,M5OPAUSE ,GUIDEBOOK ,HELP+ WOM5 MAKE 9=M$ H1L?C>E DECI.NS >.D M5OPAUSE & 2Y #F? ,EDI;N ,"P #B ( #B ,"PS ,PAGES ;I-;III & #IG-AIC ,PUBLI%$ BY3 ,! ,NOR? ,AM]ICAN ,M5OPAUSE ,SOCIETY ,PO/ ,(FICE ,BOX #IDEBG ,CLEVEL&1 ,,OH #DDAJA1 ,,USA ,TEL3 #DDJ-DDB-GEJJ ,FAX3 #DDJ-DDB-BFFJ ;,E-MAIL3 _+INFO@MENOPAUSE.ORG_: ,WEB3 _+WWW.MENOPAUSE.ORG_: ,FUR!R REPRODUC;N OR 4TRIBU;N 9 O!R ?AN A SPECIALIZ$ =MAT IS PROHIBIT$4 ,PRODUC$ 9 ,JI6Y-,BRL 7;,,TM7 0,N,NAL ,BRL ,PRESS ,9C4 #HH ,/4 ,/EPH5 ,/REET ,BO/ON1 ,,MA #JBAAE 7#HJJ7 #EDH-GCBC ,COPY"R #BJJF 0,! ,NOR? ,AM]ICAN ,M5OPAUSE ,SOCIETY4 ,? DOCU;T 0 PREP>$ 9 ,JI6Y-,BRL 7;,,TM71 A TRANSCRIP;N ME?OD : BYPASSES PRO(R1D+ 9 ORD] 63S]VE PRODUC;N "T & EXP5SE4 ,"! MAY 2 AN O3A.NAL ]ROR1 B X %D N SIGNIFICANTLY A6ECT R1D+4 ,IF X DOES1 WE WD APPRECIATE 2+ NOTIFI$4 ,TA# ( ,3T5TS ;III ,PAGE ,PO/M5OPAUSAL ,H1L? """""""""""""" #IG ,HE>T ,41SE """""""""""""""""""" #IH ,DIABETES """"""""""""""""""""" #AJG ,O/EOPOROSIS """""""""""""""""" #AAJ ,C.ER """"""""""""""""""""""""" #ABF ,! ,HORM"O ,!RAPY ,/ORY """"""""" #ADD ,E/ROG5 ,!RAPY 7,,ET7 """"""""" #ADF ,PROGE/OG5 & ,,EPT """""""""""" #AEA ,CU/OM-,COMP.D$ ,HORM"OS """""" #AEH ,BIOID5TICAL ,HORM"OS """"""""" #AFA ,3TRA9DIC,NS """""""""""""""""" #AFB ,SIDE ,E6ECTS """"""""""""""""" #AFD ,RISKS """""""""""""""""""""""" #AFH ,WEI<+ ,B5EFITS & ,RISKS ( ,,EP/,,EPT """""""""""""""" #AGB ,DI6]5T ,WOM51 ,DI6]5T ,NE$S "" #AGD ,A*IEV+ ,OPTIMAL ,H1L? """""""""" #AGD ,LIFE/YLE ,*ANGES """"""""""""" #AGE ,:5 ,M ,HELP IS ,NE$$ """"""""" #AHF ,A ,"T ( ,NEW ,2G9N+S """"""""""" #AHH ,A4I;NAL ,RES\RCES """""""""""""" #AIA ,,M5OPAUSE ,,GUIDEBOOK #IG ,PO/M5OPAUSAL ,H1L? ,MO/ WOM5 :O R1D ? PUBLIC,N >E 9T]E/$ 9 ! ISSUES RELAT$ 6M5OPAUSE & P]IM5OPAUSE4 ,H["E1 H1L? PRO#MS 9 ! YE>S T FOLL[--DUR+ PO/M5OPAUSE-->E RELEVANT Z WELL4 ,DECI.NS MADE >.D M5OPAUSE A6ECT A WOMAN'S H1L? =! RE/ ( H] LIFE4 ,WOM5 :O R1* M5OPAUSE E>LY1 :E!R NATURAL OR 9DUC$1 H A GRT] NE$ = ? 9=M,N1 Z !Y SP5D M YE>S 9 PO/M5OPAUSE4 ,9 ! PO/M5OPAUSAL YE>S1 ALL WOM5 EXP]I;E ! PHYSICAL E6ECTS ( AG+ & MAY AL 2 A6ECT$ 0! HORM"O *ANGES RESPONSI# = M5OPAUSE4 ,^! *ANGES C 9CLUDE S]I\S H1L? 3DI;NS1 S* Z HE>T 41SE1 DIABETES1 O/EOPOROSIS1 & C.ER4 ,DET]M9+ RISK FACTORS = ^! 41SES Z E>LY Z POSSI# ALL[S WOM5 6EMPLOY PREV5TIVE /RATEGIES4 ,M5OPAUSE PRES5TS AN OPPORTUN;Y =A WOMAN 6"UGO A P]SONAL RISK EVALU,N1 :E!R X'S =! F/ "T OR A REASSESS;T4 ,,HE>T ,,41SE ,_M WOM5 ?9K ( HE>T 41SE Z A MAN'S 41SE4 ,9 R1L;Y1 41SES (! HE>T & CIRCULATORY SY/EM 7C>DIOVASCUL> 41SES7 >E ! NUMB]-"O KILL] ( WOM5 9 ,NOR? ,AM]ICA4 ,AF AGE #EE1 M ?AN HALF ( ALL D1?S 9 WOM5 >E CAUS$ 0C>DIOVASCUL> 41SE4 ,M WOM5 ?AN M5 DIE F HE>T 41SE4 ,? MAY 2 2C HE>T 41SE IS (T5 DETECT$ AT LAT] /AGES 9 WOM5 ?AN 9 M5 2C WOM5'S SYMPTOMS C 2 DI6]5T ?AN M5'S4 ,*E/ PA9 )\T HE>T 41SE IS V -MON 9 "Y] WOM51 B 9 OLD] WOM51 *E/ PA9 HAS A HI<] LIKELIHOOD ( 2+ RELAT$ 6HE>T 41SE4 ,:ILE A MAN'S RISK = HE>T 41SE 9CR1SES SIGNIFICANTLY AF AGE #DE1 A WOMAN'S RISK 9CR1SES AF M5OPAUSE1 :AT"E H] AGE4 ,WOM5 :O EXP]I;E PREMATURE M5OPAUSE1 NATURAL OR 9DUC$1 MAY H AN EV5 GRT] RISK = HE>T 41SE4 ,HE>T 41SE RATES 9 PO/M5OPAUSAL WOM5 >E TWO 6?REE "TS HI<] ?AN ^? 9 PREM5OPAUSAL WOM5 (! SAME AGE1 #II L1D+ "S 6SU7E/ T ! BODY'S E/ROG5 PROVIDES "S PROTECTIVE B5EFITS4 ,RESE>* 6CL>IFY ? REL,N%IP IS ONGO+4 ,! MO/ -MON =M ( HE>T 41SE IS CORON>Y >T]Y 41SE 7"S"TS CALL$ CORON>Y HE>T 41SE74 ,! CORON>Y >T]IES SUPPLY ! HE>T MUSCLE ) NUTRI5TS & OXYG54 ,CORON>Y >T]Y 41SE RESULTS :5 ! BUILDUP ( PLAQUE 7FATTY DEPOSITS7 9 ! L9+ ( CORON>Y BLOOD VESSELS REDUCES BLOOD FL[4 ,:5 "O ( ^! >T]IES 2COMES -PLETELY BLOCK$1 DEPRIV+ ! HE>T MUSCLE ( OXYG51 A HE>T ATTACK O3URS4 ,\TSIDE ! HE>T1 41S$ BLOOD VESSELS C CAUSE ADV]SE 3DI;NS S* Z /ROKE & HI< BLOOD PRESSURE4 ,POOR CIRCUL,N 9 ! LIMBS C L1D 6DI6ICULTY WALK+ & EV5 6LOSS ( LIMBS4 ,A C>E;L ASSESS;T (A WOMAN'S HE>T 41SE RISK IS V IMPORTANT1 & M5OPAUSE IS AN EXCELL5T "T 6TAKE /OCK4 ,/UDIES H ID5TIFI$ S"EAL FACTORS T 9CR1SE A WOMAN'S RISK = HE>T 41SE 7SEE 2L74 ,! HI<] A WOMAN'S RISK1 ! M A7RESSIVE H] PREV5TIVE /RATEGY %D BE4 ,HE>T ,41SE ,RISK ,FACTORS = ,WOM5 -- ,AGE #EE OR OLD] -- ,BLACK RACE/E?NIC;Y -- ,CURR5T CIG>ETTE SMOK+ -- ,PHYSICAL 9ACTIV;Y -- ,WEIT ATTACK 2F AGE #EE2 A "M OR SI/] :O _H A HE>T ATTACK 2F AGE #FE2 A CLOSE BLOOD RELATIVE :O _H A /ROKE4 -- ,PREMATURE M5OPAUSE1 ESPECI,Y IF R1*$ 2F #CE ,MA9TA9+ ,HE>T ,H1L? #AJA ,:ILE "S RISK FACTORS _C 2 *ANG$1 O!RS C 2 