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Postmenopausal Preventive Health

Menopause is the permanent end of menses and fertility, defined as occurring 12 months after your last period.  With a life expectancy of close to 80 years, the average woman is postmenopausal for almost a third of her life.

Hormone therapy has received an abundance of negative attention.  However, hormone therapy is still highly effective in treating menopausal symptoms. Women taking combined estrogen and progestin therapy have a higher risk of myocardial infarction and venous thromboembolism in one year, stroke after three years and breast cancer after five years. Estrogen alone does not increase the risk of breast cancer in postmenopausal women with a history of a hysterectomy. Hormone therapy should be prescribed at the lowest effective dose for the shortest duration necessary to control menopausal symptoms.  Hormone therapy is appropriate for women who feel the benefits of menopausal symptom relief outweigh the risks.

Osteoporosis is a condition characterized by a decrease in bone density, resulting in fragile bones.  One half of postmenopausal women will experience an osteoporotic fracture during their lifetime.  Bone mineral density screening is recommended for all women 65 years and older.  Screening is also recommended in women younger than 65 years with risk factors including menopause before age 48, surgery to remove ovaries before menopause, smoking, low calcium and vitamin D intake, Family history of osteoporosis, Caucasian or Asian race, hyperthyroidism, long term history of oral steroid therapy.

Coronary heart disease is the most common cause of death in women.  Women 45 years and older should routinely be screened for diabetes, hypertension and hypercholesterolemia to decrease the risk of heart disease.  Eating a healthy diet, regular exercise and smoking cessation also decreases the risk of heart disease.

The United States Preventive Task Force recently changed its recommendations for breast cancer screening to mammography every two years for women age 50 to 74. The American Cancer Society continues to recommend annual mammography starting at age 40 and for as long as a woman is in good health.

Cervical cancer screening with Pap smear is recommended for all women who have a cervix and are or have been sexually active. Women older than 30 years that have had three consecutive normal pap smears may reduce screening to every 2-3 years. Screening can be discontinued after ages 65 if there have been normal pap smears. Pap smears are not required for women who have had a total hysterectomy for benign indications. Colon cancer screening is recommended for all women age 50 years and older.

Due to changes over the past few years regarding preventive care for women, I encourage postmenopausal women to have regular physical exams and dialogue with their physicians to make informed decisions regarding their healthcare.  Remember, you only have one life to live. Live it to the fullest!