For this Discussion, you will select a specific womens health issue. You will research this issue, and share common symptoms, recommended diagnostic tests, and common

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Maturitas Volume 80, Issue 1, January 2015, Pages 24-30

Review

Health issues for menopausal women: The top 11 conditions have common solutions

Gabriella M. van Dijk , Maryam Kavousi , Jenna Troup, Oscar H. Franco

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Outline

https://doi.org/10.1016/j.maturitas.2014.09.013 Get rights and content

Highlights

• A top eleven of menopausal health issues has been described.

• Health issues in middle-aged and elderly women are likely to coexist.

• To improve women's quality of life, prevention of chronic diseases and disability

is a key aspect.

• Menopausal health issues share common solutions.

Abstract

Multiple health issues affect women throughout the life course differently from men, or do not affect men at all. Although attention to

women's health is important in all stages in life, health among middle-aged and elderly women has not received sufficient attention by

scientists and policy-makers. Related to the menopausal transition and the experiences accumulated until that age, many diseases occur or

further develop in middle-aged and elderly women. To improve women's quality of life and guarantee a long-lasting and active role for

middle-aged and elderly women in society, prevention of chronic diseases and disability is a key aspect.

In this manuscript we give an overview of the major health issues for peri- and post-menopausal women, we summarize risk factors and

interventions to improve menopausal health. Based on the available scientific literature and the global burden of disease endeavor, we have

selected and herein describe the following top 11 key health issues, selected in terms of burden exerted in women's mortality, morbidity,

disability and quality of life: cardiovascular disease, musculoskeletal disorders, cancer, cognitive decline and dementia, chronic obstructive

pulmonary disease, diabetes mellitus, metabolic syndrome, depression, vasomotor symptoms, sleep disturbances and migraine.

Keywords

Noncommunicable diseases; Menopause; Risk Factors; Interventions; Nutrition; Lifestyle

1. Introduction

1 1

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Although specific attention to women's health is important in all stages in life, health in middle-aged and elderly women (50+ years) is of

particular interest in life course health research. Related to menopause and the experiences accumulated until that age, many diseases occur

or develop in middle-aged and elderly women. On average, women live 6–8 years longer than men [1]. Considering the increase in the

prevalence of various health issues with advancing age, women constitute a greater proportion of older people suffering disability. Based on

the Global Burden of Diseases 2010 study, the difference between life expectancy and healthy life expectancy is 11.5 years for females [2]. To

improve women's quality of life and guarantee a long-lasting and active role for elderly women in the society, prevention of chronic diseases

and disability is a key aspect.

In the present review, we aim to give an overview of the key health issues, risk factors and care approaches for women during and after

menopause.

2. Major health issues for menopausal women

Middle-aged and elderly women may experience a variety of disorders leading to death or hampering their quality of life. According to the

Global Burden of Diseases [3], the top causes of death in women in developed countries worldwide are cardiovascular diseases (CVDs;

including ischemic heart disease and stroke), cancer, chronic obstructive pulmonary disease (COPD), and diabetes (Table 1). Disease prevalence

differs between women aged 50–69 and women aged over 70. Notably, the top 5 causes of death for women aged 50–69 has not changed since

1990.

Table 1. Top causes of death (presented in descending order) in developed countries globally for women aged 50–69 years and women aged

over 70 years, according to the Global Burden of Disease Study in 2010.

Ischemic heart disease Ischemic heart disease

Stroke Stroke

Breast cancer Alzheimer's disease

Lung cancer Lower respiratory infections

Colorectal cancer COPD

Cirrhosis Other cardiological and circulatory diseases

COPD Colorectal cancer

Ovarian cancer Hypertensive heart disease

Diabetes Lung cancer

Pancreatic cancer Diabetes

Stomach cancer Breast cancer

Cervical cancer Chronic kidney disease

All these diseases cause disability at different levels. Table 2 displays disabling diseases presented by years of life lived with disability (YLD)

and by disability adjusted life years (DALY). Musculoskeletal diseases, cancer, CVD, diabetes, COPD, Alzheimer's diseases and depression are

identified in the top list of disabling diseases in both age groups. The top 5 diseases presented by DALY for both age groups and for YLD for

women aged 50–69 has not changed since 1990, only the order of the diseases has changed.

