrease in estrogen levels occurs, resulting in a reduction in collagen, a component of supporting structures. Consequently, pelvic muscles, ligaments and tissues progressively become less elastic, elongated and weaker. These changes lead to a weakened pelvic fl oor and a loss of bladder control. Therefore, it is common for women to experience urinary stress incontinence, i.e. a sudden loss of urine during physical exertion, such as coughing, sneezing, laughing or lifting. The weakened pelvic fl oor muscles are unable to tighten enough to prevent leaking when such sudden pressure is put on the abdomen.

Too many women are still unaware of available treatments. Conservative, non surgical approaches aimed at restrengthening the pelvic fl oor muscles are generally recommended as a fi rst step to overcome urinary stress incontinence and regain control of the bladder.

Pelvic fl oor strengthening using vaginal cones is a long-recognized and simple technique to help women perform their pelvic muscle exercise at home, without disrupting their normal activities. Once a selected cone is inserted in the vagina, it triggers a refl ex contraction of the pelvic muscles to prevent the cone from slipping out. A slight effort to hold the cone in place is needed to optimize the exercise. During the 15-minute exercise session, a woman should continue to be active and perform her usual daily activities Once she can hold a cone in her vagina with no effort for 15 minutes, she can move up to the next heavier cone for the next exercise session. Her goal should be to hold the heaviest cone she can comfortably support to complete the exercise programme.

Liubov Gargaun, MD (Hon.)Medical Advisor, Duchesnay Inc.

Vaginal Cones for Pelvic Floor Reeducation• 5 small cones of increasing weight (approx. from 5 mg to 55 mg)• Personal and easy-to-use home therapy• Short time commitment• Effi cient method to target and exercise the pelvic fl oor muscles• Nice and discreet package presentation• Self-motivating improvement in muscle tone and stress incontinence symptoms• Available in Canadian pharmacies, with a prescription or directly from the pharmacist.

For more information about LadySystem®, visit www.ladysystem.caTo discuss urinary stress incontinence, join the community

www.laughingwithoutleaking.ca

Liubov Gargaun, MD (Hon.)Medical Advisor, Duchesnay Inc.

Vaginal Cones for Pelvic Floor Reeducation

HoW I Made It

ALWAYS CHECK A CHANGE WITH YOUR DOCTOR

ALWAYS CHECK

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AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOStAN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt AUgUSt 2010 · 5

ing test, most diagnoses occur in the late stages, when the survival rate can be as low as 30 per cent.

Cynthia considers herself one of the lucky women with an early stage diagno-sis.

“Ovarian cancer may have changed my life but I am determined not to let it ruin my life,” she says. “I’ve learned that life has no guarantees, so I’m living each of my days to the fullest and I’m living without regrets. Anything that’s within my con-trol, I’m going to take it and run with it.”

September is National Ovarian Cancer Awareness Month. For further informa-tion on ovarian cancer and other gyneco-logic cancters, and for event information across the country, visit the website of Ovarian Cancer Canada at www.ovarian-canada.org.

Ovarian Cancer Canada is a member of the Canadian Menopause Coalition.

Source: Ovarian Cancer Canada

Burning. itching. Dryness. Pain.

theBigOW.ca.ca

have you exPerienceD. . .

Talk About vaginal atroPhyAs we approach menopause, and especially when we pass it, many of us will experience The Big Ow, or symptoms of ‘vaginal atrophy’. Your doctor knows about it – ask about low-dose, mess-free treatment options.

Who said that menopause means a loss of libido? Sensuality is possible at any age as long a woman takes the time to get in touch with her physical body and her inner soul.

“When you’re under stress, it’s dif-fi cult to feel sensual,” says Carolyn Braddock, a U.S.-based educator and Tai Ji advocate. “But fl uidity in the mind, body and spirit will create fl u-idity in the natural lubrication of the physical body.”

While menopausal women often

experience a decline in sexual inter-est, the loss can’t be attributed to vaginal dryness alone. Dr. Nathalie Gamache of the Federation of Medi-cal Women of Canada says hot fl ashes, insomnia and weight gain – especially when combined with chronic ill-nesses such as heart disease, arthri-tis and cancer – can further impair a woman’s sex drive. Medications to treat such conditions can have nega-tive side eff ects on sexual health, she adds. Unfortunately, women often feel uncomfortable addressing sexual concerns with their doctor.