3TROLL$ OR MODIFI$ 6CR1TE A M HE>T-H1L?Y LIFE/YLE4 ,! FOLL[+ >E RISK FACTORS T C 2 *ANG$ ) LIFE/YLE MODIFIC,N &/OR V>I\S !RAPIES4 .,DON'T .SMOKE4 ,( ALL ! LIFE/YLE FACTORS T C 2 *ANG$1 SMOK+ CESS,N HAS ! GRTE/ IMPACT ON SAV+ LIVES4 ,SMOK]S >E 3SID]ABLY M LIKELY 6H A HE>T ATTACK ?AN NONSMOK]S4 ,B "!'S GD NEWS4 ,:5 A WOMAN /OPS SMOK+1 NO MATT] H[ L;G OR H[ M* %E SMOK$1 H] RISK ( HE>T 41SE DROPS RAPIDLY4 ,"! >E _M O!R GD R1SONS N 6SMOKE4 ,^! 9CLUDE 9CR1S$ VITAL;Y1 IMPROV$ APPE>.E1 & DECR1S$ RISK ( O/EOPOROSIS & C.ER (! C]VIX1 LUNGS1 M\?1 & ?ROAT4 ,"! >E NUM]\S PROGRAMS & AIDS AVAILA# 6HELP WOM5 QUIT SMOK+4 .,3TROL .BLOOD .PRESSURE4 ,HYP]T5.N 7HI< BLOOD PRESSURE7 IS DEF9$ Z AN >M CUFF R1D+ GRT] ?AN #ADJ/#IJ MM ,HG4 ,X IS PREF]A# 6KEEP BLOOD PRESSURE 2L #ABJ/#HJ4 ,EV5 MILD ELEV,NS C D\# ! RISK ( /ROKE OR HE>T ATTACK4 ,HI< BLOOD PRESSURE 2COMES M -MON Z WOM5 AGE4 ,9 FACT1 M ?AN #EJ@3P ( ALL WOM5 OV] AGE #EE >E A6ECT$4 ,BLACK WOM5 >E ESPECI,Y SUSCEPTI#4 ,REGUL> BLOOD PRESSURE TE/+ IS IMPORTANT 2C HI< BLOOD PRESSURE R>ELY CAUSES SYMPTOMS4 ,HI< BLOOD PRESSURE C 2 3TROLL$ 0EAT+ A H1L?Y DIET1 LIMIT+ ! 9TAKE ( SALT & ALCOHOL1 EX]CIS+ ON A REGUL> BASIS1 & REDUC+ /RESS4 ,3TROLL+ WEIE AVAILA# 65H.E ! B5EFICIAL E6ECTS ( ^! LIFE/YLE MODIFIC,NS4 ,! EVID;E SUPPORT+ ! USE ( ANTIHYP]T5SIVE DRUGS 6PREV5T A WIDE RANGE ( ADV]SE H1L? E6ECTS IS V /R;G4 .,3TROL .*OLE/]OL4 ,ABNORMAL LEVELS ( *OLE/]OL 9 ! BLOOD C CAUSE A BUILDUP ( PLAQUE ON ! 9N] WALLS (! >T]IES T SUPPLY BLOOD 6! HE>T &! RE/ (! BODY4 ,? IS CALL$ A!ROSCL]OSIS 7H>D5+ (! >T]IES74 ,PLAQUE SL[S BLOOD FL[ #AJC & C BLOCK A VESSEL 5TIRELY4 ,IF ? HAPP5S 6A BLOOD VESSEL 9 ! HE>T1 A HE>T ATTACK C O3UR4 ,IF ? HAPP5S 6A BLOOD VESSEL 9 ! BRA91 A /ROKE C O3UR4 ,BR++ *OLE/]OL LEVELS 6)9 NORMAL LIMITS HAS A SIGNIFICANT IMPACT ON HE>T 41SE RISK4 ,TOTAL *OLE/]OL %D 2 LESS ?AN #BJJ MG/D,L 7#E.AG MMOL/;,L74 ,O!R GOALS 9CLUDE MA9TA9+ HI< LEVELS ( HI<-D5S;Y LIPOPROTE9 *OLE/]OL 7,,HDL1 ! 8GD *OLE/]OL07 & L[ LEVELS ( L[-D5S;Y LIPOPROTE9 *OLE/]OL 7,,LDL1 ! 