Table 2. Top disabling diseases (in descending order) in developed countries globally for women aged 50–69 years and women aged over 70 in

2010, presented in years lived with disability (YLD) and in disability adjusted life years (DALY).

Low back pain Low back pain Ischemic heart disease Ischemic heart disease

Major depressive disorder Alzheimer's disease Low back pain Stroke

Other musculoskeletal diseases Falls Stroke Alzheimer's disease

Causes of death

50–69 years 70+ years

Years lived with disability Disability adjusted life years

50–69 years 70+ years 50–69 years 70+ years

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Neck pain Other musculoskeletal diseases Other musculoskeletal diseases COPD

Osteoarthritis Major depressive disorder Breast cancer Low back pain

Diabetes Diabetes Major depressive disorder Diabetes

Anxiety disorders Osteoarthritis Lung cancer Falls

Falls COPD Diabetes Other musculoskeletal diseases

COPD Neck pain COPD Lower respiratory infections

Migraine Other hearing loss Neck pain Colorectal cancer

Ischemic heart disease Ischemic heart disease Osteoarthritis Breast cancer

Rheumatoid arthritis Stroke Colorectal cancer Lung cancer

A wide variety of conditions have been studied in peri- and postmenopausal women. A systematic search in PubMed (July 2013) revealed that

in line with the Global Burden of Diseases findings, the most frequently studied conditions were CVD (including coronary heart disease – CHD,

hypertension and stroke), cancer and depression. Although not part of the top 10 causes of death or disability in the Global Burden of Disease

study, vasomotor symptoms but also osteoporosis were often studied in peri- and postmenopausal women. Other frequently studied diseases

found in PubMed were body weight change, type 2 diabetes mellitus (DM), metabolic syndrome (MetS), sleep disturbances and urogenital

symptoms. Less frequently mentioned in the literature were cognitive decline and dementia and migraine. COPD and respiratory infections

were not found to be extensively studied in (post)menopausal women.

Based on the available scientific literature and the Global Burden of Disease study, we selected the following top eleven major health issues in

peri- and postmenopausal women to be discussed in this review (Fig. 1): CVD, musculoskeletal diseases, cancer, dementia, chronic respiratory

disease, diabetes, MetS, depression, vasomotor symptoms or hot flashes, sleep disturbances and migraine. Most – not all – of these conditions

are closely related to menopause or to changes occurring during this period of life.

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Fig. 1. “Metawoman”: top eleven major health issues in peri- and postmenopausal women.

Years lived with disability Disability adjusted life years

50–69 years 70+ years 50–69 years 70+ years

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The Global Burden of Disease study indicates several risk factors for death and disability among women over 50 years including dietary risks,

metabolic factors such as high blood pressure and total cholesterol, high and low body mass index (BMI), physical inactivity, smoking,

household air pollution and alcohol [3]. Besides some general risk factors, each health issue in menopausal women has its specific risk factors.

3. Cardiovascular disease: number one cause of mortality and morbidity

CVD is the leading cause of mortality and morbidity among women in developed countries and is a major cause of disability. About 54% of all

deaths and 39% of all disability among women over 70 are caused by CVD. Corresponding percentages are 31% and 18% for women aged 50–69

[3].