But people who maintain an active sex life tend to live longer and happier, says Dr. Gamache, and there is help for women of any age to get their groove back. Moisturizers and lubricants can increase comfort during intercourse and enhance the senses. Local estro-gen preparation is ideal for severe dry-ness.

Ms. Braddock wishes more North American women would adopt East-ern thinking where “elder love” is cel-ebrated. Alas, menopausal women this side of the ocean feel they are “shriv-eling up.” Instead, she urges them to

light candles, use lubricant, try sex toys, and listen to their body’s voice.

“If we continue to have good sen-sual and sexual experiences, we keep the juices fl owing which helps to cre-ate better health in our organs,” says the 63-year-old spokesperson for Aloe Cadabra lubricant. “Menopause is a magical time. It’s the wise woman who lets her hair down and gets a little mischievous.”

Keep it fun: how to stay sensual at any ageCHaNGe

Suzanne Wintrob

[email protected]

coming out of the shadows on urinary incontinenceIncontinence is a common health condition that is rarely discussed as people living with the condition are often too em-barrassed to discuss it with their healthcare providers. In fact, the World Health Organi-zation calls incontinence “one of the last medical taboos.”

The fact is that as many as 3.3 million Canadians—nearly 10 per cent of the population—experience some form of incontinence. The number is sure to go higher because the number of individuals living with incontinence is likely to increase as the population ages, as the prevalence of inconti-nence tends to increase with age.

What is urinary incontinence?Incontinence has been defi ned as

the “involuntary leakage of urine.” So, for example, any time that urine is released when you don’t want it to be released—when you laugh, sneeze or exercise, for example–you are expe-

riencing urinary incontinence. The important thing to remember is that it is not normal; you don’t have to live with it! You have options.

There are four main kinds of incontinence:

■■ Stress Urinary Incontinence (SUI), which is the leaking of urine with coughing, sneezing, straining, exercise or any other type of exer-tion. Fifty percent of individuals with incontinence have SUI.

■■ Urge Incontinence (UI) is leaking of urine associated with the sudden uncontrollable urge to empty the bladder. The urge to empty the bladder cannot be delayed and leakage occurs. UI is a key symptom of the overactive bladder syndrome.

■■ Overfl ow incontinence (OI) is con-stant leaking or dribbling from a full bladder. OI implies that normal urina-tion is impossible.

■■ Mixed incontinence (MI) is a combination of stress and urge

incontinence.

What triggers incontinence?Urinary incontinence can be caused by a weakening of the pelvic muscles and urethra muscles (the tube that con-nects the bladder with the outside) or because of damaged ligaments. When weakened, the pelvic muscles and urethra cannot contract enough to hold urine in when stress is placed on them, such as during a strong cough or sneeze. Factors that may cause uri-nary incontinence are increasing age; menopause can bring on or worsen all forms of incontinence because estrogen loss contributes to the weak-ness of muscles and tissues in the pelvic fl oor area, which supports the bladder and urinary tract; weakened pelvic muscles; previous pregnancies; smoking; obesity.

What can you do?Speak to your Family Physician, who will set-up tests to determine

a diagnosis. There are many diff er-ent healthcare professionals who specialize in urinary incontinence care that may be able to support you during diagnosis and treatment: Physiotherapists, Nurse Continence Advisors, Urologists, Urogynaeco-logists. Initial treatment may include counselling about lifestyle changes and pelvic fl oor exercises that may improve your condition; information about various pharmaceutical treat-ments for urge incontinence; the use of absorbent products; and the explo-ration of surgical options.For more information visit www.canadiancontinence.ca.

Canadian Continence Foundation is a member of the Canadian Menopause Coalition.

Source: Canadian Continence Foundation

What is vaginal atrophy?

1Vaginal atrophy refers to the changes to the vaginal tissues that happen as a

result of estrogen defi ciency. When a woman reaches menopause, and sometimes leading up to it, she loses estrogen in her body. The loss of estrogen causes the vaginal tis-sues to thin and lose elasticity, and also causes the vagina itself to become narrower and shorter and to lose some its natural blood sup-ply. All of these changes lead to a number of common symptons.

How many women experience vaginal atrophy?

2Every woman eventually becomes estrogen defi cient during menopause, so every

woman experiences these symptoms to some degree. Unfortu-nately, I think there a lot of women suffering in silence out there. Women need to understand that vaginal atrophy is not a disease; it’s a natural state. It’s a consequence of estrogen defi ciency, which happens to everybody.

