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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #9

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LEARNING OBJECTIVES

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Learning Objectives

  • Define the clinical diagnosis of menopause.

  • Describe the key changes in sex steroid hormones that occur during the menopausal transition.

  • List common menopausal symptoms and describe their relationship to chronic disease risk.

  • Describe the significant changes in bone health, obesity, and body composition and the cardiovascular risks that are associated with the menopausal transition.

  • List physiologic changes during the menopausal transition that may link menopause to physical functioning decline and osteoarthritis (OA).

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Key Clinical Points

  1. Between 60% and 80% of menopausal women experience vasomotor symptoms (VMS) at some point during the menopausal transition; VMS are associated with sleep difficulties and changes in cardiovascular risk.

  2. Physiologic changes associated with cardiovascular disease (CVD) risk begin in the midlife, including an accelerated increase in total cholesterol, low-density lipoprotein-cholesterol (LDL-C), apolipoprotein B, and adverse changes in intima-media thickness and adventitial diameter of the carotid artery.

  3. Sleep difficulties increase as women transition through menopause, and women with surgical menopause report the highest prevalence of problems.

  4. The increase in weight during the midlife is related to both aging and ovarian aging. This midlife increase in body weight is associated with both increased fat mass and decreased lean mass.

  5. In women, half of the lifetime loss in bone mineral density (BMD) occurs during the menopausal transition and early postmenopausal period.

  6. Up to 25% of newly postmenopausal women have substantial functional limitations.

  7. The incidence of OA among women increases fivefold between the ages of 40 to 49 and doubles again between the ages of 50 and 59, with up to 66% of women having radiographic evidence of knee OA in early postmenopause.

  8. Women are twice as likely to suffer from depression as compared to men, and the menopausal transition and postmenopausal period are associated with increased risk of depression as compared to the premenopausal period.

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INTRODUCTION

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The profile of female geriatric patients will be changing considerably over the next decade. A substantial number of women born during the baby boom following World War II are at or beyond midlife, resulting in an increasing number of women who will be seeking treatment for symptoms associated with menopause and for chronic conditions that have their origin in midlife (see Chapter 5 for details on demographics). Further, the cohort of US women who are now at midlife is unique. More than three-quarters are in the workforce; more than one-third have college degrees; and family composition has changed remarkably as evidenced by the number of live births that have declined by almost half.

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The midlife encompasses approximately the ages of 40 to 65 and, for women, the menopausal transition. For many women, this life stage will be a significant milestone and a harbinger of their health status and their interaction with health care systems for the ensuing decades. Thus, it is important to understand the ...

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