Menopause and Osteoporosis
1. Postmenopausal Bleeding:
Menopause is the time in your life when menstruation stops permanently
for at least 6 months in a row. It usually
happens around 50 years of age. Menopause
also happens if you have surgery to remove
your ovaries.
Some of the factors causing postmenopausal bleeding are:
1. Hormone (estrogen) replacement therapy
2. Atrophy of the vagina, which is thinning
and drying of the lining of the vagina
3. Polyps (small growths) in the uterus
or on the cervix
4. Endometrial hyperplasia (enlarged cells
of the lining of the uterus),
5. Infection of the cervix (cervicitis:
acute or chronic).
6. Cancer of the uterus, cervix, or vagina
7. Some types of ovarian tumors
8. Anticoagulants (blood-thinner medicines).
After your Doctor examination he may order some tests, such as:
• Blood tests to verify that you
are menopausal.
• Biopsy (removal of a small amount
of tissue) from the vagina, cervix, or
uterus for lab tests.
• Thyroid hormones level, coagulation
tests, other.
• Radiology investigation as: ultrasound scan, MRI, CT-scan.
Additional investigation done by the Doctor, might include:
1. Endometrial biopsy or D&C, a procedure in which your provider
scrapes the inside of the uterus to get
tissue, which is sent to the lab for tests.
2. Hysteroscopy, a procedure in which
your health care provider uses an instrument
with a light to look inside the uterus
for polyps or other possible problems
3. Laparoscopy, a procedure in which your
provider uses an instrument with a light
to look into your pelvis through a small
cut in the skin of your abdomen
Some of these tests can be done in your Doctor's office, but some are
done in the hospital.
If you have bleeding after menopause,
it is very important to contact the Doctor
as soon as possible to find out the cause.
2. Bone Mineral Density Testing
A bone mineral density test is used to measure the density (strength)
of your bones.
Your bones naturally lose some density, as you get older. The loss
of density weakens the bones. If your
bones are somewhat less dense than normal,
you have osteopenia. If your bones have
lost a lot of density, you have osteoporosis.
Each year there are approximately 700,000
spine fractures and 250,000 hip fractures
in the US. Most of these fractures occur
in people who have osteoporosis. To help
prevent such fractures, it is important
to diagnose osteoporosis. Osteoporosis
can then be treated with diet, exercise,
and sometimes medicines to help make the
bones strong again.
Bone mineral density tests are much more sensitive than normal x-rays.
Normal x-rays do not detect bone loss until at least 30% of the bone
mass has been lost. Bone mineral density tests allow health care providers
to diagnose weakening bones at earlier stages. The test helps your health
care provider decide if you need treatment for osteoporosis.
Dual energy x-ray absorptiometry (DEXA) is the most commonly done
of the tests that use radiation. It is
painless. During the test you lie down
on a padded table. It's best not to move
while the test is being done, but you
can breathe normally. It takes just a
few of minutes to check the bone density
of your spine and hip. (The hip and spine
are the most common areas checked because
they are most prone to fracture if your
bones are weakened.) The amount of radiation
used for this test is very low. It is
about the same amount you would get on
a long plane flight and less than you
are exposed to during a typical chest
x-ray. There are other tests besides the
DEXA scan.
The test results are expressed as 2 types of scores:
• The T-score compares your bone mineral density (BMD) to the
expected bone density value of a healthy young adult (about age 30)
of the same sex and ethnicity.
• The Z-score compares your BMD to the BMD of a healthy person
who is about the same age and body size as you.
The T score is usually used to make treatment decisions using a statistical
measure called a standard deviation (SD). The SD measures the difference
between your BMD and that of a healthy young adult (the reference value).
Every -1 SD ("minus 1 standard deviation") equals a 10 to
12% decrease in bone density. T score results are classified as follows:
• A T score between 0 and -1 standard deviation (SD) is considered
to be normal.
• A T score between -1 and -2.5 SD is classified as osteopenia
(low bone mass).
• A T score of -2.5 SD or less is classified as osteoporosis (very
low bone mass).
The Z score is used to interpret the test results if you are outside
the normal testing range (very young or very old). It is the number
of standard deviations (SD) above or below the reference value for your
age.
It's always a good idea to talk to your Doctor about your results and
make sure that you understand what they mean.
If interested in learning more call Dr. Marcovici at 860-409-1930 for
an appointment!!
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