From the Guidelines
To prevent menopause symptoms and maintain health during this transition, hormone replacement therapy (HRT) and lifestyle modifications are recommended, as they address hormonal changes, support bone and cardiovascular health, and improve overall quality of life.
Introduction to Menopause Prevention
Menopause is a natural biological process that cannot be prevented entirely. However, symptoms and health during this transition can be managed.
Recommended Approach
The approach should include:
- Hormone replacement therapy (HRT) for symptom relief, typically using estrogen (0.3-1.0 mg daily of oral estradiol or 0.025-0.1 mg/day patch) with progesterone (if you have a uterus) 1.
- Lifestyle modifications:
- Regular exercise (150 minutes weekly of moderate activity)
- A balanced diet rich in calcium (1200 mg daily) and vitamin D (800-1000 IU daily)
- Limiting alcohol and caffeine
- Not smoking
Targeted Treatments
For specific symptoms, targeted treatments include:
- Moisturizers for vaginal dryness
- Selective serotonin reuptake inhibitors for hot flashes (like paroxetine 7.5-25 mg daily)
- Cognitive behavioral therapy for mood changes These approaches are based on the most recent evidence from the USPSTF recommendations 1, which emphasize the importance of individualized decision-making and consideration of risks and benefits for HRT.
Key Considerations
- The quality of evidence on the benefits and harms of HRT varies for different hormone regimens 1.
- Other expert groups have recommended that women who decide to take HRT for the relief of menopausal symptoms use the lowest effective dose for the shortest possible time 1.
- Phytoestrogens (isoflavones) may have some benefits, but the evidence is inconclusive 1.
From the Research
Preventing Menopause-Related Issues
To prevent menopause-related issues, several strategies can be employed, including:
- Hormone therapy, which has been shown to be effective in reducing symptoms and improving quality of life 2, 3, 4
- Instituting preventative strategies early, particularly in younger postmenopausal women (under 60 years), to decrease mortality and improve metabolic and cardiovascular health 2, 5
- Considering the timing of hormone replacement therapy (HRT) initiation, as it has been found to significantly reduce all-cause mortality and cardiovascular disease when initiated in women at younger than 60 years and/or at or near menopause 5
Hormone Therapy
Hormone therapy can be an effective treatment for menopausal symptoms, including:
- Vasomotor symptoms and genitourinary syndrome of menopause 4
- Osteoporosis, with estrogen therapy consistently decreasing mortality with a favourable risk-benefit profile in low-risk women 2
- Cardiovascular disease, with transdermal estrogens posing a lower risk of venous thromboembolism and stroke than oral estrogens 3
Key Considerations
When considering preventative strategies for menopause-related issues, it is essential to:
- Take into account the individual's age, time since menopause, and comorbidity status 4, 5
- Weigh the risks and benefits of hormone therapy, including the type and route of administration 3, 4
- Consider the importance of timing of HRT initiation, as it can significantly impact the effectiveness of treatment 5