8BAD *OLE/]OL074 ,T>GET LEVELS = ,,HDL >E AT L1/ #EJ MG/D,L 7#A.BI MMOL/;,L72 = ,,LDL1 OPTIMAL LEVELS >E LESS ?AN #AJJ MG/D,L 7#B.EI MMOL/;,L71 EV5 L[] = WOM5 ) HE>T 41SE RISKS4 ,*OLE/]OL-H1L?Y TIPS 9CLUDE EAT+ FOOD ) LL OR NO *OLE/]OL OR ANIMAL FAT & AVOID+ HYDROG5AT$ OIL & TRANS-FATTY ACIDS F.D 9 FOODS & PREP>$ FOODS )A L;G %ELF LIFE4 ,EX]CIS+ ON A REGUL> BASIS & 3TROLL+ WEIE AL B5EFICIAL4 ,3SUM+ L[-FAT SOY FOODS OR SUPPLE;TS 7#BE MG SOY PROTE9 DAILY7 MAY IMPROVE *OLE/]OL LEVELS SLI5'T 5\<1 A *OLE/]OL-L[]+ PRESCRIP;N M$IC,N C 2 A4$4 ,^! M$IC,NS1 CALL$ /AT9S1 H BE5 %[N 6REDUCE ! RISK (A F/ MAJOR HE>T ATTACK4 ,E/ROG5 !RAPY C AL 9CR1SE ,,HDL & L[] ,,LDL1 B IS NO L;G] RECOMM5D$ = PREV5T+ HE>T 41SE4 .,3TROL .TRIGLYC]IDES4 ,MO/ FATS 9 ! BLOOD EXI/ Z TRIGLYC]IDES4 ,A H1L?Y LEVEL ( LESS ?AN #AEJ MG/D,L 7#A.FI MMOL/;,L7 C USU,Y 2 MA9TA9$ 0LIMIT+ ALCOHOL 9TAKE1 AVOID+ FOOD ) FAT & SUG>1 EX]CIS+ REGUL>LY1 KEEP+ WEI7 >E TWO 6F\R "TS M LIKELY 6DEVELOP C>DIOVASCUL> 41SE4 7,SEE M AB DIABETES1 9CLUD+ H[1 ON PAGE #AJG47 .,EX]CISE .REGUL>LY4 ,A S$5T>Y LIFE/YLE IS ALM Z GRT A RISK FACTOR = HE>T 41SE Z SMOK+ 2C ( DIM9I%$ CIRCUL,N & WEI PHYSICAL ACTIV;Y PROMOTES HE>T H1L? & #AJE HAS BE5 %[N 6REDUCE ! RISK ( HE>T ATTACKS 9 WOM54 ,= HE>T H1L?1 ALL WOM5 %D AIM = AT L1/ #CJ M9UTES ( MOD]ATE 9T5S;Y AEROBIC EX]CISE 7BRISK WALK+1 = EXAMPLE7 MO/ "DS--PROVID$ T ? LEVEL IS F/ APPROV$ 0_! H1L?C>E PROVID]4 ..,MA9TA9 H1L?Y WEIT 41SE4 ,WOM5 :O >E SIGNIFICANTLY OV]WEIIETY ( FRUITS1 VEGETA#S1 GRA9S1 L[- OR NONFAT DAIRY PRODUCTS1 FI%1 LEGUMES1 & S\RCES ( PROTE9 L[ 9 SATURAT$ & TRANS FAT 7S* Z P\LTRY1 L1N M1TS1 & PLANT S\RCES74 ,AVOID FOODS T H A HI< AM.T ( *OLE/]OL & SATURAT$ & TRANS FAT4 ,LIMIT+ SALT MAY HELP 3TROL HI< BLOOD PRESSURE4 ,ALCOHOL 3SUMP;N %D N EXCE$ "O OR TWO DR9KS A "D1 & NO M ?AN SEV5 P] WEEK4 .,REDUCE ./RESS4 ,A /RESS;L LIFE/YLE 9CR1SES RISK ( HE>T 41SE & _M O!R H1L? PRO#MS4 ,EX]CISE1 M$IT,N1 & RELAX,N TE*NIQUES C SIGNIFICANTLY REDUCE /RESS4 ..,IF AT HI< RISK = HE>T 41SE1 TAKE A BABY ASPIR9 .DAILY4 ,/UDIES H F.D T DAILY L[-DOSE 8BABY0 ASPIR9 7#HA MG7 L[]S A WOMAN'S RISK IF %E IS AT HI< RISK = HE>T 41SE4 ,DAILY ASPIR9 USE MAY C>RY M RISKS ?AN B5EFITS = WOM5 N AT RISK = HE>T 41SE4 ..,DON'T USE E/ROG5 !RAPY 6PREV5T HE>T .41SE4 ,PREVI\SLY1 E/ROG5 !RAPY 0 ?"