Menopause: Assessment and Treatment

Assessment

• The evaluation begins with a medical history and a physical examination.
  
• If the menopausal status is in doubt (e.g., in a young woman with absence of menstrual periods), testing for blood hormones may be helpful.
• For women at risk for osteoporosis, evaluation with dual X–ray absorptiometry (DEXA) scans may be used to measure bone density. An initial examination at 65 is reasonable; earlier screening has been suggested in women who smoke or have family histories of osteoporosis or fractures.
• Women with risk factors for coronary artery disease should be followed regularly and treated as necessary for prevention, which may include treatment for high blood pressure and elevated cholesterol levels.

Treatment

Menopause is a normal part of life, and no treatment is typically required. Symptoms, when they occur, are usually tolerable and eventually pass. However, for women with particularly disturbing symptoms, the following considerations may be helpful:

• Hormone therapy is highly effective, but entails significant risks. Women considering this therapy should be counseled that it has been associated with an increased risk of heart disease, stroke, breast cancer, and endometrial cancer. Other effective treatments for hot flashes include some antidepressant medications (e.g., paroxetine), clonidine, and gabapentin.
• Nutritional therapies may be useful (see Nutritional Considerations).
• Women should be counseled on dietary steps and, if necessary, medical interventions to prevent or treat osteoporosis.
• Exercise is important for stimulating bone formation, as well as for cardiovascular health. Exercise also reduces vasomotor symptoms. Physically active women reported approximately 50 percent fewer (and less severe) hot flashes, compared with sedentary women, although strenuous exercise may also trigger these episodes. However, randomized, controlled trials have not examined the efficacy of exercise in managing hot flashes, and not all studies have reported benefits. 
• Relaxation and other stress management techniques: These lifestyle interventions appear to reduce hot flashes and improve other menopausal symptoms. Several studies have found significant decreases (30 to 100 percent) in hot flashes with the use of relaxation and paced respiration (slow, deep breathing), and with the use of coping skills training.