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Postmenopausal lifestyle.

It is clear that a woman's lifestyle can modify her health after the menopause. This may seem self-evident, but the data appearing in the journals are impressive.

Adiposity

In affluent societies longevity is increasing, with a quarter more people living to 75 years or older than a century ago. Life expectancy in the USA has now reached an all-time high of 78 years for the population. Will this trend continue, or will the march of adiposity halt or even reverse the statistics? Certainly being overweight or obese is now much more common, with 66% of women in the USA falling into this category today compared with 15% 30 years ago.

Looking at the effects of a raised body mass index (BMI) on health in older women, Sun et al. (BMJ 2009; 339: b3796) showed that being overweight in midlife reduces a woman's chances of enjoying optimal health in old age. This was a large study of over 17 000 nurses who were healthy, in their 50s and lived at least another 20 years, and it revealed an inverse linear relationship between BMI and health. The more overweight the women were, the lower their chances were of a healthy old age, or put another way, an obese woman has 80% lower odds of a healthy survival than a lean woman.

Exercise

It has long been known that women who exercise regularly have a lowered risk of breast cancer postmenopausally. The risk reduction is about a third, but exactly when and how much exercise is needed remains unanswered. To help resolve the 'timing and intensity' query, Peters et al. (BMC Cancer 2009; 9: 349) asked over 100 000 women about their physical activity and linked it to their propensity for developing breast cancer.

It is clear that moderate to vigorous exercise in late adulthood offers the greatest protection. The last decade premenopausally seems the most critical, and the research reinforces the notion of breast cancer risk being modifiable by lifestyle. The mechanism is probably by a combination of lowering sex hormone levels, modulating insulin metabolism and reducing chronic inflammation. Another benefit of keeping fit.

While on the subject of breast cancer, it seems that women who experience breast tenderness on starting hormone replacement therapy may be more at risk from breast cancer than those who do not develop symptoms. Looking back on symptoms reported by women in the active treatment arm of the Women's Health Initiative study, Crandall et al. (Arch Intern Med 2009; 169: 1684-1691) concluded that new-onset tenderness was associated with an increased risk of breast cancer. Self-reporting of tenderness compared with no tenderness gave women a hazard ratio of 1.5, which aligns it with other indicators of risk assessment in the Gail model.

What women experience at the menopause may give important clues as to their future risk profile. History-taking and advice about lifestyle are crucial in the perimenopausal period.

Athol Kent

Editor

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Title Annotation:THE BEST OF THE REST: A summary of some of the best recent landmark articles from the international journals
Author:Kent, Athol
Publication:South African Journal of Obstetrics and Gynaecology
Article Type:Report
Geographic Code:6SOUT
Date:Feb 1, 2010
Words:485
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