Nonpharmacologic therapies for menopause-related symptoms have not been studied in large randomized trials, and evidence of benefit is not well documented. Owing to minimal adverse effects with these types of interventions, it is prudent for patients to try lifestyle or behavioral modifications before and in addition to pharmacologic therapy. The most common nonpharmacologic interventions for vasomotor symptoms include the following:3,8,9
• Limit alcohol and caffeine
• Limit spicy foods
• Keep cool, and dress in layers
• Increase exercise
• Paced respiration
Exercise demonstrated an improvement in QoL but did not improve vasomotor symptoms. Paced respiration, a form of deep, slow breathing, improved vasomotor symptoms in a small group of patients.
Dyspareunia may result from vaginal dryness. Water-based lubricants may provide relief for several hours after application. Moisturizers may provide relief for a longer period of time and potentially can prevent infections by maintaining the acidic environment in the vagina. Both these treatments require frequent application.
A decline in estrogen concentrations also may be associated with urinary stress incontinence. Kegel exercises are recommended as a first-line intervention for stress incontinence, although pharmacologic therapy also may be necessary. Kegel exercises strengthen the pelvic floor muscles and help to keep the urethra from opening at inappropriate times, such as when lifting heavy objects, coughing, or sneezing. These exercises have no adverse effects, take little time, may be done inconspicuously, and when done correctly, may help to restore normal urine flow.
Dtsaiss aVomaifvo noofxrmoo^i therapies
Discuss atornatvo nonhormonal iNyapKts
History ot CHOor CHD risk (actors
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Personal fwvxyoi (yeast cancer
Oiscuss aternabve nontormonal tfwapies iHTof estrogen a'one (women with hysterectomy at lowest dose lor störtest durafton
Reassess every 6-12 months
FIGURE 50-1. Treatment algorithm for postmenopausal women. (From Refs. 2, 6, 7.)
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