Most women typically think about hot flashes, osteoporosis and insomnia when it comes to perimenopausal symptoms, not itchy or sensitive eyes. Yet, women are more affected by eye disease than men and dry eye syndrome in particular is commonly associated with menopause. In the United States, millions of people age 50 or older have dry eye syndrome with the majority of these being women.

Ocular dryness results from a chronic lack of sufficient lubrication on the surface of the eye due to tear deficiency or excessive tear evaporation. There are many causes including medications, smoking, LASIK surgery and environmental conditions. But dry eye syndrome is more frequent in post-menopausal women, affecting about 60% of menopausal women, due to hormonal fluctuations. Although symptoms typically begin as mild, if left untreated, the cornea can become scarred or infection may result.

Do You Suffer from Dry Eye Syndrome?

Symptoms of dry eye syndrome include:

• Persistent dryness
• Scratchy or gritty feeling
• Stringy mucus
• Irritation
• Burning
• Feeling as if something is in the eye
• Watery eyes
• Redness
• Contact lens intolerance
• Light sensitivity

Treatment for Dry Eyes

Since dry eye syndrome can progress from subtle irritation to inflammation or infection of eye tissues, a visit to an eye specialist is recommended if symptoms persist. Treatment typically begins with the application of artificial tears, lubricating eye drops or gels, applied every few hours. Lubricating eye ointments are thicker, last much longer and are typically used to lubricate the eyes overnight.

If symptoms persist, drops containing cyclosporine may be prescribed to decrease the inflammation associated with dryness.

Healthy Aging Eyes

In addition to dry eye syndrome, other eye diseases may arise post-menopause. The leading causes of vision impairment and blindness are primarily age related eye diseases. Cataract, glaucoma, macular degeneration and diabetic retinopathy are all major health concerns with aging – with a greater prevalence of glaucoma and macular degeneration in women. There seems to be a link between the onset of menopause and macular degeneration – the leading cause of vision loss and blindness in Americans aged 65 and older.

The number of women with age-related eye disease is expected to double within the next three decades. A recent study published in the journal Ophthalmology reports that postmenopausal women using hormone therapy for a long period of time may be at an increased risk for cataract extraction, especially those drinking more than one alcoholic drink daily.

For maintaining healthy eyes as you age, strive for a complete exam with an eye specialist every 1 to 2 years, taking extra care if you have diabetes or a family history of eye disease. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year – a number on the rise with the relentless diabetes epidemic.

Menopause marks a transition to new health risks for women but with lifestyle adjustments and proactive medical care, these risks can be managed. For many, eye health has never been a concern in the past, but like many other changes that occur as we age, it should become a consideration as we schedule our annual health exams and forge a new path post-menopause for healthy aging.

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The presentation and emergence of diabetes in women as they age creates a unique clinical challenge for both women and their healthcare providers. Around the time of menopause, there are important changes in body composition and insulin sensitivity, which impact both the risk for diabetes mellitus as well as glycemic control in those women with established diabetes. For some, menopause is the time for a first diagnosis of diabetes. For others, with existing diabetes, symptoms may be affected by the use of hormone replacement therapy, a common treatment for menopausal vasomotor symptoms, such as hot flashes.

Diabetes is the most common chronic disease in post-menopausal women and is a predisposing factor for cardiovascular disease, a leading cause of death for mature diabetic women. Women with diabetes are more likely to have a heart attack, and at a younger age, than women without diabetes. They are also at greater risk than men for certain microvascular complications such as diabetic retinopathy.

Are You At Risk for Diabetes?

Who is at risk? Those who are overweight, sedentary, age 45 yrs and older, those with a family history of type 2 diabetes, certain ethnic groups (including African Americans and Hispanics) and women who developed gestational diabetes during pregnancy).

The Burden of Diabetes on Women

Since more than half of persons with diabetes are women, the burden of the disease falls disproportionately on women – with a greater representation by those mid-life and beyond. Although the death rates of men with diabetes dropped in recent decades, those of women with diabetes has increased. With the American Diabetes Association estimating that about 9.3 million women have diabetes and the ongoing projected increase in this population, there is an urgency to improving clinical care and outcomes for women as they age.

