Menopause%20-and-%20hormone%20therapy Patient Education

Diet

• Diet rich in plant-based foods (eg vegetables, fruits, whole grains)
• Low in polyunsaturated 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 helps in intestinal Ca absorption and bone mineralization reducing the risk of falls and fractures
  • Recommended vitamin D intake for patients ≥50 years of age: 800-1000 IU/day
  • The main sources of vitamin D intake are from sun exposure (>15 minutes/day), fortified milk, cereals, egg yolks, salt water fish and liver
• Various calcium preparations and combinations with vitamin D and other vitamins/minerals are available. Please see Osteoporosis in Women disease management chart for dosage guidelines

Exercise

• Regular exercise can:
  
  • Decrease stress
  • Cause lighter periods
  • Reduce severity of 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 (at least 5 days/week) 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, eg 6-9 hours every night
• 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, eg breathing exercises, meditation 

Optimization of BP and Glucose Levels 

• Reduction of modifiable risk factors, eg hypertension and DM, help prevent CVD