The Menopause Consultation – An Opportunity For Preventative Care Using Lifestyle Medicine
by Dr Kafayat Lee (GP and Certified Lifestyle Medicine Physician- IBLM, ASLM)Cardiovascular Risk
Cardiovascular risk increases in women after menopause, due to loss of oestrogen that contributes to increased LDL levels, insulin resistance and changes in vascular function.3 These findings can be seen in women who go through premature menopause – with a higher cardiovascular risk compared with women who go through changes at an average age.4,5 The Australian Bureau of Statistics (ABS) data shows that while the overall prevalence of cardiovascular disease has decreased in recent decades, it remains a leading cause of death. In 2022, over 21% of women aged 55-64, increasing to over 33% aged 65-74 and over 46% of those aged 75 and older self-reported as having high blood pressure, a critical risk factor for heart disease.6 Menopausal women are at higher risk of developing type 2 diabetes. Women with diabetes have an increased risk of coronary heart disease compared to men with diabetes, highlighting the increased vulnerability of postmenopausal women to cardiovascular complications.7 The menopause consultation is the perfect way of exploring these risk factors and others such as smoking, lack of exercise, poor diet etc. A detailed lifestyle prescription, health coaching and referral to other team members for advice and guidance, are ideal opportunities to give patients tools to optimise their health.Breast Cancer Risk
Many patients are aware of the increased risk of breast cancer with age and combined oral oestrogen and progesterone menopausal hormone therapy. However, they are often unaware that lifestyle risk factors like smoking have shown to increase oestrogen levels in premenopausal women and are associated with an increase in oestrogen receptor positive cancers.8 High alcohol intake, high intake of red meat, and shift work have also been found to increase risk of breast cancer.9 A BMI increase of 5kg/m2 increases the risk of postmenopausal breast cancer.10 Moderate physical activity has been shown to reduce breast cancer risk.9,11 Smoking cessation has been shown to reduce risk of breast cancer recurrence and decreased mortality in female breast cancer survivors.12,13 Counselling on optimising sleep, smoking cessation and reduction of alcohol, with a set lifestyle plan and referrals to team members to aid in achieving goals will be useful in risk reduction.Osteoporosis Risk
Osteoporosis risk increases in the menopause and premature menopause confers higher risk of osteoporosis. A survey in 2009 showed that, while 93% of women agree that osteoporosis is a serious condition, 8 out of 10 do not believe that they are at personal risk.14 There is a 54% risk of osteoporotic fractures in women over the age of 50.15 Smoking and high alcohol intake also increase the risk of osteoporosis.9 Optimising a well-balanced diet, adequate calcium intake, maintaining adequate vitamin D, smoking cessation and reduction in alcohol intake are essential in reducing the risk of osteoporosis and associated fractures.9,16 Exercise has been shown to reduce the risk of developing osteoporosis.17 OneroTM exercises are evidenced based on research from Griffiths University’s LIFTMOR study to improve bone density in postmenopausal with low bone mass.18Colorectal Cancer Risk
67% of colorectal cancers are diagnosed over the age of 60 in Australia.19
Although menopause has not been directly found to be causative of colorectal cancer, changes e.g. weight gain, which is more common in menopause, leading to obesity has been linked to an increase in colorectal cancers.9,20
Smoking, alcohol and a diet rich in red and processed meat have been shown to increase the risk of colorectal cancer.9
In Conclusion
The medical history during a Perimenopause/Menopause consultation is the perfect opportunity to identify modifiable risk factors as well as non-modifiable health risk factors.
As evidenced above, a lot of risk factors overlap and a detailed history, Lifestyle prescription and team-based approach will help achieve risk reduction and optimal health.
Studies have shown sustained improvement in diet and physical activity after individual lifestyle counselling.21,22
The public trust health professionals for information and health advice.23 Lifestyle Medicine Practitioners share a common goal to uphold good health and aid disease prevention using evidence-based interventions. We are in a unique position to guide women through the perimenopause and menopause to good health. Let’s do it together.
- Panay N et al. (2024). Menopause and MHT in 2024: addressing the key controversies – an International Menopause Society White Paper. Climacteric, 27(5), 441–457. https://doi.org/10.1080/13697137.2024.2394950
- Australasian Menopause Society – Lifestyle and Behavioural Modifications for Menopausal Symptoms (2019) : https://www.menopause.org.au/hp/information-sheets/lifestyle-and-behavioural-modifications-for-menopausal-symptoms
- Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials. JAMA. 2013;310(13):1353–1368. doi:10.1001/jama.2013.278040
- Shuster LT et al. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010 Feb;65(2):161-6. doi: 10.1016/j.maturitas.2009.08.003. Epub 2009 Sep 5. PMID: 19733988; PMCID: PMC2815011. 10.1016/j.maturitas.2009.08.003
- Gita D. Mishra et al;: The InterLACE study: Design, Data Harmonization and Characteristics Across 20 Studies on Women’s Health; Maturitas Volume 92, October 2016, Pages 176-185. https://doi.org/10.1016/j.maturitas.2016.07.021
- https://www.abs.gov.au/statistics/health/health-conditions-and-risks/hypertension-and-high-measured-blood-pressure/latest-release#:~:text=reported%20hypertension%20prevalence-,Over%20one%20in%20ten%20(11.6%25%20or%203.0%20million)%20people,from%204.7%25%20to%2012.4%25).