\ 6REDUCE ! RISK ( HE>T 41SE1 PRIM>ILY 2C ( XS B5EFICIAL E6ECTS ON *OLE/]OL4 ,H["E1 M REC5T /UDIES H %[N T "S TYPES ( HORM"O !RAPY 9CR1SE ! RISK ( HE>T 41SE1 BLOOD CLOTS1 & /ROKE4 ,REC5TLY1 "! HAS BE5 DEBATE ON :E!R ! AGE AT : A WOMAN 2G9S E/ROG5 !RAPY MAKES A DI6];E1 Z "S /UDIES %[ HE>T B5EFITS :5 />T+ HORM"OS CLOS] 6M5OPAUSE4 ,X APPE>S 9 "S /UDIES T ONLY :5 A WOMAN )A RISK ( HE>T 41SE />TS HORM"O !RAPY AF M5OPAUSE T #AJG PRO#MS CD >ISE4 ,CURR5T GOV]N;T RECOMM5D,NS >E CAUTI\S1 /AT+ T E/ROG5 %D N 2 US$ 6PREV5T HE>T 41SE4 ,AL1 A WOMAN ) HE>T 41SE %D N 2G9 E/ROG5 !RAPY )\T C>E;L 3SID],N (! RISKS4 7,SEE M AB HORM"O !RAPY ON PAGE #ADD47 ,,DIABETES ,) DIABETES1 EI ! BODY DOESN'T PRODUCE 5 9SUL9 OR ! CELLS >5'T A# 6USE ! 9SUL91 OR A P]SON IS S OV]WEI71 ! BASIC FUEL =! CELLS4 ,:5 GLUCOSE DOESN'T G 96! CELLS1 X BUILDS UP 9 ! BLOOD4 ,IF A FA/+ BLOOD GLUCOSE LEVEL IS ABV #ABF MG/D,L 7#G.J MMOL/;,L71 DIABETES IS DIAGNOS$4 ,DIABETES IS A S]I\S 41SE--! FIF?-D1DLIE/ 41SE 9 ! ,UNIT$ ,/ATES4 ,! NUMB] ( P DIAGNOS$ ) DIABETES IS 3T9U,Y 9CR1S+1 MO/LY 2C ( XS ASSOCI,N ) OBES;Y4 ,AB "O-?IRD ( WOM5 )! 41SE DON'T "K !Y H X4 ,& GIV5 ! CURR5T EPIDEMIC ( OBES;Y1 M & M >E AT RISK ( DEVELOP+ DIABETES4 ,DIABETES 9CR1SES ! RISK ( C>DIOVASCUL> 41SE TWO 6F\R "TS1 A4+ 6! 9CR1S$ RISK SE5 ) AGE4 ,EV5 :5 BLOOD GLUCOSE LEVELS >E "U 3TROL1 DIABETES 9CR1SES ! RISK = HE>T ATTACK & /ROKE4 7,SEE PAGE M AB REDUC+ C>DIOVASCUL> RISK ON PAGE #IH47 ,DIABETES IS AL ASSOCIAT$ ) AN 9CR1S$ RISK ( O!R ADV]SE H1L? 3DI;NS1 9CLUD+ VI.N LOSS1 KIDNEY FAILURE1 UT]9E C.ER1 GALL/"OS1 N]VE DAMAGE 7"S"TS L1D+ 6AMPUT,N71 & PREMATURE M5OPAUSE4 ,H["E1 MO/ P ) DIABETES C LIVE L;G & HAPPY LIVES ) PROP] M$ICAL C>E & ATT5;N 6H1L?Y HABITS4 ,Z P AGE1 !Y >E M LIKELY 6DEVELOP ! MO/ -MON TYPE ( DIABETES--TYPE #B DIABETES1 "S"TS CALL$ ADULT-ONSET DIABETES4 ,B S9CE DIABETES C'T 2 CUR$1 X MAKES M S5SE 6TAKE /EPS 6PREV5T X4 ,EVID;E /R;GLY SU7E/S T H1L?Y LIFE/YLES C PREV5T MO/ CASES ( #AJI TYPE #B DIABETES4 ,S"EAL RISK FACTORS = DEVELOP+ TYPE #B DIABETES H BE5 ID5TIFI$4 ,"S ( ^! C'T 2 ALT]$1 B O!RS C4 ,OBES;Y IS ! NUMB] "O RISK FACTOR1 RESPONSI# = AN E/IMAT$ #HJ@3P 6#IE@3P (! CURR5T DRAMATIC 9CR1SE 9 TYPE #B DIABETES 9 ! DEVELOP$ _W4 ,OBES;Y IS DEF9$ Z A BODY MASS 9DEX ( #CJ KG/M-SQU>$ OR M1 A CALCUL,N T 3SID]S BO? BODY WEIS 6PLAY A /R;G ROLE 9 9SUL9 RESI/.E1 B ! WAY ! FAT IS 4TRIBUT$ IS AL SIGNIFICANT4 ,WEI.D ! ABDOM5 & 9 ! UPP] "P (! BODY 7APPLE-%AP$ R ?AN PE>-%AP$ 9DIVIDUALS ) WIDE HIPS7 IS ASSOCIAT$ ) 9SUL9 RESI/.E & DIABETES1 Z WELL Z HE>T 41SE4 ,9 FACT1 J AB E RISK FACTOR = HE>T 41SE 7SEE PAGE #IH7 IS AL A RISK FACTOR = TYPE #B DIABETES4 ,O!R RISK FACTORS = TYPE #B DIABETES _C 2 ALT]$4 ,^! 9CLUDE ADVANC+ AGE1 FAMILY HI/ORY ( DIABETES1 P]SONAL HI/ORY ( GE/,NAL DIABETES 7DIABETES >IS+ DUR+ PREGNANCY71 NON:ITE RACE/E?NIC;Y1 & M5OPAUSE4 ,WOM5 ) RISK FACTORS %D 2 SCRE5$ = DIABETES >.D M5OPAUSE4 ,WOM5 :O H DIABETES >E /R;GLY URG$ 6"W ) _! H1L?C>E PROVID]S 6MANAGE ! 41SE & H A H1L?Y LIFE/YLE4 ,DIET1 EX]CISE1 & WEIE ESPECI,Y IMPORTANT = ANY WOMAN :O IS AT HI< RISK OR HAS ! 41SE4 ,OV]WEI 3TROL 0LOS+ WEI4 ,,O/EOPOROSIS ,PO/M5OPAUSAL O/EOPOROSIS IS A SKELETAL 4ORD] 9 : B"O /R5G? HAS W1K5$ 6A PO9T ": ! B"O IS FRAGILE & AT HI<] RISK = FRACTURES4 ,B"O /R5G? & ?US FRACTURE RISK >E DEP5D5T ON BO? #AAA B"O QUAL;Y & B"O M9]AL D5S;Y4 ,-PRES.N FRACTURES (! V]TEBRAE (! SP9E >E ! MO/ FREQU5T TYPE ( O/EOPOROTIC FRACTURE1 & MO/ D N CAUSE NOTICEA# SYMPTOMS4 ,H["E1 WOM5 :O H MULTIPLE SP9E FRACTURES OR :O H SEV]E OR REC5T FRACTURES MAY EXP]I;E *RONIC BACK PA94 ,9 SEV]E CASES1 LOSS ( HEIE M S]I\S4 ,NE>LY "O-QU>T] ( HIP FRACTURE VICTIMS OV] AGE #EJ DIE )9 #A YE> ( _! FRACTURE1 TYPIC,Y F PNEUMONIA DUE 6LACK ( MOBIL;Y4 ,AB "O-?IRD H "S L;G-T]M LOSS ( MOBIL;Y4 ,ONLY AB "O-?IRD ( SURVIVORS >E A# 6RETURN 69DEP5D5T LIV+4 ,B"OS GR[ DUR+ *ILDHOOD & ADOLESC;E1 R1*+ _! /R;GE/ PO9T 7P1K B"O MASS7 2T ! AGES ( #BJ & #CJ4 ,F !N ON1 B"O LOSS O3URS GRADU,Y =! REMA9D] ( LIFE1 ) A3EL],N 6AB #B@3P P] YE> AT #B 6#C YE>S 2F M5OPAUSE UNTIL #C 6#D YE>S AFW4 ,!N1 B"O LOSS SL[S 6AB #A@3P 6#A.E@3P P] YE> UNTIL1 0AGE #HJ1 _M WOM5 H LO/ AB #CJ@3P ( _! P1K B"O MASS4 ,BO? AN 9ADEQUATE AM.T ( B"O MADE DUR+ GR[? YE>S & AN 9CR1S$ RATE ( B"O LOSS 9 ADULTHOOD C 3TRIBUTE 6O/EOPOROSIS4 ,B O!R FACTORS H BE5 ID5TIFI$ T 9CR1SE A WOMAN'S RISK ( HAV+ W1K B"OS1 9CLUD+ H]$;Y 7! GRTE/ 9FLU;E71 LACK ( EX]CISE1 C]TA9 M$ICAL 3DI;NS & TR1T;TS1 & M5OPAUSE 7ESPECI,Y PREMATURE M5OPAUSE74 ,! 