menopause%20-and-%20hormone%20therapy
MENOPAUSE & HORMONE THERAPY
Spontaneous/Natural menopause is the final menstrual period confirmed after 12 consecutive months of amenorrhea with no pathological cause.
Induced menopause is the permanent cessation of menstruation after bilateral oophorectomy (ie surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy).
Perimenopause/Menopause transition/Climacteric is the duration when menstrual cycle & endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause.
Premature menopause is menopause before 40 years of age whether natural or induced while early menopause is spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or under 45 years of age.

Lifestyle Modification

Diet

  • Diet rich in plant-based foods (eg vegetables, fruits, whole grains)
  • Low saturated fats, trans-fatty acids, sugar and salt
  • High fiber, milk and meat
  • 6-8 glasses of water/day
  • Lifelong intake of adequate calcium (Ca) is associated with higher peak bone mass which reduces the risk of osteoporosis/fracture in later life
    • Recommended Ca intake: 500-1200 mg/day
    • The main sources of Ca intake are from dairy products; vegetables (eg broccoli, cabbage) are also a good source
    • Vitamin D (Vit D) helps in intestinal Ca absorption and bone mineralization
    • Recommended Vit D intake for patients >50 years of age: 800-1000 IU/day
    • The main sources of Vit D intake are from sun exposure (>15 minutes/day), fortified milk, cereals, egg yolks, salt water fish and liver

Exercise

  • Regular exercise can:
    • Decrease stress
    • Cause lighter periods
    • Reduce menopausal symptoms
    • Decrease bone loss
    • Improve balance and strength
  • Exercise program should be individualized taking into account a woman’s age, ability and preferences
  • Moderate aerobic exercise for 30 minutes on most days even in 10-minute sessions is recommended for its cardioprotective effects
  • Weight-bearing exercise for at least 20-30 minutes/day is recommended to prevent osteoporosis
    • Muscle strengthening of the upper and lower limbs, abdomen and back for 30-60 minutes 3x/week can improve bone mass and reduce back pain
  • Flexibility training (eg tai chi, yoga)
    • Improves balance thereby preventing falls and fractures

Perimenopausal Weight Gain

  • Weight gain during perimenopause is common
    • Associated with an age-associated reduction in metabolic rate
    • Shift in ratio of lean-to-fat body composition
  • Can be minimized with low-fat diet, moderate calorie restriction and modest increase in exercise

Weight Loss in Obese Individuals

  • Achieved mainly by dietary changes and exercise
  • Weight loss should be gradual - 10% of body weight in 3-6 months
  • 5-10% weight loss can improve insulin resistance syndrome-associated abnormalities

Smoking Cessation

  • Encourage patient to quit
  • Higher doses of estrogen may be needed to control vasomotor symptoms in smokers

Alcohol

  • May aggravate menopausal symptoms (eg vasomotor symptoms, insomnia, depression)
  • Excess alcohol may be associated with increased risk of osteoporosis (caused by nutritional deficiencies, including Ca deficiency), limit daily intake to <20 g
  • Increased risk of falls due to imbalance

Caffeine

  • May aggravate insomnia and vasomotor symptoms
  • Caffeine increases Ca urinary excretion
    • Increase dietary Ca to counteract Ca deficiency
    • Add low-fat milk to coffee and tea

Clothing

  • Wear lighter clothing

Sleep

  • Maintain regular sleeping time
  • Avoid exercise late in the day
  • Take a hot shower or bath immediately before going to bed
  • Sleep in a cooler environment

Stress Reduction

  • Adequate sleep and relaxation exercises are helpful
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