**3.7 Obesity**

*Hormone Therapy and Replacement in Cancer and Aging-Related Diseases*

in public discourse or the media (Maturitas 2014; 79–349).

Postcoital soreness and bleeding (Maturitas 2014; 79–349) Vulval/vaginal itching, soreness, burning, and discomfort Urinary frequency, urgency, nocturia, and recurrent UTIs

women complain of the following:

Dyspareunia

Urge incontinence

urinary tract infections.

disrupt the conjugal life.

**3.6 Cardiovascular disease**

**3.5 Osteoporosis**

Vaginal dryness or lack of lubrication

term, which suggests "wasting away" and that vaginitis imply an infective or

inflammatory condition. Neither the old terms encompass the urological symptoms. Furthermore, "vagina" was not regarded as a socially acceptable enough word to use

Due to menopause, the withdrawal of estrogen causes dryness of the vagina, loss of elasticity and flexibility of the vagina, and damage of the vaginal epithelium. So

On examination the vagina seems short and narrow, with the absence of rouge, and appears pale. About 20–30% of postmenopausal women have urgency and have urinary incontinence. With genital prolapse, women may suffer from recurrent

This dryness of the vagina causes decreased lubrication and sexual dysfunction [6]. The single entity of dyspareunia affects all that domains of sexual function. If not treated timely, women complain severe sexual dysfunction, which totally

Accelerated osteoclastic activity and reduced osteoblastic activity and calcitonin activity due to reduced estrogen and aging process lead to osteoporosis. Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk. Osteoporotic fracture burden is increasing worldwide. About half of women 50 and older will have an osteoporosis-related fracture in their lifetime. During the menopausal transition period, the average reduction in bone mass density (BMD) is about 10%. Approximately half of women are losing bone even more rapidly, perhaps as much as 10–20% in those 5–6 years around menopause.

Women could be asymptomatic, or they might have persistent unexplained back pain, recurrent fractures, fracture from minimal trauma, loss of height, and spinal deformities. The incidence of fractures increases, particularly of the distal radius, vertebral body, and upper femur beyond menopause. Wedge compression fractures of the spine lead to backache. Women complaining chronic back pain, bone pain, joint pain, and muscle pain must consult a doctor to exclude osteoporosis. Maintaining optimum body weight and avoiding sedentary work, bone toxic agents, too much alcohol, and smoking are the key strategies to prevent osteoporosis.

With the loss of cardioprotective action of estrogen by its action on lipids, endothelial function, and anti-inflammatory effect, menopausal women are more liable to get ischemic heart disease. Symptoms of coronary heart disease (CHD) in women are somewhat different from typical male type of angina, which are usually brought by exertion and relieved by rest. Women with myocardial infarction have atypical symptoms like fatigue, shortness of breath, and atypical chest pain. Many may have nonobstructive coronary heart disease (CHD); angiogram may not show typical obstruction in the coronary arteries. CHD is the commonest cause of death among postmenopausal women; the ratio of CHD in men to women becomes 1:1

**50**

Menopause along with aging process is associated with an increased risk of obesity and a shift to an abdominal fat distribution with associated increase in health risks. Changes in body composition at menopause may be caused by the decrease in circulating estrogen. For fat distribution shifts, the relative increase in the androgen-estrogen ratio is likely to be important. Large majority of these women have an increased body mass index and waist circumference. Midsection fat distribution is pronounced during menopause and beyond. Women gaining weight especially with increased abdominal girth are prone to develop metabolic syndrome and cardiovascular disease.

But weight gain during midlife and beyond is just not due to menopausal status [8]. So women must try to maintain the optimum body weight.
