Women’s Health by the Decades

By Megan Willome

The 50s — A Rebeginning

Pictured: Photo by Cecy Ayala

The Wacoan is continuing its series on women’s health, one decade at a time. This month we consider the 50s, a time for women to refocus on their own health. This shift in perspective can be one of the gifts of midlife change.

In the second season of “Fleabag,” two women are talking in a bar and discussing menopause.

“I was told it was horrendous,” the younger one says.

“It is horrendous, but then it’s magnificent,” the other replies. “Something to look forward to.”

Certainly not all women look forward to what used to be whispered about in hushed tones as The Change, but menopause is something women in midlife now feel more comfortable discussing. It is a normal — although not always easy — part of a woman’s aging process. That’s what Katherine Haynes, M.D. tells her patients.

“My encouragement is aging is not necessarily an easy process,” Haynes said. “I’m 48. I’d like to think I’m 26, but I’m not. Even simple things change, like the collagen in your skin is not the same.”

Dr. Haynes is from Fort Smith, Arkansas, and attended the college of medicine at the University of Arkansas for Medical Sciences in Little Rock. She did her residency at the University of Tennessee Health Science Center in Memphis and has worked in Waco since 2005. She practices at Ascension Medical Group Providence Women’s Health.

Wacoan writer Megan Willome spoke with Dr. Haynes by phone to learn what healthy steps women can take in midlife, what options women have to treat menopausal symptoms, and how this time of life can be what she calls a “rebeginning.”

WACOAN: Why did you decide to go into obstetrics and gynecology as your medical specialty?

Haynes: When I started the process, when I was in medical school, it was the last thing I thought I wanted to do. A couple things drew me in — the surgical aspect of it. I enjoy doing things with my hands. I considered other surgical specialties but wanted a practice where I could develop more long-term relationships with my patients.

What I really enjoy is developing relationships with women over a long period of time. I see them as teenagers, then later when they’re grown and having babies, then I transition with them through menopause. I enjoy those long-term relationships — with them and with their families. Often I get to know their kids and their husbands. There are a lot of specialties where you don’t get that.

WACOAN: It’s a unique doctor-patient relationship.

Haynes: There are so many social things that affect a patient’s physical well-being — death of a husband or tragic things they can go through. Social situations and health are very intertwined. It’s nice to be able to be there for them.

WACOAN: You’ve mentioned that you see a lot of different ages in your practice. What do you like about caring for women in their 50s?

Haynes: The thing I like the most, since I’m close to entering that phase myself, is it’s easy to relate to what they’re going through, what they’re experiencing. Normally they’re at a point in their life where kids are grown, so we share stories about kids, or we exchange ideas about raising teenagers.

WACOAN: Setting aside menopause for a moment, what are other health issues women in their 50s should have on their radar?

Haynes: There’s a lot of health maintenance at this time. Patients get their first colon screening around the age of 50. Typically that includes a colonoscopy. We talk about bone health, prevention of osteopenia and osteoporosis. Do they get enough calcium in their diet? Do they get weight-bearing exercise?

We also do lab work. We’re checking for elevated cholesterol, thyroid disease, checking kidney and liver function, screening for diabetes, making sure they’re getting routine mammograms every one to two years.

We do a family history review. We focus on any type of heredity-related cancers. We talk to them about genetic screening if we’re seeing a pattern in their family history.

WACOAN: So it’s an important time for screenings.

Haynes: We are also doing some of these in their 40s, like mammograms, Paps when needed. From ages 35-50, things are pretty routine — we monitor your periods, make sure you start mammograms. Then after 50 we have to start worrying about other things as you’re growing older, things that need a little more maintenance.

One of main things, in early the 50s, is that’s when the transition into menopause takes place. There may be changes in menstrual cycles. Along with that they’ll notice symptoms like hot flashes, night sweats, vaginal dryness. Sometimes weight gain can come along with menopause a little bit. Since I’m in OB-GYN health, that’s what we focus on in my practice.

WACOAN: I would think questions about menopause would be at the forefront for most of your patients in this age group.

Haynes: Yes. We do some education beforehand about what to expect, what to look out for, what’s normal versus what’s not. I go through, ‘This is what you should see — your periods will space out, become lighter, you may skip a month.’ That’s typical. What I don’t want to see happen is like a period that’s bleeding longer or periods becoming closer together. If that happens, pick up the phone and call me.

WACOAN: What do you advise women in terms of treatment for menopausal symptoms?

Haynes: Treatment for menopause these days depends on the patient’s quality of life. If they say, ‘I have two to three hot flashes a day, but it doesn’t really bother me,’ that doesn’t necessarily warrant treatment with hormones. If they’re miserable and having 15-20 a day, sweating their makeup off, waking up all night long, then those are issues to address and improve their quality of life.

