Menopause Lifestyle and Prevention

Women have many choices in the ways they can treat symptoms of menopause. All women, however, should aim for a healthy lifestyle. Eat a healthy diet, including 1,500 mg of calcium daily, lower the amount of fat in your diet, and maintain the right balance of calories to support an active lifestyle. If you are overweight, losing weight is encouraged.

• Quit or try to cut down on smoking.
• Drink alcohol moderately, if at all.
• Exercise for 30 minutes at least three times a week.
• Avoid stressful situations.
• Have a yearly mammogram and breast examination by a health professional.

Preventing disease will be a major concern after you go through menopause. Your risk of bone loss and bone fractures (both of which are osteoporosis symptoms), heart disease, and other conditions increases as you age.

To prevent bone loss:

Maintain a healthy diet and exercise. Other treatments for preventing bone loss and osteoporosis symptoms include calcium tablets and Vitamin D. These can be taken separately or combined in a pill.

Other bone treatments require a prescription:

• The hormone calcitonin is used to block bone breakdown.
• The bisphosphonate family of drugs blocks the breakdown of bone and results in an increased amount of bone. Commonly prescribed bisphosphonates include risedronate and alendronate.
• Hormone therapy is effective at preventing bone loss and fractures, but you should weigh the risks against the potential benefits.
• The "designer estrogens," tamoxifen and raloxifene also help to prevent bone loss.
• Parathyroid hormone is used to add bone in severe cases of bone loss.

To prevent heart disease:

A healthy diet and regular exercise can help to keep your heart healthy as you age. If your cholesterol is high, however, you may need cholesterol-lowering drugs. These drugs are called the "statin" drugs, such as, rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin.

The role of estrogen in preventing heart disease is being debated by scientists. Recently, the American Heart Association announced that no woman should take estrogen for the sole purpose of preventing heart disease. Right now more studies are being conducted to learn whether estrogen prevents heart disease and stroke. Hormone therapy combining estrogen plus progestin does not reduce the risk of heart disease in women with or without previous heart disease, and may actually increase the risk of heart disease and stroke in some cases. Newer studies are looking at the ways hormone therapy affects the heart in recently menopausal women with symptoms (those in their 50's) compared to women who have gone at least 15-20 years without a period. While hormone therapy may have some heart benefits in the younger group of postmenopausal women, there is currently not enough medical evidence to warrant its use solely for this purpose, although ongoing studies seek to provide more information.

Preventing other diseases:

Some studies have shown other preventive roles for estrogen. More studies are needed to learn how effective estrogen might be in preventing these diseases. For example:

• Estrogen loss may be linked with Alzheimer's disease, a fact that led to the notion that taking estrogen after menopause might help to prevent this disease. However, the Women's Health Initiative data suggest that women who initiate hormone therapy at age 65 or older have worsening dementia than women who take no hormones. Whether there is an optimal age to initiate estrogen treatment, or whether the results would have been different if estrogen had been started at the time of the menopause is unclear. Until more is known, hormone therapy cannot be recommended for prevention of Alzheimer's disease.
• Taking estrogen plus progestin lowers the risk of developing colon cancer.
• Taking estrogen lowers the risk of developing age-related macular degeneration, a degeneration of the retina of the eye.
• Taking estrogen lowers the risk of bone fractures, one of the leading symptoms of osteoporosis.

It should be remembered that each woman is different, and the benefits of hormone therapy need to balanced against its risks as well as the complete health status of each and every woman to come up with the best plan.

Editors:

Nanette Santoro, MD
Director, Division of Reproductive Endocrinology
Dept. of OB/GYN and Women's Health
Albert Einstein College of Medicine

Richard J. Santen, MD
Professor of Medicine
University of Virginia Health System