3SEQU;E ( O/EOPOROSIS IS FRACTURE4 ,RESE>* HAS %[N T S"EAL FACTORS 9CR1SE A WOMAN'S RISK = O/EOPOROTIC FRACTURES4 7,SEE PAGE #AAC74 ,AL? "S DECL9E 9 B"O /R5G? 9 WOM5 C 2 ATTRIBUT$ 6AG+1 L[] E/ROG5 LEVELS >E ! MAJOR CAUSE4 ,WOM5 EXP]I5C+ PREMATURE M5OPAUSE1 EI NATURAL OR 9DUC$1 >E AT GRT] RISK = W1K5$ B"OS ?AN O!R WOM5 ! SAME AGE :O H N #AAC R1*$ M5OPAUSE4 ,H["E1 0AGE #GJ1 :5 FRACTURES >E M LIKELY 6O3UR1 ^! WOM5 >E AT ! SAME RISK Z WOM5 :O R1*$ M5OPAUSE AT ! AV]AGE AGE4 ,MAJOR ,RISK ,FACTORS = ,O/EOPOROTIC ,FRACTURE -- ,ADV.ED AGE -- ,L[ B"O M9]AL D5S;Y -- ,PREVI\S FRACTURE 7O!R ?AN SKULL1 FACIAL B"O1 ANKLE1 F+]1 & TOE7 Z AN ADULT -- ,HI/ORY ( HIP FRACTURE 9 A P>5T -- ,WEILY DETEC;N ( B"O LOSS C L1D 6TR1T;T T MAY PREV5T FUR!R B"O LOSS & REDUCE ! *.E ( FRACTURE4 ,ALL PO/M5OPAUSAL WOM5 %D 2 ASSESS$ 0A H1L? PROVID] = RISK FACTORS = O/EOPOROSIS & FRACTURE &! TELLTALE SIGNS ( B"O LOSS4 ,PROL;G$ & SEV]E PA9 9 ! MI4LE (! BACK IS A POSSI# 9DICATOR ( O/EOPOROTIC SP9E FRACTURES4 ,*ANGES 9 ! %APE (! SP9E & LOSS ( HEIE A4I;NAL SIGNS4 ,:ILE X'S NORMAL 6LOSE "S HEIE REQUIR$ 6MAKE ! DIAGNOSIS4 ,/&>D ;X-RAYS >E N S5SITIVE 5 6REV1L O/EOPOROSIS UNTIL A 3SID]A# AM.T ( B"O HAS ALR BE5 LO/4 ,M1SUR+ B"O M9]AL D5S;Y 7,,BMD7 IS ! BE/ WAY 6EVALUATE B"O /R5G? & PREDICT FRACTURE RISK4 ,TD1 ,,BMD IS M1SUR$ 9 WAYS T >E N ONLY M A3URATE ?AN /&>D ;X-RAY1 B >E AL SAFE & PA9.S4 ,H["E1 WOM5 #AAE (T5 "Q :E!R & :5 6OBTA9 A ,,BMD M1SURE;T4 ,,NAMS HAS EVALUAT$ ALL ! P]T95T CL9ICAL /UDIES1 L1D+ 6XS RECOMM5D,N ( ,,BMD TE/+ = TWO GR\PS-- ALL PO/M5OPAUSAL WOM5 :O >E #FE & OLD]1 & ALL PO/M5OPAUSAL WOM5 ) M$ICAL CAUSES ( B"O LOSS1 REG>D.S ( AGE4 ,H1L?Y WOM5 "Y] ?AN #FE D N NE$ TE/+1 AC 6,,NAMS1 UN.S !Y >E PO/M5OPAUSAL & !Y AL H AT L1/ "O (! FOLL[+ RISK FACTORS = FRACTURE3 CURR5T SMOK]1 WEI5T1 & PREVI\S FRACTURE 7O!R ?AN SKULL1 FACIAL B"O1 ANKLE1 F+]1 & TOE7 AF M5OPAUSE4 ,M1SUR+ ,,BMD 9 O!R WOM5 MAY "S"TS 2 RECOMM5D$ ON AN 9DIVIDUAL BASIS1 B X IS N CO/-E6ECTIVE = L>GE POPUL,NS4 ,AL? "! >E S"EAL TE/S 6M1SURE ,,BMD1 DUAL-5]GY ;X-RAY ABSORPTIOMETRY 7,,DXA7 IS ! BE/1 EXPOS+ A WOMAN 6ONLY AB #AJ@3P (! RADI,N US$ 9 A *E/ ;X-RAY4 ,,DXA IS PREF]R$ = DIAGNOS+ O/EOPOROSIS 2C X M1SURES SP9E1 HIP1 & TOTAL BODY ,,BMD1 ! IMPORTANT SITES ( O/EOPOROTIC FRACTURES4 ,ULTRAS.D1 : DOES