The important thing is to focus on what problems you’re addressing with your treatment. We can get a little bit swayed by what our friends are doing — ‘Oh look, she takes X and she feels great!’ We have to get back to basics. Is your quality of life poor, or do you feel good? If you feel good, I wouldn’t start adding a bunch of things into the mix. If you are having difficulties, then they need to be addressed with your physician.

Some people start chasing numbers — estrogen levels, progesterone levels. I talk to my patients about this: Don’t chase numbers. How you feel with your estrogen level of 40 may be different than how someone else may feel with an estrogen level of 60. Testosterone levels are another one where people can focus on the numbers. For results, you have to look at the whole picture of the person. How does the patient feel? How do we help them feel better?

WACOAN: Do you have patients who ask about treatment with bioidentical hormones?

Haynes: When they want bioidentical hormones, another thing I would say is it’s a bit of a fad these days. But there are bioidentical hormone therapies that are FDA-approved. It’s something to ask your doctor about.

WACOAN: What changes in treatment have you seen since medical school?

Haynes: One of the best things is we have so many different options for treatment of menopausal symptoms. It used to be, back in my training, you had the Premarin pill and that was it. Now we have pills, patches, gels, creams. We have a lot of different things at our disposal to try because everyone responds differently.

Vaginal dryness can also be an issue. We used to only have two options, two creams. Now there are probably seven or eight ways to treat vaginal dryness.

WACOAN: Do you find that women are pretty open to talk about their experiences in this area, or do you have to prompt them a little?

Haynes: Women are pretty open. There’s a maturity that comes with this age group. They’re not as shy or embarrassed as they were in their 30s. Sometimes I do have to prompt a little bit, but it’s a different season of life. People are more open.

WACOAN: I think one of the things women struggle with is wondering whether their personal experience of menopause is normal.

Haynes: There are three transitions a woman goes through in her life: premenopause, then perimenopause (that lasts three to five years, usually, and periods may be irregular as part of that). Then you transition into menopause. That’s the same as post-menopause — those terms are used interchangeably. The biggest problem is we can’t predict when [menopause] is gonna happen. It can be as early as 45 or as late as 58.

And there are other things that can cause these symptoms as well. Is this menopause or thyroid disease? There are other medical issues that can arise midlife, so it’s important for women to see their doctor regularly, once a year, for prevention, for education about what’s coming. A big piece of the patient-physician relationship is learning when to call us.

WACOAN: Another factor is no one knows how long this transition will last.

Haynes: If a patient needs hormones, it’s recommended that they stay on them for three to five years before we transition them off of those.

It does get better. Hot flashes become less frequent, night sweats less frequent.

WACOAN: What kinds of emotional changes can women expect at this time?

Haynes: We start to see a little bit of anxiety. Some of it is surrounding the process of menopause. Hot flashes can make you feel anxious because of the actual hot flash — when is it going to happen next? In some ways the stress about the hot flash becomes difficult.

Also women in this age group may be caring for aging parents, so they may be juggling a lot of things there.

Some of it we can’t really explain — patients who were never anxious before begin to experience a level of anxiety that’s new to them.

WACOAN: What do you tell women who are experiencing these emotional changes?

Haynes: It’s not all about the hormones. There are treatments that are nonhormonal options. Hormones are great as far as helping with basic things, like hot flashes and night sweats, but they don’t help when it comes to anxiety and feeling overwhelmed. Hormones are not treatment options for that.

WACOAN: With that in mind, what are some things every woman should be doing to improve her health as she enters her 50s?

Haynes: I would definitely say finding an exercise routine that they feel is sustainable for a long period of time. It’s important to find an exercise they enjoy. That’s different for everybody.

Also focusing on overall health as opposed to numbers, like weight. I’d like to weigh what I weighed at 18, but that’s not gonna happen unless I make myself miserable.

They also need to have good cardiovascular health, be doing some type of weight-bearing exercise because that builds bone strength, muscle strength and helps metabolism.

WACOAN: As a physician, is there anything that’s surprised you about women in this age group?

Haynes: One of the things that’s great for us is the access patients have to knowledge. I feel like the internet has pros and cons, but a lot of times it’s great because the conversation we have is more directed and focused because they’ve done a little bit of research on their own. We can talk more intelligently about what’s potentially going to happen. That’s been great. People feel empowered to get education from other places.

WACOAN: What advice do you have for women in their 50s?

Haynes: My encouragement is we all struggle with different aspects of aging. That’s the hardest part. But the silver lining is this is a great stage of life. Many women are transitioning to empty nest. They’re able to foster relationships they haven’t had time to foster because they’ve been so focused on their kids. It’s a rebeginning, sometimes, for things that we haven’t had time to focus on.

It’s also a refocus on our health. For me, a lot of it, when your kids are growing up, you’re so busy with dentist appointments, sports, things like that. It’s hard to focus on your own health because you’re focusing on the health of everyone in your family. It’s time to focus on what we want to place importance on.