Originally posted on Women's Voices for Change.
Dear Dr. Pat,
I am 58 years old, 5 feet, 2 inches tall and I weigh 170 pounds. My doctor tells me that I am pre-diabetic and has warned me that I am increasing my risk for heart disease, stroke and cancer because of my weight. I am still having my periods, and they are a bit longer and heavier than they used to be: eight days and eight pads on the heavy days. I miss an occasional period here and there. None of my girlfriends still have their periods at this age, but I figured that I was just hormonally younger than them. I have never had any female problems. There is no gynecologist in my county anymore. My doctor told me that I need to go to the regional medical center to find out why I am still having my periods. That's a big trip and a big expense for me. Do I really need to go?
It is hard for doctors and patients these days in rural America. Costs are fixed, new government regulations have allowed big insurance companies to lower their payments to doctors and hospitals and there's been a decrease in Medicaid payments to individual doctors and hospitals. Doctors in high-malpractice categories like obstetrics and gynecology can no longer afford to practice in these areas. It is heartbreaking to hear stories like yours of no obstetrical or gynecologic care without a long drive to a bigger county. And with the costs of travel on the rise, this will only decrease access to basic care.
Your local doctor has given you very good advice on two matters: weight loss and the need to see a gynecologist. Overweight women do have an increase in diabetes, high blood pressure, coronary artery disease, stroke and other vascular diseases. In addition, women who are overweight in the late menopausal transition and after menopause have a real increase in endometrial cancer. Epidemiologic data has found a two- to five-fold increase in the risk of developing endometrial cancer among obese pre-menopausal and post-menopausal women. In clinical studies, obesity has in fact been associated with at least 40 percent of endometrial cancer cases.
In an overweight woman, menopause may be delayed, and periods may become heavier and longer because estrogen levels are still high even after the ovaries no longer produce appropriate levels of progesterone. (The high level of estrogen in overweight women is partly the work of fat cells, which turn adrenal hormones into estrogen -- along with other hormonal changes that also increase the active form of estrogen.) This hormonal imbalance, with high estrogen and low progesterone, creates an environment in the body that can cause an increase in endometrial hyperplasia and often endometrial cancer.
The most pressing issue for you is to have a clinical exam by a gynocologist, and then a sonogram of your pelvic organs. The gynecologist will then make a decision based on your age and your history -- including the delayed menopause and your long and heavy bleeding -- and the information we have about obesity and endometrial cancer. It is likely that you will have an endometrial biopsy, then further surgery based on what is found in that sample.
Then, Ruth, it is time to address the underlying cause of so many health problems that you are beginning to develop: your weight.
Obesity is the major cause of so many preventable illnesses in America. Now that we have less access to health care, each of us must do our part to decrease our risk for developing the diseases that are related to being overweight. Not only are Americans now forced to deal with austerity measures in the provision of basic services, we must all do the hard things that will keep us out of the doctor's office and out of the hospital.
Life change is always hard, but you have been given two very powerful reasons to get started. So, begin a gentle daily exercise plan, cut out the foods you know you should not eat, control your portion sizes and eat more frequent small meals.
There is no way out now, Ruth. Just start.
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