Some health changes associated with menopause - such as hot flashes, mood swings, irregular bleeding, and difficulty sleeping - are acute (short-term) effects, typically lasting a few months or a few years during perimenopause and early postmenopause. They will usually go away on their own, even without treatment. Prolonged periods of reduced estrogen levels, however, have the potential to cause chronic (long-term) effects in later years, such as osteoporosis, vaginal atrophy, and, possibly, heart disease.
A full discussion with your doctor about current disturbances and future health risks will help determine an individual woman's best treatment options. Some women will find treatment improves their quality of life significantly. Other women do not require or request specific medical management for the hormonal changes of menopause and choose only to maintain a healthy lifestyle. However, all women will benefit from a visit to their menopause specialist (gyn, family doctor) to make sure that the decisions they are making about their health are informed decisions.
For acute symptoms of menopause and for lowering the risk of chronic diseases that can increase after menopause, various treatment options are available, including lifestyle changes, nonprescription remedies, prescription therapies, and complementary and alternative medicine (CAM) therapies. These four categories of options are discussed fully in the next sections of this booklet.

Positive lifestyle changes can have an enormous impact on health. A customized lifestyle modification strategy is an essential element in a comprehensive therapeutic plan that can apply to a woman throughout her life span. These adjustable lifestyle choices include substance use, exercise, nutrition, weight management, and stress reduction.

Use of tobacco and illegal substances, as well as excessive use of alcohol and caffeine, contribute to poor health. Without doubt, smoking is the single most preventable cause of illness and premature death. The reasons to quit or never to start are numerous. Smoking increases the risk of heart and lung disease, osteoporosis, and many types of cancer, including lung and cervical cancer. It may double the risk of Alzheimer's disease and other similar mental diseases. Smokers may also experience menopause up to two years earlier than nonsmokers. Many women successfully quit smoking, sometimes after several attempts. Healthcare providers can offer a variety of smoking cessation aids, including prescription nicotine products (in gum or skin patch regimens) and antidepressants to decrease psychological dependence on smoking. Nicotine products and two prescription meds (Zyban, and Chantix) are FDA-approved to help "kick the habit." Support groups and hypnosis are other potentially helpful options. A combination of behavior modification techniques and prescription drug therapy appears to be the most successful.

For many serious diseases, physical inactivity is a lifestyle risk factor. Adequate exercise is a crucial ingredient often missing from daily life. Brisk walking, running, aerobics, dancing, tennis, and weight-training are but a few of the activities that help the heart, bones, muscles, balance, and body weight.
Proper exercise is a powerful remedy for many menopause complaints and can help prevent future menopause-related diseases. It promotes better, more restorative sleep, and it stimulates production of "feel-good" brain chemistry (endorphins) that turns aside negative thoughts and depressed feelings. Some women report having fewer hot flashes when they exercise regularly. A key first step is to develop a practical, long-term, individually suited exercise plan.
There are three types of exercise: aerobic, weight bearing, and flexibility (stretching). A moderate aerobic exercise regimen of at least 30 minutes each day has the greatest effect on heart and lung health. A brisk two-mile walk is a good aerobic exercise. Weight-bearing exercise, such as walking or working with weights to build muscle, can delay or prevent bone loss. Early in life, exercise promotes higher bone mass; later in life, it can have a modest effect on declining bone loss. Flexibility exercises, such as yoga and stretching, help maintain function while aging and may improve balance, which can decrease the risk of fractures caused by falls. A healthcare provider can help determine the initial level of exercise appropriate for individual needs. Then, finding ways to make exercise a permanent part of daily life will help ensure a healthier future.

"You are what you eat" may sound trite, but it's true. A balanced diet low in saturated fat and high in whole grains, fruits, and vegetables, with adequate water, vitamins, and minerals contributes to good health. Women at perimenopause and beyond have special dietary concerns, because both heart disease and osteoporosis are greatly affected by diet. Heart disease risk can be lowered by using little or no cholesterol or animal fat. Instead, choose olive or canola oil for cooking, and avoid hydrogenated oil found in some peanut butters and margarines. Limit salt and alcohol intake, include five or more servings daily of fruits and vegetables, and include soy foods (such as soy milk and tofu) to lower cholesterol levels (see Phytoestrogens & Soy).
A balanced diet is important for bone development and maintaining bone strength. Some women - especially those who are elderly and have reduced appetites, who diet frequently, who don't consume dairy products, or who have eating disorders - may not consume adequate vitamins and minerals to maintain optimal bone mass.
Osteoporosis risk can be lowered by an adequate intake of calcium, starting in the teen years. This builds bone mass and bone strength to a peak during the 20s and allows the body to draw from this "bone bank account" from then on. As women reach menopause, consuming adequate calcium is still important as ever. NAMS recommends that postmenopausal women consume 1,200 to 1,500 mg of elemental calcium daily. This is significantly more than the average amount consumed each day by women aged 50 to 65 (only 700 mg).
Calcium intake can be increased by eating more calcium-rich dairy products (low-fat or nonfat preferred). A glass of milk or portion of other dairy product provides about 300 mg of calcium. Increased intake of leafy green vegetables and calcium-fortified foods and juices also increases calcium intake. If sufficient calcium is not found in the diet, a calcium supplement can be used (see Nonprescription Remedies).
Vitamin D also plays a major role in helping the body absorb calcium. At least 15 minutes of sun exposure daily (without a sunscreen) is the generally accepted amount the body needs to form its supply. Certain foods (such as fortified milk, liver, and tuna) or a vitamin D supplement can help reach the recommended daily level for postmenopausal women - 400 to 600 IU (see Nonprescription Remedies). New research suggests that at least this amount is needed by women who are never in the sun or who live in northern regions.

Being overweight increases the risk of heart disease and invites other diseases, such as diabetes and arthritis. The most dangerous location of body fat for heart health is the waistline and stomach. As they age, midlife women often gain two pounds a year. When diet and exercise are not enough to control weight, support groups or weight-management organizations may help. Additional therapies are available for those who have a more severe weight problem.
Being too thin is not necessarily healthy either. Premenopausal women who over-diet or over-exercise can become so thin that their menstrual periods stop temporarily. This temporary low estrogen state increases the risk of osteoporosis later in life. Everyone needs to work on strategies to maintain a healthy weight.

Prolonged stress can have a severe impact on health. Although menopause has not been shown to raise stress levels, women at midlife face many stressors, some of them new. A number of coping strategies can be used to help reduce stress (see Psychological Changes). Exercise and meditation may help. Deep, slow, abdominal breathing can increase relaxation and may also reduce hot flashes. Some women report fewer hot flashes when they engage in meditation, yoga, massage, or just a leisurely bath. It is beneficial to reduce stress and take time to relax each day. Women need to care for themselves, both physically and spiritually.

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