This is an enormous public health issue, but with some simple lifestyle changes, many women can change the course of this disease. Pre-diabetes, characterized by higher than normal glucose levels, is a warning sign and offers the most opportune time to make dietary changes, increase exercise and strive for weight loss before full diabetes develops. Recent research suggests that long-term damage is already occurring during the pre-diabetic phase. Unfortunately, about 90% of those with pre-diabetes don’t know they have it and thus proceeded to develop diabetes without warning. Although pre-diabetes is a serious medical condition, it can be treated. Preventing or delaying the onset of diabetes is an important step in health aging and ideally requires a partnership with your healthcare provider, scheduling regular health check-ups (including glucose testing) and the adoption of simple lifestyle and dietary changes.

As women approach perimenopause and menopause, weight gain becomes a challenging issue. On average, middle aged women gain about a pound a year with body composition shifting to more fat and less muscle. The weight gain is particularly frustrating since many women discover that weight loss strategies that may have worked in earlier years are no longer effective. There are serious health implications associated with the extra pounds, including increased risk of cardiovascular disease, diabetes and certain types of cancers, thus minimizing weight gain is critical for healthy aging. However, adoption of new weight loss strategies should be safe and must include enduring life style adjustments for long term success. Unfortunately many women search for a quick fix and some are turning to risky procedures such as lipodissolve.

Lipodissolve is Unregulated

Lipodissolve, billed as non-surgical fat removal, is an unregulated and potentially dangerous procedure offered by spas across the U.S. Spas offer lipodissolve, as a series of injections described as a “fat-melting” alternative to liposuction. The process is also known as injection lipolysis, lipozap, lipotherapy, and mesotherapy. There is no standardized list of ingredients for these injections since they are typically chemical cocktails with a makeup that varies depending on the pharmacy or spa that prepares the injections. The American Society for Aesthetic Plastic Surgery (ASAPS) reports a range of adverse effects including infections, defects and tissue death after lipodissolve. The FDA has reports of permanent scarring, skin deformation, deep, and painful knots under the skin in areas where the lipodissolve treatments were injected.

FDA Cracks Down on “Fat-Melting”

The Food and Drug Administration (FDA) is cracking down with long overdue warnings for the claims spas are making about lipodissolve since the injections have not been proven safe or effective and are not approved by the agency.

FDA warnings have gone out to six U.S companies:

• Monarch Medspa in King of Prussia, PA
• Spa 35 in Boise, ID
• Medical Cosmetic Enhancements in Chevy Chase, MD
• Innovative Directions in Health in Edina, MN
• PURE Med Spa in Boca Raton, FL
• All About You Med Spa in Madison, IN

So although a quick-fix for menopause weight gain may be tempting, lipodissolve is not FDA-approved and the safety and efficacy of the procedure has not been established.

Many mid-life women experience changes in sexual health including vaginal atrophy, vaginal dryness and painful sexual intercourse. Since many women do not discuss these issues, we are conducting an anonymous survey to better understand the types of sexual health issues women are dealing with so we can design appropriate educational materials. We appreciate your responses and will share our results.

In a previous blog post – Sexual Changes during Perimenopause and Beyond – I reviewed some of the sexual changes that may occur with menopause. One of the most common sexual issue for postmenopausal women is vaginal atrophy (atrophic vaginitis), the thinning and inflammation of vaginal walls induced by declining estrogen. Vaginal atrophy can lead to vaginal dryness and painful sexual intercourse.

Although many women do not seek help for this condition, estrogen treatment has been proven effective in restoring vaginal health and improving symptoms.

Estrogen Options

There are a number of low dose hormone therapies available in a variety of forms such as vaginal tablets, rings and creams. These local therapies relieve dryness and painful intercourse by rebuilding the lining of the vagina and urethra. Compared with oral formulations, locally administered estrogen therapies have lower risks because they do not act systemically with minimal absorption throughout the body. Another option is now available with the recent FDA approval of a lower dose (10mcg) formulation of Vagifem (estradiol vaginal tablets, from Novo Nordisk) for the treatment of atrophic vaginitis due to menopause. Vagifem is already available as a 25mcg vaginal tablet but the new dose formulation makes it the lowest local estrogen dose available in the U.S., giving women another option for consideration.

