The turning point in women's health? A Look at Prevention in Menopause Management

Women spend about a third of their lifetimes during menopause, which usually occurs between the ages of 50 and 52 and marks a turning point in women’s health. In knife A Menopause Series has now been published in which leading experts in the field include cardiometabolic changes occurring in women during the menopausal transition, factors predictive of future cardiometabolic diseases, and preventive strategies (hormonal and non-hormonal) to reduce menopause. Let’s discuss. Postmenopausal women were screened, at least later in life, to prevent chronic diseases, improve their quality of life, and ultimately contribute to a better and longer life.

Many diseases appear 10-15 years after the onset of menopause. These include weight gain and obesity, metabolic syndrome, diabetes, osteoporosis, arthritis, heart disease, dementia and cancer. Therefore, the occurrence of menopause is an important opportunity to resort to preventive strategies that reduce mortality and provide quality of life boosters.

The onset of menopause and the period just before it (perimenopause), as a natural part of the female reproductive aging process, provides several prevention and screening strategies for chronic cardiometabolic diseases. This includes hormone therapy.

Symptoms of Menopause and Osteoporosis

The use of hormone therapy has been shown to be effective, particularly for menopausal symptoms (sweating or similar) and osteoporosis, and also improves metabolic and cardiovascular risk profile. Estrogen, when started early, which is important here, consistently reduces mortality in young postmenopausal women (under 60 years of age) with a favorable risk-benefit profile in low-risk women. Non-hormonal agents that have shown some benefit in placebo-controlled studies, but less than menopausal hormone therapy, are clonidine, antihypertensives, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and gabapentin.

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heart disease

The use of conventional treatments for cardiovascular disease, such as statins and aspirin, has not found any benefit for primary prevention in women. In comparison to these data, estrogen, when initiated within the first few years of menopause, is associated with a reduction in coronary and all-cause mortality. This was revealed by data from the Women’s Health Initiative in women over the age of 50.,59 years, one Cochrane meta-analysis and another meta-analysis. The magnitude of this reduction was consistently around 30%, compared to only 12–14% for the lifestyle intervention.

cancer

Cancer screening is of paramount importance in menopause management. Mammography should be done every other year in at-risk women between the ages of 45 and 50 and those between the ages of 69 and 74. Annual screening is possible in high-risk women. Colorectal cancer screening is recommended starting at age 45, either through colonoscopy or a stool sample (Hemocult test). Postmenopausal women should have a cervical cytology or HPV test every five years until age 65. Modifiable risk factors (eg, dietary factors such as smoking, alcohol, high BMI, high-fat diet and physical inactivity) may also play an important role in reducing the incidence of cancer.

central nervous system and cognition

The biggest fear in post-menopausal women is loss of cognitive function. Several observational data, including a meta-analysis of women exposed to estrogen shortly after menopause, have shown protection against the development of Alzheimer’s disease. In the only prospective study in women (Women’s Health Initiative), there was an increased risk of starting treatment at age 65 or older. Thus early onset is important, as has been described in several other studies. Endogenous estrogen exposure and prolonged earlier postmenopausal onset of estrogen have been positively associated with higher cognitive status later in life. To date, there are no prospective long-term data on women treated with estrogen shortly after menopause and the development of Alzheimer’s disease. However, women who suffer from premature ovarian failure show a loss of estrogenic action in the brain, again suggesting an earlier onset.

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conclusion

In addition to relieving symptoms in postmenopausal women, the focus of this series of articles was also the prevention of chronic diseases, which tend to increase rapidly after menopause. Early initiation of hormone therapy has been shown to play an important role in symptom control and improvement in quality of life while reducing mortality. In principle, such therapy does not even need to be long-term, which would reduce the potential long-term risks, which still have to be investigated using prospective studies.

Lobo, RA; Gompel, A: Menopause 2. Management of menopause: an approach towards prevention. Lancet Diabetes Endocrinol 2022; 10(6): p457-470

Nappi, RW; Chedraui P; Lambrinodaki, I; Simoncini, T: Menopause: a cardiometabolic transition. Lancet Diabetes Endocrino 2022; 10(6): p42-456