However, there is still a paucity of information about CVD in women. This is probably because the disease rarely occurs in women younger

than 50 years, while CVD incidence and mortality begin to increase in men in their forties. Women presumably lose their apparent female

advantage regarding CVD after menopause. The prevalence of CVD and risk factors such as hypertension and CHD, increases rapidly at the

onset of menopause and continues to increase through the postmenopausal period [3], [4], [5]. The increased risk of CVD among menopausal

women appears to be associated with loss of ovarian function, accompanied by loss of estrogen and alterations in progesterone secretion [4];

and with the substantial metabolic changes occurring during menopause that emerge with estrogen deficiency [6] (of which the accumulation

of excess abdominal fat during menopause plays an important role) and also with deleterious changes in nutrition and lifestyle factors that

accumulate during this period of time. Conventional CVD risk factors include smoking, poor diet, decrease in physical activity, alcohol,

metabolic factors including high blood pressure, dyslipidemia (high cholesterol and low high-density lipoprotein – HDL – cholesterol), and

sleep disturbances [4], [7], [8]. Hormone replacement therapy (HRT) – although might be beneficial in early postmenopause [9], [10] – has

been suggested as a potential risk factor for CVD in menopausal women. CVD may also result from genetic factors including single-gene

mutations, gene–gene or gene–environment interactions (REF Cardiogram).

Guidelines for CVD management do not recommend HRT but focus on lifestyle and management of overweight and obesity. The recent

ACC/AHA guidelines recommend heart healthy lifestyle behaviors; consuming a healthy diet, engaging in physical activity and achieving and

maintaining a healthy weight [11], [12]. The guidelines also address cardiovascular risk assessment and cholesterol treatment to reduce the

risk; however they do not include advises regarding vitamin supplementation for which no convincing evidence has been found [13].

4. Musculoskeletal disorders: the burden increases with age

Musculoskeletal disorders are highly prevalent among older adults [3]. 9.5% of disability among women over 70% and 17% among women aged

50–69 is caused by musculoskeletal disorders. Peri- and postmenopausal women frequently suffer osteoporosis, sarcopenia and osteoarthritis.

Osteoporosis, characterized by a reduction of bone mineral density (BMD) and micro-architectural deterioration of bone tissue, resulting in

high risk of fractures, is becoming increasingly prevalent with the aging of the world's population [14]. BMD decreases with age showing a

steeper decline at menopause [15]. Consequently, osteoporotic fracture risk is higher in older women than in older men [14]. Deleterious

changes in lifestyle factors, loss of ovarian function and changes in the estrogen level are associated with a significant increase in the

prevalence of osteoporosis [4]. Besides hormonal factors, risk factors such as cigarette smoking, low physical activity, low intake of calcium

and vitamin D, inadequate sun exposure, and race are associated with osteoporotic fractures. Although HRT had a positive effect on fracture

prevention (especially in combination with calcium and vitamin D supplementation) [16], adverse effects might outweigh possible benefits.

Clinical management should, therefore, focus on other modifiable risk factors, such as adequate sun exposure and maintenance of adequate

dietary calcium and vitamin D intake. Vitamin D and calcium supplementation seem to be beneficial in older postmenopausal women [17],

[18], though caution is warranted because of possible formation of renal stones [22]. Phyto-estrogens seem to have no effect on bone health

[19].

Osteoarthritis is a common joint disorder in the elderly, characterized by the breakdown of the joint's cartilage. It is a leading cause of

disability [3], [20] and is more common among post-menopausal women than men of the same age. Changes in sex hormones are assumed to

play a role in the OA development [21]. Besides female gender, other identified risk factors are age, obesity, physical inactivity, race, history of

injury, joint mal-alignment and diet [20]. Besides avoidance of injuries and stress to the joints, prevention strategies aim at

reaching/maintaining ideal body weight by nutritional and lifestyle changes and above all maintenance of optimal levels of physical activity.

There is no consensus on the effect of glucosamine supplementation to prevent osteoarthritis and current guidelines do not support

glucosamine intake.

5. Cancer in middle-aged and elderly women

Cancer is one of the leading causes of death and disability worldwide [3], [22]. Of all deaths, 41% among women aged 50–69% and 16% among

women 70+ are attributed to cancer. Cancers of lung, breast, colorectal, ovaries, pancreas and cervix are the most prevalent types among

middle-aged and elderly women. General behavioral and lifestyle risk factors for cancer include high BMI, low fruit and vegetable intake, lack

4/10/23, 2:24 PM Health issues for menopausal women: The top 11 conditions have common solutions – ScienceDirect

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