The U.S. Preventive Services Task Force (USPSTF) published new mammography guidelines in the November 17 issue of Annals of Internal Medicine. As published, “The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms”.

Not unexpectedly, the publication has resulted in an outpouring of reactions from both the public and the medical community. Many healthcare providers, medical societies and institutions do not recommend waiting until 50 for mammography screening, citing flaws in the analysis and methods used to develop the new guidelines. Most agree there are limitations to mammography, but imaging technologies are improving and are currently better than those used in the studies reviewed by the USPSTF. Since radiologists, the only specialists trained in mammography, were not represented on the Task Force, the expertise of the panel has been called into question. Additional concerns have been expressed regarding the modeling data utilized and pivotal clinical data that was not considered by the USPSTF.

The American College of Radiology has voiced strong opposition to the guidelines stating two decades of decline in breast cancer mortality could be reversed if women 40-49 are not screened. “These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49” said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.

USPSTF Defends Mammography Guidelines

The U.S. Preventive Services Task Force responded to the reactions to their mammography recommendations on December 2, 2009 before a congressional panel. During the panel, the USPSTF states they did not tell women under 50 not to have mammograms, but that screening women under 50 is supported by limited clinical evidence and that women should decide with their physicians.

Regardless of whether physicians and patients adhere to the Task Force recommendations, the revised guidelines may have many unintended consequences for women. Although the USPSTF is an independent panel, the Medicare Improvements for Patients and Providers Act of 2008 gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for preventive services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-saving measure. Thus, there exists considerable potential for the guidelines to impact reimbursement for many women down the line.

A United Voice for Mammography

Get Primed! and Menopause Alliance are committed to supporting mammography screening for all women 40+. We need a strong, united voice to represent our needs to decision and policy makers. So please, join us and add your voice to the conversation.

• Share your comments with us on this important issue
• Subscribe to Get Primed! for updates
• Join us on twitter @getprimedcoach as we post updates to the mammography debate

For some boomers thrust into employment interviews as a consequence of job losses, it can feel like a tough sell when competing with younger, fresh looking candidates. Experience, skills and intellect aside, appearances do matter and unfortunately wrinkles and hollow eyes make many a candidate look harried rather than refreshed and eager to do the job at hand. For a boost of confidence, some women are opting for facial rejuvenation procedures before hitting the interview circuit.

Injectable dermal fillers are designed to replace the lost facial volume that occurs as one ages and can be used for a number of issues such as crow’s feet, laugh lines, brow furrows and marionette lines. Although dermal fillers are temporary, lasting anywhere from a few months to a year, there is little recovery time and virtually no downtime after the procedure.

With all the advances in the facial filler market, there are lots of options to reduce wrinkles and sagging skin, besides the more drastic step of going under the knife. Since few can afford to take on the cost, risk or downtime needed for plastic surgery, injectable dermal fillers are an option to consider.

Selecting a Professional to Inject Dermal Fillers

Selecting an experienced professional is critical since results will vary depending on the injector’s expertise. Unfortunately the increased popularity of the procedure has led to some inexperienced and untrained (or little trained) practitioners offering dermal filler injections. As a consumer, investing in a bit of research before signing on for procedures is a must. Here are a few things to keep in mind when selecting an injector:

1. Injection experience is a critical issue when selecting a physician or nurse for dermal fillers. So as a first step, ask how many procedures they have performed over the last year, and with which fillers.

2. Seek out an individual who is board certified in dermatology, facial plastic surgery or plastic surgery.

3. Ask to see “before and after” pictures of other patients.

4. Ask questions about risks, benefits and alternatives in order to make an informed decision. Don’t simply accept recommendations without all the information.

5. Do not pick a facial filler or injector based on prices. In some cases, the more expensive product may be more cost-effective.

Dermal Fillers Might Not Be the Best Solution

An experienced physician or nurse should first conduct a comprehensive facial analysis in order to recommend the most appropriate procedure and product to address your unique concerns. A qualified provider should give you a realistic assessment, and in some cases, if there is too much sagging, fillers won’t work and other options should be discussed. Many professionals suggest that the optimal age to begin fillers is in 40’s to early 50s.

Oral health is an important and often overlooked component of an adult’s general health and well-being. We all know the basics of brushing and flossing but few realize the connection between oral health and serious diseases such as osteoporosis, diabetes and heart disease. Researchers have found that people with periodontal disease, a chronic inflammatory disease that affects the gums and bone supporting the teeth, are almost twice as likely to suffer from coronary artery disease.

Osteoporosis Can Impact Your Oral Health

Women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease. Osteoporosis can make your teeth more brittle and susceptible to breakages and when the jawbone becomes less dense, tooth loss can occur. Frequent dental visits may lead to the first clue you have osteoporosis, since dental x rays may reveal early stages of the disease. Dental warning signs of osteoporosis include:

• Loose teeth
• Receding gums
• Dentures that don’t fit well

In addition to the direct impact of osteoporosis on the teeth, osteoporosis treatments, may lead to jaw necrosis – severe destruction of the jawbones. Although it is a rare occurrence, bisphosphonates, a group of medicines commonly prescribed for the treatment of osteoporosis, have been linked to development of osteonecrosis of the jaw (ONJ). The drugs in the bisphosphonate class include Fosamax, Actonel and Boniva. So if you are taking an oral bisphosphonate, it is important to inform your dentist.

A Spot of Tea for Your Teeth

In addition to the many other proposed benefits of green tea, a recent study demonstrated a lower instance of periodontal disease in subjects who regularly drank green tea. So in addition to the basics of brushing and flossing, support your oral health and general health with a spot of green tea.

With all the media attention on human papillomavirus (HPV) vaccination for young girls, many older women mistakenly believe HPV isn’t relevant to them. HPV, a sexually transmitted virus, causes almost all cases of cervical cancer. The National Cancer Institute estimates 11,270 new cases and 4,070 deaths from cervical cancer in the U.S. in 2009. And worldwide, cervical cancer is the second leading cause of cancer death among women.

An estimated 80% of women will get HPV in their lifetime. Most people do not realize they have HPV and the infection only rarely leads to cervical cancer – typically the infection will clear on its own. However, in rare cases, the body is unable to clear the HPV infection and cervical cancer can develop. Early detection is critical because cervical cancer usually does not cause any symptoms until it has advanced to a late stage.

You Can Prevent Cervical Cancer

Although Pap tests continue to be an important screening tool, Pap smears miss up to 40% of precancerous lesions. Therefore, HPV screening should also be included as a part of your regular annual exam. The HPV screening will detect the cancer causing types of HPV and identify women at risk for cervical cancer. Most cervical cancer can be prevented.  So be diligent about your annual exam and ask your healthcare provider to include the HPV test along with your next Pap!

The following resources provide additional information regarding HPV and cervical cancer:

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Strength training is one of the best tools for preventing osteoporosis and maintaining weight – it can slow the metabolic decreases, muscle loss, and weight gain that normally occur in middle-aged women.

Unless you exercise to counter muscle loss, fat replaces muscle resulting in about 1/3-1/2 lb muscle mass lost each year after age 35. To make matters worse, as you lose the muscle tissue, your metabolism also decreases. One of the best strategies to prevent muscle loss is to burn more calories, at work and at rest, by adding or increasing resistance and strength training.

Combating the Muscle Loss

In addition to reducing obesity, strength training reduces signs and symptoms of numerous diseases and chronic conditions, such as arthritis, diabetes, osteoporosis, back pain and depression.

Many women don’t realize the importance of strength training and its link to high bone mineral density. Combining adequate amounts of calcium in the diet with progressive high-intensity resistance training is the best preventative strategy for osteoporosis.

For improving muscle strength, bone density, balance, disease prevention and fat loss, pumping iron is now a proven prescription. If you can’t get to the gym, there are lots of alternatives to support your efforts at incorporating strength and resistance training such as videos, podcasts and books.

Keeping Track to Maintain Fitness Goals

It is helpful to keep a journal or a recording of how much you actually exercise each week. Tracking the amount and type of exercise is not only motivating, but also encourages incorporation of a variety of exercises. With a log, you can clearly see if you are lacking activities that support bone health such as strength training. Try using the Get Primed! Exercise Log for a month and see the benefits of tracking your activities to meet your fitness goals.

Send along any suggestions for modifying the Get Primed! Exercise Log and we will send you a customized version.