Health Recommendations for Postmenopausal Women

Based on the Results of the Women's Health Initiative (WHI) and Other Studies

The WHI is a major 15-year research program to address the most common causes of death, disability and poor quality of life in postmenopausal women. Some of these causes are heart disease, cancer, bone loss (osteoporosis) and others. Taking into account all of the findings from WHI and other studies, here are bottom-line health recommendations for women:

CARDIOVASCULAR DISEASE

Heart Disease: A heart attack is a medical emergency. Know the signs and symptoms of a heart attack. Hormone therapy should not be used to prevent heart disease. In women with heart disease, hormone therapy should not be used to prevent further disease. Hormone therapy increases the risk of blood clots. Below are things women can do to reduce their risk for heart disease.

  • Do not smoke. If you smoke, quit. Women who smoke are 2 to 6 times more likely to suffer a heart attack than non-smoking women.

  • Aim for a healthy weight. Being overweight causes many preventable deaths. Eat a healthy and balanced diet and drink an adequate amount of liquids.

  • Get moving. Make a commitment to be more physically active. Aim for 30 minutes of activity on most, if not all days of the week.

  • Eat for heart health. Choose a diet that is low in saturated fat, trans fat, and cholesterol. Include whole grains, vegetables, and fruits. Read the labels on the food container before buying it.

  • Know your numbers. Ask your caregiver to check your blood pressure, cholesterol (total, HDL, LDL, triglycerides) and blood glucose. Work with your caregiver to improve any numbers that are not normal.

  • High blood pressure. Limit or stop your table salt intake (try salt substitute and food seasonings), avoid salty foods and drinks. Read the labels on the food container before buying it. Avoid becoming overweight by eating well and exercising.

STROKE

Stroke is a medical emergency. Stroke can be the result of a blood clot in the blood vessel in the brain or by a brain hemorrhage (bleeding). Know the signs and symptoms of a stroke. To lower the risk of developing a stroke:

  • Avoid fatty foods.

  • Quit smoking.

  • Control your diabetes, blood pressure, and irregular heart rate.

THROMBOPHLIBITIS (BLOOD CLOT) OF THE LEG

Hormone treatment is a big cause of developing blood clots in the leg. Becoming overweight and leading a stationary lifestyle also may contribute to developing blood clots. Controlling your diet and exercising will help lower the risk of developing blood clots.

CANCER SCREENING

  • Breast Cancer: Women should take steps to reduce their risk of breast cancer. This includes having regular mammograms, monthly self breast exams and regular breast exams by your caregiver. Have a mammogram every one to two years if you are 40 to 49 years old. Have a mammogram annually if you are 50 years old or older depending on your risk factors. Women who are high risk for breast cancer may need more frequent mammograms. There are tests available (testing the genes in your body) if you have family history of breast cancer called BRCA 1 and 2. These tests can help determine the risks of developing breast cancer.

  • Intestinal or Stomach Cancer: Women should talk to their caregiver about when to start screening, what tests and how often they should be done, and the benefits and risks of doing these tests. Tests to consider are a rectal exam, fecal occult blood, sigmoidoscopy, colononoscoby, barium enema and upper GI series of the stomach. Depending on the age, you may want to get a medical and family history of colon cancer. Women who are high risk may need to be screened at an earlier age and more often.

  • Cervical Cancer: A Pap test of the cervix should be done every year and every 3 years when there has been three straight years of a normal Pap test. Women with an abnormal Pap test should be screened more often or have a cervical biopsy depending on your caregiver's recommendation.

  • Uterine Cancer: If you have vaginal bleeding after you are in the menopause, it should be evaluated by your caregiver.

  • Ovarian cancer: There are no reliable tests available to screen for ovarian cancer at this time except for yearly pelvic exams.

  • Lung Cancer: Yearly chest X-rays can detect lung cancer and should be done on high risk women, such as cigarette smokers and women with chronic lung disease (emphysemia).

  • Skin Cancer: A complete body skin exam should be done at your yearly examination. Avoid overexposure to the sun and ultraviolet light lamps. Use a strong sun block cream when in the sun. All of these things are important in lowering the risk of skin cancer.

MENOPAUSE

Menopause Symptoms: Hormone therapy products are effective for treating symptoms associated with menopause:

  • Moderate to severe hot flashes.

  • Night sweats.

  • Mood swings.

  • Headaches.

  • Tiredness.

  • Loss of sex drive.

  • Insomnia.

  • Other symptoms.

However, hormone therapy products carry serious risks, especially in older women. Women who use or are thinking about using estrogen or estrogen with progestin treatments should discuss that with their caregiver. Your caregiver will know if the benefits outweigh the risks. The Food and Drug Administration (FDA) has concluded that hormone therapy should be used only at the lowest doses and for the shortest amount of time to reach treatment goals. It is not known at what doses there may be less risk of serious side effects. There are other treatments such as herbal medication (not controlled or regulated by the FDA), group therapy, counseling and acupuncture that may be helpful.

OSTEOPOROSIS

Protecting Against Bone Loss and Preventing Fracture: If hormone therapy is used for prevention of bone loss (osteoporosis), the risks for bone loss must outweigh the risk of the therapy. Women considering taking hormone therapy for bone loss should ask their health care providers about other medications (fosamax and boniva) that are considered safe and effective for preventing bone loss and bone fractures. To guard against bone loss or fractures, it is recommended that women should take at least 1000-1500 mg of calcium and 400-800 IU of vitamin D daily in divided doses. Smoking and excessive alcohol intake increases the risk of osteoporosis. Eat foods rich in calcium and vitamin D and do weight bearing exercises several times a week as your caregiver suggests.

DIABETES

Diabetes Melitus: Women with Type I or Type 2 diabetes should keep their diabetes in control with diet, exercise and medication. Avoid too many sweets, starchy and fatty foods. Being overweight can affect your diabetes.

COGNITION AND MEMORY

Cognition and Memory: Menopausal hormone therapy is not recommended for the prevention of cognitive disorders such as Alzheimer's disease or memory loss. WHI found that women treated with hormone therapy have a greater risk of developing dementia.

DEPRESSION

Depression may occur at any age, but is common in elderly women. The reasons may be because of physical, medical, social (loneliness), financial and/or economic problems and needs. Becoming involved with church, volunteer or social groups, seeking treatment for any physical or medical problems is recommended. Also, look into getting professional advice for any economic or financial problems.

ACCIDENTS

Accidents are common and can be serious in the elderly woman. Prepare your house to prevent accidents. Eliminate throw rugs, use hip protectors, place hand bars in the bath, shower and toilet areas. Avoid wearing high heel shoes and walking on wet, snowy and icy areas. Stop driving if you have vision, hearing problems or are unsteady with you movements and reflexes.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis causes pain, swelling and stiffness of your bone joints. It can limit many of your activities. Over-the-counter medications may help, but prescription medications may be necessary. Talk with your caregiver about this. Exercise (walking, water aerobics), good posture, using splints on painful joints, warm baths or applying warm compresses to stiff joints and cold compresses to painful joints may be helpful. Smoking and excessive drinking may worsen the symptoms of arthritis. Seek help from a physical therapist if the arthritis is becoming a problem with your daily activities.

IMMUNIZATIONS

Several immunizations are important to have during your senior years, including:

  • Tetanus and a diptheria shot booster every 10 years.

  • Influenza every year before the flu season begins.

  • Pneumonia vaccine.

  • Shingles vaccine.

  • Others as indicated (example: H1N1 vaccine).