- Peters SA et al. Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775,385 individuals and 12,539 strokes. Lancet. 2014 Jun 7;383(9933):1973-80. doi: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60040-4/abstract. Epub 2014 Mar 7. PMID: 24613026.
- Jones, M.E.et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Res 19, 118 (2017). https://doi.org/10.1186/s13058-017-0908-4
- Nurses Health Studies: Key Research Findings from the Nurses’ Health Studies https://nurseshealthstudy.org/sites/default/files/pdfs/table%20v2.pdf
- Renehan et al (2008). Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet (London, England), 371(9612), 569–578. https://doi.org/10.1016/S0140-6736(08)60269-X
- Rockhill B et al. A Prospective Study of Recreational Physical Activity and Breast Cancer Risk. Arch Intern Med. 1999;159(19):2290–2296. DOI: 10.1001/archinte.159.19.2290
- Kenfield SA et al. Smoking and Smoking Cessation in Relation to Mortality in Women. JAMA. 2008;299(17):2037–2047. doi:10.1001/jama.299.17.2037-2047. doi: 10.1001/jama.299.17.2037
- J Heberg, J. et al. (2020). Smoking cessation prolongs survival in female cancer survivors – the Danish nurse cohort. European journal of oncology nursing : the official journal of European Oncology Nursing Society, 47, 101796. https://doi.org/10.1016/j.ejon.2020.101796
- https://www.osteoporosis.foundation/sites/iofbonehealth/files/2020-04/how_fragile_is_her_future.pdf
- Chrischilles, et al (1991). A model of lifetime osteoporosis impact. Archives of internal medicine, 151(10), 2026–2032. a. doi:10.1001/archinte.1991.00400100100017
- https://www.osteoporosis.foundation/sites/iofbonehealth/files/2019-03/2015_HealthyNutritionHealthyBones_ThematicReport_English.pdf
- Howe, T. E. et al (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane database of systematic reviews, (7), CD000333. https://doi.org/10.1002/14651858.CD000333.pub2
- ONEROTMExercises for osteoporosis treatment. https://onero.academy/osteoporosis-exercises/
- Australian Institute of Health and Welfare Canberra; 2018, Colorectal and other digestive-tract cancers; Cancer Series Number 114. https://www.aihw.gov.au/getmedia/892d43f7-ab5d-48fe-9969-129f138687f3/aihw-can-117.pdf?v=20230605165443&inline=true
- Larsson, S. C., & Wolk, A. (2007). Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies. The American journal of clinical nutrition, 86(3), 556–565. https://doi.org/10.1093/ajcn/86.3.556
- Baumann, S., Toft, U., Aadahl, M. et al. The long-term effect of screening and lifestyle counseling on changes in physical activity and diet: the Inter99 Study – a randomized controlled trial. Int J Behav Nutr Phys Act 12, 33 (2015).https://doi.org/10.1186/s12966-015-0195-3
- Elmer, P. J. et al. for the PREMIER Collaborative Research Group (2006). Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of internal medicine, 144(7), 485–495. https://doi.org/10.7326/0003-4819-144-7-200604040-00007
- Mainous, A. G.3rd . et al. (2024). Conflict among experts in health recommendations and corresponding public trust in health experts. Frontiers in medicine, 11, 1430263. https://doi.org/10.3389/fmed.2024.1430263
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.
Dr Kafayat Lee
Hello, I’m Kafa, a Certified Lifestyle Medicine Physician and GP based in Melbourne, Australia for 12 years.
My most fulfilling consultations over the years are where I collaborate with my patients to achieve good health and wellbeing. I have a special interest in Women’s Health, especially in the Perimenopause and Menopause with my aim to make consultations accessible to women wherever they are in Australia and promote a long, healthy life.
I have found the community of lifestyle medicine to be fulfilling, supportive and you can find me extolling the virtues of Lifestyle Medicine to anyone that can listen on any given day.
My passion is great coffee. I can be frequently found exploring new cities, and on my travels asking locals for their favourite coffee spots - it’s always a bonus if it comes with an awesome view!
Find me at www.drkafal.com.
