Women spend regarding a third of their lifetime during menopause, which usually occurs between the ages of 50 and 52 and signals a turning point in women’s health. in the Lancet a menopause series has now been published in which leading experts in the field discuss the cardiometabolic changes that occur in women during the transition to menopause, factors that predict future cardiometabolic diseases, and preventive strategies (hormonal and non-hormonal) to alleviate the menopause Symptoms in postmenopausal women were investigated, not least in order to prevent chronic diseases later in life, to improve the quality of life and ultimately to contribute to a better and longer life.
Many diseases appear 10-15 years following the onset of menopause. These include weight gain and obesity, metabolic syndrome, diabetes, osteoporosis, arthritis, cardiovascular disease, dementia and cancer. Therefore, the onset of menopause is an important opportunity to resort to preventive strategies that reduce mortality and provide a quality of life booster.
The onset of menopause and the period just before it (perimenopause), as a natural part of the female reproductive aging process, offers a number of prevention and screening strategies for chronic cardiometabolic diseases. This includes hormone therapy.
Menopause Symptoms and Osteoporosis
The use of hormone therapy has proven to be effective, especially for menopausal symptoms (sweating or similar) and osteoporosis, and also improves the metabolic and cardiovascular risk profile. Estrogen, when initiated early, which is crucial here, consistently reduces mortality in younger postmenopausal women (less than 60 years) 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 with menopausal hormone therapy, are clonidine, antihypertensives, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and gabapentin.
cardiovascular diseases
Traditional treatments for cardiovascular disease, such as the use of statins and aspirin, have not found benefit for primary prevention in women. Compared 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 aged 50–59 years, a Cochrane meta-analysis and another meta-analysis. The magnitude of this reduction was consistently around 30%, compared to just 12-14% for lifestyle interventions.
Krebs
Screening for cancer is of paramount importance in menopause management. Mammography should be done every other year in intermediate-risk women from age 45 to 50 to age 69 to 74. Annual screening is possible in high-risk women. Colorectal cancer screening is recommended from the age of 45, either through a colonoscopy or a stool sample (hemoccult test). Postmenopausal women should have cervical cytology or HPV testing every five years until age 65. Modifiable risk factors (eg, smoking, alcohol, high BMI, dietary factors such as a high-fat diet and physical inactivity) may also play an important role in reducing cancer incidence.
Central nervous system and cognition
One of the biggest fears postmenopausal women have is the loss of cognitive function. Several observational data, including meta-analyses of women exposed to estrogen shortly following menopause, have shown protection from 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 aged 65 years or older. Early onset is thus crucial, as has been described in several other studies. Endogenous estrogen exposure and earlier postmenopausal onset of estrogen over a longer period of time have been found to be positively associated with higher cognitive status later in life. To date, there are no prospective long-term data on women who were treated with estrogen shortly following 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, once more suggesting an earlier onset.
Conclusion
In addition to symptom relief in postmenopausal women, the focus of this series of articles was also the prevention of chronic diseases, the prevalence of which increases sharply following menopause. Early initiation of hormone therapy has been shown to play an essential role in symptom control and improvement in quality of life, while reducing mortality. In principle, such a therapy does not have to be long-term either, which would reduce potential long-term risks, which still have to be investigated using prospective studies.
Lobo, RA; Gompel, A: Menopause 2. Management of menopause: a view towards prevention. Lancet Diabetes Endocrinol 2022; 10(6): P457-470
Nappi, RW; Chedraui P; Lambrinoudaki, I; Simoncini, T: Menopause: a cardiometabolic transition. Lancet Diabetes Endocrine 2022; 10(6): P42-456