0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
Menopause 969➣Nonpharmacologic: vaginal lubricants/moisturizers, regular
sexual stimulation
➣Pharmacologic: short-term estrogen/HRT, vaginal estrogen
creams, vaginal estrogen ring, herbal preparations/dietary sup-
plements
■CHD (leading cause of death in women):
➣CHD increases in older women.
➣Assessment, counseling about risk factors
➣Smoking cessation
➣Exercise, diet, weight loss if overweight
➣Stress management
➣Control of BP, diabetes if present
➣Optimal total serum cholesterol, LDL, HDL, triglycerides
➣Statins
■Osteoporosis:
➣Assessment, counseling about risk factors
➣Dietary calcium and vitamin D
➣Exercise
➣Fall prevention
➣Smoking cessation
➣Limit alcohol
➣Bone mineral density (BMD) testing for all postmenopausal
women with fractures and consider for:
Postmenopausal women <65 y who have additional osteoporo-
sis risk factors
All women >65 y
All women whose decision to begin treatment would be influ-
enced by BMD result
■Consider osteoporosis treatment for postmenopausal women with
vertebral or hip fractures, or BMD T-score−2.0 (or−1.5 if additional
risk factors):
➣Bisphosphonates
➣SERMs
➣Calcitonin
➣PTH analogs
➣Calcium and vitamin D (supplemental only)specific therapy
■None
Estrogen replacement therapy is of questionable safety for long-
term therapy: