by Elaine Sanford, writer for the
Regional Medical Center at Memphis
Diane Pace is a Ph.D., family nurse practitioner who is involved in a research project to better understand and treat patients of menopausal age. She completed her dissertation at the University of Tennessee in the area of menopause and the cardiovascular effects of the use of hormone Replacement Therapy (HRT) and last month, she completed her certification as a Menopause Clinician. Dr. Pace is a nurse practitioner at The Health Loop clinic on South Third. Dr. Pace became interested in the topic because many of her patients are approaching this mid-life age, and because she wanted to know more about the subject. “I wanted information that I could share with my patients that would empower them to make healthy decisions about their lifestyle behaviors at this point in their lives,” said Pace.
“Menopause is not a disease, it is a mid-life developmental change, and women need to make lifestyle modifications to accommodate the changes that they will experience,” she said. “Now that the life expectancy for women is about 76 years, women will spend at least 1/3 of their life in the post-menopausal stage.” For this reason, women need to be educated about estrogen deficiency, which occurs in menopause, as well as osteoporosis, heart disease, urinary disorders and other mid-life issues.
Dr. Pace says many women are confused about when menopause actually occurs. She describes menopause as the point when the menstrual cycle has cased to occur for 12 consecutive months. Pace refers to the time of irregular cycles occurring 1-4 years prior to the last menstrual cycle as menopause-transition. Following the last cycle, she says women are considered to be post-menopausal.
In the United States, the average age for women to become menopausal is about 51 years. However, some recent studies suggest that African-American women may become menopausal between the age of 46 and 49 years. Because every woman has a different menopausal clock, Dr. Pace says there is no marker to assess if a woman is in menopausal transition. The determination is usually made based on the woman’s symptoms. However, symptoms such as flushes, mood swings, and physical complaints, seem to vary across each individual and across cultures, with some women not even experiencing symptoms. “Women may have irregular monthly cycles or they may have two or more periods in one month. It is a highly variable time with no consistent pattern.”
In the early phases of her study, Dr. Pace says she approached the subject from a biological standpoint feeling that menopause was a condition that needed to be managed. Since finding out that there is no typical menopausal patient, she has changed her approach to a more holistic delivery of care, assisting the woman to identify their needs, and counseling on options, which are individualized. “While African-American women may complain more of flushes, Asian women may complain of muscle aches. The point is that women are different.”
Dr. Pace’s program of research has dealt primarily with investigating the effects of HRT on menopausal women. She says she is involved in research to investigate the cardiovascular effects of HRT in African-American women. “Few African-American women have participated in the studies investigating the effects of HRT, so we don’t really know if the benefits/risks are the same as they are for Caucasian women.” Although many studies have been done involving HRT, some have raised many more questions than answers about the use of the therapy. For example, observational studies in the past have seemed to indicate that HRT is effective in preventing heart disease. According to Dr. Pace, we know now that it may still have a positive effect in protecting the cardiovascular system in women without established disease, but it may have no or perhaps deleterious effect in women who have already experienced a cardiac event. “More studies, like the one I am now conducting with African-American women, are necessary to provide us with more information to ensure that we can properly counsel menopausal women about the benefits and risks of taking HRT,” says Dr. Pace.
Another unanswered question about HRT is whether or not the therapy increases the risk of breast cancer. So far, studies have been inconclusive. But the real question should not be whether HRT can increase the risk of breast cancer (which, by the way, being a college graduate has also been linked to an increased risk of breast cancer), but rather whether there is an increased risk of death from breast cancer among women who take HRT.
Women on HRT are much more likely to have their annual mammograms done, identifying tumors at their very early development where medical intervention can result in highly favorable outcomes. Studies also suggest that women with breast cancer who also take hormones tend to respond better to intervention. We also know that HRT increases breast density (fullness) which could mask tumors. Dr. Pace is hoping that a large multi-center trial through UT related to menopause called the Women’s Health Initiative, will provide some of these answers. The project is scheduled for completion by 2005.
Dr. Pace recently obtained added qualification through certification as a Menopause Clinician by the North American Menopause Society (NAMS), which offers an exam to professionals who are responsible for the clinical management of menopausal patients. This certification is only offered to physicians, nurse practitioners and physician’s assistants. She took the exam at the National Convention in New Orleans this past October. Only about 300 medical professionals have achieved this certification in the United States.
Dr. Pace is a national appointee to the Consumer Education Committee for NAMS. She is the Primary Investigator for the PACE study, a large research grant studying the cardiovascular effects of HRT on African-American women. Approximately 100 women will be involved in the 12-week study, which will involve a series of blood tests and a 24-hour cardiogram, collected 3 times. Participants must be 45 to 65 years of age and be post-menopausal; that is, they must not have had a menstrual cycle for at least one year and not have had a hysterectomy or have diabetes. Women are paid $200 for their participation in the study.
To contact Dr. Pace for a confidential consultation, or to make an appointment at the South Third Clinic for counseling, call (901) 946-4501.