Older women’s health: the big issues (Part 2)

For older women, the different stages in their later life present both health challenges and opportunities to promote and protect wellbeing. Professor Clare Gerada, a London-based GP, defines these stages as “big birthday events”, as reaching the age of 50, 60 or 70 means it is time start to face particular health issues, from menopause to weak bones.

Professor Gerada says these birthday events are also an opportunity for women to look at their lifestyle and make healthy changes, such as quitting smoking, reducing alcohol consumption, and improving diet, with encouragement and support from healthcare practitioners.

Further reading:

• A women’s health agenda (Part 1)

But for older women, these key stages of life can involve facing stigma and discrimination, such as a lack of access to Hormonal Replacement Therapy (HRT) to relieve menopause symptoms, and the misdiagnosis of menopause as depression, says Professor Gerada.

“I know of women who have been treated for menopause with antidepressants as though they are depressed, when actually, they are having terrible symptoms, such as night sweats and mood changes,” she says.

To help raise awareness of, and address these kinds of women’s health inequalities, the Public Policy Projects (PPP), a global, independent, subscription-based public policy institute, is working on a major new report entitled State of the Globe: Redressing the Balance – A Women’s Health Agenda. Co-chaired by Professor Gerada, the project aims to put women at the centre of their own health, and practitioners are invited to contribute by giving examples of best practice (see box below).

As part of day-to-day practice, Professor Gerada says healthcare practitioners can inform older women about what to expect from the different stages of health in later life, and how to age in the healthiest way possible.

Menopause: treatments and lifestyle

Menopause is a defining stage in the cycle of women’s health, and usually occurs between 45 and 55 years of age, as a woman’s oestrogen levels decline. According to the NHS, in the UK, the average age for a woman to reach the menopause is 51.

GPs can offer treatments and suggest lifestyle changes if women have severe menopausal symptoms that interfere with their day-to-day life, including HRT and vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness.

For women going through the menopause, this is a time for practitioners to reinforce messages about the importance of eating a healthy, balanced diet and exercising regularly, as maintaining a healthy weight and staying fit can improve some menopausal symptoms.

A diagnosis of menopause should involve “a heavy-duty consultation” looking at health and lifestyle issues, says Professor Gerada.

“As you enter this stage in your life there are two things that are important to address – your weight and smoking.

“For me, menopause is an opportunity to talk to – not nag – women about their diet, and also the harmful effects of smoking and that it’s time to think about quitting,” she says.

During consultations with women with the menopause, where appropriate, Professor Gerada talks about the importance of stopping smoking, as it “reverses the beneficial effects of HRT”, and advises women about the benefits of weight loss.

Bone health

Women who have been through the menopause are at an increased risk of developing weak bones that may break more easily (osteoporosis) as a result of the lower level of oestrogen in the body.

A woman’s medical history and lifestyle prior to turning 50 is “the biggest predictor of their bone health”, says Professor Gerada.

Practitioners can advise women to reduce their chances of developing osteoporosis by taking HRT, exercising regularly, quitting smoking, eating a healthy diet that includes plenty of sources of calcium, such as low-fat milk and yoghurt, and taking calcium and/or vitamin D supplements.

Women aged 50 plus are also advised to cut down on alcohol, which can contribute to bone loss and weakened bones, and increase their risk of osteoporosis. Professor Gerada says advice about alcohol consumption generally is particularly relevant to this cohort of women, which has witnessed the biggest rise in alcohol consumption in recent years.

Eyes, teeth, and feet

By the time women enter their seventies, Prof Gerada advises that their three healthcare priorities should be their eyes, teeth, and feet.

Eye tests should be taken at least every two years, and more often if the woman has diabetes, a history of glaucoma, or is aged 70 or over. Again, it is important to quit smoking, which increases the risk of developing age-related macular degeneration – the most common cause of sight loss in the UK – and cataracts.

A dental check-up should be between 12-24 months, or more frequently, depending on the dentist’s recommendation. Limiting sugar consumption is recommended to prevent tooth decay. And again, cutting down on alcohol and stopping smoking are important for oral health.

Foot care is extremely important for women as they get older, both for health and for safety, as the risk of falls increases. GPs can advise about eligibility for a chiropodist or podiatrist, for treatment for foot conditions.

Furthermore, for women in their 70s, Professor Gerada says it makes sense “while they’re still fighting fit” to “start looking at trip hazards in their homes”.

By advising older women about simple steps they can take to boost their wellbeing, Professor Gerada says practitioners can help them to live “a better, healthier old age”.

Women’s health: patient resources

• Menopause Matters
• Women’s Health Concern – patient support from the British Menopause Society
• Royal Osteoporosis Society
• Falls Prevention NHS

Kathy Oxtoby is a medical journalist.