There is a higher incidence of dysglycemia/impaired glucose tolerance, blood pressure, dyslipidemia and increased waist circumference, all worse in postmenopausal women. Risks respectively for diabetes, BP, higher bad cholesterol as in LDL, triglycerides and lower good cholesterol like HDL are more commonly associated with menopausal women.
Peri and postmenopausal women have an increased risk of cardiovascular events (myocardial infarction, etc.) due to falling oestrogen levels, worsening lipid profile parameters, stiffening of arteries, accelerated atherosclerosis, weight gain and insulin resistance, etc. In addition, Epi and pericardial fat deposition is known to be more post menopausally. Although under 40 yrs age men are at higher risk for heart attack, perimenopausal women have an equal if not slightly higher risk of heart attack.
Brittle bones, increased risk of fractures, joint pains, myalgias etc., are commonly seen in this age group, mainly due to altered vitamin D and calcium homeostasis. There is a solid need to replenish these in them. Bone densitometry studies, DEXA scans etc., can establish the degree of osteopenia, and some might need zoledronic acid and vitamin D and calcium, denosumab, magnesium, etc.
Recurrent UTIs are common in these age groups primarily owing to decreased bladder tone, partial or complete prolapse, dryness etc. In addition, some diabetic meds cause glucosuria, and recurrent genital fungal and bacterial infections may be common. Treating the fungal and bacterial infection and its underlying causes may help these individuals stop the culprit drug for a while. The white discharge also may be a common symptom and needs appropriate treatment.
There is a steep rise in mood disorders such as depression, anxiety, insomnia etc. Adequate support systems from. Family and friends may help; in rare cases, treatment with medicines may be mandated.
While irregular periods may be expected, if bleeding is disproportionate, one must get tested for a pap smear and, in some instances, Dilatation and curettage. In addition, endometrial cancer risk is higher postmenopausal; hence, the treating doctors' team requires high index suspicion.
These may worsen, especially in deficiency of B complex, vitamin C, D, and E. Adequate supplementations have helped immensely in many women. In refractory cases, hormone replacement therapy can help.
It is widespread in this subset of patients owing to various etiologies. This increases manifold one's risk of diabetes, and active interventions to prevent gain must be carried out. A diabetic diet, exercise and rarely medicines that can help reduce weight, such as liraglutide, are known to avoid such unhealthy weight gain. Moreover, increasing weight predisposes to other disorders such as obstructive sleep apnea, osteoarthritis, pulmonary hypertension, fatty liver, nonalcoholic steatohepatitis, thyroid disorders etc.
Defective memory and issues with language skills, attention, mood etc., arise in many post-menopausal women owing to falling oestrogen.
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