The greatest risk for malignancy is the link noted between endometrial cancer and unopposed estrogen therapy. The addition of at least 10 days of progestin therapy along with estrogen therapy eliminates the increased risk of endometrial cancer but may cause withdrawal bleeding. Less bleeding usually occurs with combined, continuous administration of both. Alternatives to hormonal replacement include limitation of foods high in saturated fat and nitrites and avoiding red meat, coffee, tea, chocolate, colas, and alcohol. Vitamins E and D, vitamins of the B complex, calcium gluconate or carbonate, and magnesium may be prescribed by some health care providers.
Regular exercise is especially important during and after the climacteric years.
Exercise stimulates the production of endorphins, which increase one's sense of well-being, improve circulation, and help prevent osteoporosis. Patient education is extremely important in the management of perimenopausal symptoms. Many times the patient suffers because of misinformation and lack of understanding that menopause is a natural process in the life of every woman. The manner in which she reacts to the changes taking place at this period of her life depends to a great extent on her feelings of self-esteem. Knowing what to expect, having a knowledgeable and empathetic person who takes her symptoms seriously and offers support and guidance, and being able to get some control over what is happening to herself can significantly improve the menopausal woman's physical and mental health.