What should a woman do if she notices any of the symptoms?

3Talk to your primary care physician. Vaginal atrophy is something that can be

treated. It’s important to understand that it will not go away on its own like hot fl ashes or other temporary symp-toms of menopause. In fact, it can continue throughout life. You shouldn’t ignore even one symptom.

Dr SHaWna JoHnSton

Associate professor,

department of Obstetrics & gynaecology and

Urology, Queens Univerisity

!nEWs

VaGINaL atroPHY

AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt

Heart disease and stroke are the leading cause of death for Canadian women, yet most don’t know this. While still perceived as a man’s disease, more women now die of cardiovascular disease than men. Sadly, women who experience heart disease do less well than men. This is The Heart Truth™.

According to the latest mortality statistics from Stats Canada, more than 34,000 Canadian women died of heart disease and stroke in 2006. Women are less likely than men to survive a heart attack or stroke. Only 21 per cent of men will die after expe-riencing a heart attack or stroke, compared to 38 percent of women.

Only one in eight women knows

■■ Question:Why should women aged 40 to 60 be aware of their risks for heart disease and stroke?

■■ Answer: the changes that occur during menopause can increase the risk for cardiovascular disease

AN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOStAN iNdepeNdeNt SUppLeMeNt by MediApLANet tO tHe NAtiONAL pOSt AUgUSt 2010 · 7

heart disease and stroke: It’s the leading cause of death for women

Source: The Heart Truth Campaign

doN’t MISS!

nEWs

Vitamin D is produced by the interaction of the sun on the skin. Because Canada is in the northern latitudes, we don’t get much of that happening between October and April. Vitamin D is not easily obtained from dietary sources, and many Canadians are vitamin D deficient, especially during the winter months.

Vitamin D, as well as calcium, are both essential in preventing osteoporo-sis; Vitamin D may also reduce other health risks such as diabetes and immune system disorders. Osteopo-rosis Canada’s Guidelines on Vitamin D say: 800–ß2000 IU daily for adults over 50 or with osteoporosis (daily doses over 2000 IU may be required by some people with osteoporosis but

should only be taken under medical supervision).

400–1000 IU daily for adults under 50 without osteoporosis or condi-tions aff ecting vitamin D absorption, such as celiac disease, cystic fi brosis or Crohn’s disease.

“Each person’s vitamin D require-ments may vary considerably depending on many factors, so it’s very important to check with your physician about how much vitamin D you should be taking,” says Dr. Famida Jiwa, Acting President & CEO of Osteoporosis Canada.

Osteoporosis can occur without you even knowing it: the way you fi nd out is sometimes only once you actually have a fracture. Risk factors include: a family history of osteoporosis; long-term low intakes of calcium and vitamin D; diseases that inhibit intestinal absorption of nutrients, or require long-term

treatment with steroid medication such as prednisone.

Things you can do now to reduce your risk of osteoporosis: take 1000-1200 mg of calcium per day and the recommended dosage of vitamin D; do weight-bearing exercise such as walking, dancing, stair climbing; schedule 30 minutes of exercise four to six times a week to improve mus-cle strength, increase endurance and fl exibility, and decrease your risk of falling.

For more information on osteopo-rosis, visit www.osteoporosis.ca or call 1-800-463-6842.

Osteoporosis Canada is a member of the Canadian Menopause Coalition.

are you getting enough of the sunshine vitamin?

Famida JiwaActing president & CeO, Osteoporosis Canada

Statistics are alarming:■■ One in four post menopausal

Canadian women has osteoporosis.■■ A 50-year-old woman has a 40

percent chance of developing hip, vertebral or wrist fractures.

■■ One in four women who have a new vertebral fracture will fracture again within one year.

FaCtS

Heart disease and stroke are the leading cause of death for Canadian women, yet most don’t know this. While still perceived as a man’s disease, more women now die of cardiovascular disease than men. Sadly, women who experience heart disease do less well than men. This is The Heart Truth™.

According to the latest mortality statistics from Stats Canada, more than 34,000 Canadian women died of heart disease and stroke in 2006. Women are less likely than men to survive a heart attack or stroke. Only 21 per cent of men will die after expe-riencing a heart attack or stroke, compared to 38 percent of women.

