Are there specific health concerns that I should know about that become more important during, and after the menopausal transition?

Menopause does not mean that your general health will automatically deteriorate. However, additional preventive healthcare is recommended around this time. This is partly due to the physiological changes associated with menopause and partly due to age-related changes in health. Here are some of the most important things to consider as you enter the perimenopause/menopause years:

 

  • Breast cancer screening: Breast cancer is the second most common cancer in women and the second most common cause of cancer related deaths. The lifetime risk of breast cancer is about 12% or 1 in 8 women and most of these cancers occur in women with no specific risk factors. The risk for breast cancer increases with age with most women being diagnosed after the age of 50. Woman aged 40-49 have a higher risk than younger women but not as high as after the age of 50.


Cancers diagnosed earlier have a better prognosis with a higher chance of survival. Many medical organizations have made recommendations about breast cancer screening. In general, screening for breast cancer with mammography in average risk women should begin sometime between the ages of 40 and 50, depending on which recommendations are followed. Screening should be done every one or two years and continue till age 74.

 

  • Osteoporosis screening: One of the important functions of estrogen is to maintain bone density by inhibiting the development of cells that break down bone, called osteoclasts. The steep decline in estrogen levels that accompany menopause causes a decrease in bone density.

    Osteoporosis is diagnosed when bone density decreases beyond a certain point. Osteopenia is a milder form of bone density loss that precedes osteoporosis. These conditions greatly increase the risk of bone fractures, which cause a lot of suffering and can even cause death in the case of hip fractures.

    Screening can help diagnose osteoporosis or osteopenia before a fracture, and treatment can be initiated to decrease the risk of fractures. The United States Preventive Services Task Force (USPSTF) recommends screening for osteoporosis in women aged 65 and older without risk factors for osteoporosis and for postmenopausal women younger than 65 who are at increased risk of osteoporosis. Screening is done with Dual-energy X-ray Absorptiometry (DEXA) scan. The most commonly used tool to screen for fracture risk is the FRAX calculator. Some risk factors for osteoporosis that the FRAX calculator takes into account include smoking, caucasian race, rheumatoid arthritis, heavy alcohol use (3 or more drinks per day), and people taken glucocorticoids (e.g. prednisone, hydrocortisone) for any condition.

Lifestyle behaviors associated with healthier skeletal health include a nutritious diet, weight bearing exercise, avoiding smoking, and avoiding excess alcohol (more than one drink daily for women).

 

  • Cervical cancer screening: Cervical cancer screening continues to be important throughout, and after, the transition to menopause. The USPSTF recommends cervical cancer screening with pap testing every 3 years or pap testing plus testing for high risk HPV testing every 5 years. According to the USPSTF, women can stop cervical cancer screening if they fulfill one of the following:
    • Women who have had a hysterectomy (with removal of the cervix) due to reasons other than cancer should stop screening if they have no history of abnormal pap smears.
    • Women over 65 should stop cervical cancer screening if they’ve had three negative paps in a row or two negative pap plus HPV tests in a row within the past 10 years, with the last test being in the previous 5 years.

 

  • Cardiovascular disease: After menopause, women have greater increases in cardiovascular risk and end up catching up to their male counterparts in terms of cardiovascular risk. This seems to be at least partially due to withdrawal of a protective effect of estrogen on different parts of the cardiovascular system.

 

Hormone therapy after menopause has not been shown to protect against cardiovascular disease although there is a possibility that it is protective if started in younger women who have recently gone through menopause.

 

Cardiovascular risk factors that should be addressed are high cholesterol, high blood pressure, smoking, and diabetes. This is also a great time to pay more attention to healthy diet and begin an exercise program (with your doctor’s approval) if you don’t already have one.



  • Colorectal cancer screening: Colorectal cancer is the third most common cancer in women and the third most common cause of cancer deaths in women. Early detection through screening can save lives. Most colorectal cancers are diagnosed after age 50 although cases in people under 50 are on the rise.

 

For people with average risk, the USPSTF recommends screening for colorectal cancer starting at age 50 and continuing till age 75. The American Cancer Society recommends screening for colorectal cancer starting at age 45 in those with average risk and continuing till age 75. People aged 76-85 can discuss continuing screening with their doctor. Colon cancer screening should stop once people reach 85. Various screening methods are available, including colonoscopy, fecal immunohistochemistry (FIT) testing, flexible sigmoidoscopy, Cologuard, and CT colonography. Discuss with your doctor which method is best for you.



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