Only one in eight women knows

that heart disease and stroke are their biggest health risk. That’s why the Heart and Stroke Foundation launched The Heart Truth, a cam-paign designed to share the truth about heart disease and stroke and save the lives of women across the country.

It is especially important for women aged 40 to 60 to be aware of their risks. A woman’s body goes through many changes during

menopause, and these changes can increase her risk for cardiovascular disease. After menopause, women’s levels of estrogen decrease. Lower levels of estrogen can increase a woman’s LDL blood cholesterol (the harmful kind of cholesterol) and decrease her levels of HDL blood cho-lesterol (the benefi cial kind) making her more vulnerable to heart disease and stroke.

With The Heart Truth, The Heart and Stroke Foundation is invit-ing and supporting women across Canada to take charge of their heart health, to make connections between risk factors and heart disease and stroke; to talk to their doctors about heart health; and ultimately, to reduce the number of women who die from heart disease and stroke. Join our community: www.facebook.com/TheHeartTruth.

■■ Question:Why should women aged 40 to 60 be aware of their risks for heart disease and stroke?

■■ Answer: the changes that occur during menopause can increase the risk for cardiovascular disease

FaCtS

The good news is that women can reduce their risk by as much as 80 per cent by making lifestyle changes including:

■■ Staying smoke free or quit-ting smoking—while smoking is an addiction and quitting may be diffi cult, it may become easier with help and a plan from www.heartandstroke.ca

■■ exercising and eating right—30 minutes of exercise and seven to

10 servings of vegetables and fruit each day plus limited consump-tion of saturated and trans fat and sodium puts women on the right track.

■■ Knowing, controlling and talking to their doctor about their blood pressure and cholesterol levels. For some women, medication may be required. taking the Know Your risk quiz on www.thehearttruth.ca is a great fi rst step.

SHoWCaSe

“it is especially important for women aged 40 to 60 to know their risks.”

The Heart Truth Campaign

Suzanne Wintrob

editorial@mediaplanet.

MARIA RICUPERO RD, CDEPhoto credit: Maria Ricupero

doN’t MISS!

MARIA RICUPERO RD, CDE

Seven times more Canadian women die annually from coronary disease than breast cancer. That’s worrisome because statistics reveal that 45 percent of Canadian women between the ages of 18 and 74 areliving with high cholesterol–a major risk factor for heart disease, stroke and diabetes. The number rises to a frightening 80 percent among post-menopausal women aged 65 to 74.

Waist watching“In menopause there is weight gain which accumulates around the waist,” says Maria Ricupero, a Toronto-based Registered Dietitian and Certified Diabetes Educator (CDE). “That’s a concern because your heart is there, your organs are there, and the fat located around your waist is metabolically active and can increase risk of heart disease and diabetes.” Yet there is hope for women who want to get their cholesterol under control. According to the Heart & Stroke Foundation, even a one point reduction in total cholesterol can reduce the risk of coronary heart disease by 25 percent. Put simply, cholesterol is a fat in the blood that the body uses to make cell membranes, vitamin D and hormones. It comes in two forms, which Ricupero likens to trucks. Bad cholesterol, or low-density lipoprotein (LDL), acts like a dump truck by moving through the bloodstream and dumping itself along the artery walls. This, in turn, can lead to a buildup of plaque and makeit diffi cult for blood to fl ow to the heart and through the body. Good cholesterol, or high-density lipo-protein (HDL), acts like a garbage truck by picking up the excess LDL and delivering it to where it gets excreted.

Make healthy a habitRicupero says lowering cholesterol is as simple as making lifestyle changes. The earlier that happens, the better the results: “Often people wait until they have an issue before they take action. But if healthy habits are in place as early as your 30s and 40s, it can have a signifi cant eff ect on reducing the risk of heart disease.” Among her tips: exercise briskly fi ve days a week for at least 30 minutes, eat colourful plants, avoid processed foods, watch food portions, drink moderately, and stop smoking. “It’s not about being perfect every single day,” she explains. “But if every day and with every action we can be mindful and practise the art of balance, it will cut some of the edge as far as feeling overwhelmed and not bothering to make any change at all.”

cholesterol: how you can keep it under control

Source:Osteoporosis Canada

Suzanne Wintrob

[email protected]

WORK OUT FOR YOUR HEART

HEALTH

WORK OUT FOR YOUR HEART

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