N REQUIRE RADI,N1 IS US$ 6M1SURE B"O D5S;Y 9 P]IPH]AL BODY SITES1 S* Z ! WRI/ OR HEEL4 ,ULTRAS.D M1SURE;TS C 2 US$ 6PREDICT FRACTURE RISK2 H["E1 !Y _C 2 US$ 6MAKE ! DIAGNOSIS ( O/EOPOROSIS OR 6MONITOR ! E6ECTS ( !RAPY4 ,TE/+ ( ,,BMD IS N NE$$ V (T5 S9CE B"O D5S;Y DECL9ES ONLY AB #A@3P 6#A.E@3P EA* YE>4 ,= MO/ PO/M5OPAUSAL WOM5 :O >E N 2+ TR1T$ = O/EOPOROSIS1 REP1T ,,DXA TE/+ IS N USE;L UNTIL #C 6#E YE>S H PASS$4 ,"?\T LIFE1 B"O IS 3/ANTLY RENEW$1 ) OLD B"O 2+ BROK5 D[N & NEW B"O 2+ =M$--A PROCESS CALL$ B"O REMODEL+4 ,LAB TE/S C M1SURE B"O BR1KD[N PRODUCTS 9 ! BLOOD & UR9E4 ,AL? ^! M1SURE;TS >E N HELP;L = DIAGNOSIS ( O/EOPOROSIS1 "S H1L?C>E PROVID]S F9D !M USE;L 9 MONITOR+ RESPONSE 6O/EOPOROSIS TR1T;T4 ,PREV5;N & ,TR1T;T #AAG ,! PRIM>Y GOAL ( O/EOPOROSIS !RAPY IS 6PREV5T FRACTURES 0/OPP+ OR SL[+ LOSS ( B"O MASS1 MA9TA9+ B"O /R5G?1 & M9IMIZ+ OR ELIM9AT+ FACTORS T 3TRIBUTE 6FALLS & FRACTURES4 ,AL? FRACTURES DUE 6O/EOPOROSIS TYPIC,Y O3UR 9 LAT] YE>S 7AGE #HB IS AV]AGE = HIP FRACTURE1 MID-#GJ'S = SP9E71 X'S IMPORTANT 6A4RESS B"O H1L? Z E>LY Z POSSI#4 ,S9CE M5OPAUSE H]ALDS A /EEP DECL9E 9 B"O /R5G?1 X IS AN EXCELL5T OPPORTUN;Y 6GET S]I\S AB B"O H1L?4 ..,LIFE/YLE MODIFIC,N & NONPRESCRIP;N .!RAPIES4 ,MA9TA9+ A H1L?Y LIFE/YLE--9CLUD+ N SMOK+1 REGUL> WEI+ EX]CISE1 & ADEQUATE 9TAKE ( CALCIUM & VITAM9 ;,D--MAY SL[ B"O LOSS 9 ! E>LY PO/M5OPAUSAL YE>S & REDUCE FRACTURE RISK4 ,ADEQUATE 9TAKE ( CALCIUM & VITAM9 ;,D IS AL ESS5TIAL :5 US+ ANY M$IC,N PRESCRIB$ = O/EOPOROSIS4 ,X IS IMPORTANT T WOM5 ASSESS _! DAILY DIET>Y CALCIUM 9TAKE & ADD A SUPPLE;T :5 APPROPRIATE4 ,MO/ WOM5 9 ,NOR? ,AM]ICA 3SUME AB #FJJ MG ( CALCIUM P] "D1 :ILE ! RECOMM5D$ DAILY 9TAKE IS AT L1/ #A1BJJ MG P] "D4 ,CALCIUM IS BE/ ABSORB$ "? DIET>Y S\RCES1 B SUPPLE;TS S* Z CALCIUM C>BONATE & CALCIUM CITRATE >E SAFE & E6ECTIVE4 ,CALCIUM C>BONATE %D 2 TAK5 ) M1LS & LIMIT$ 6#EJJ MG OR LESS P] DOSE4 ,VITAM9 ;,D IS ESS5TIAL =! 9TE/9AL ABSORP;N ( CALCIUM4 ,AL? EXPOSURE 6SUNLIE ! CAUSE ( NE>LY #IJ@3P ( ALL O/EOPOROTIC FRACTURES4 ,REDUC+ RISK = FALLS IS1 "!=E1 AN IMPORTANT B"O-H1L? /RATEGY4 ,9/ITUTE FALL PREV5;N M1SURES S* Z PROVID+ AMPLE LIS 9 ! %[]4 ,TAP]+ OR /OPP+ ALCOHOLIC B"EAGES OR M$IC,NS T C CAUSE DIZZI;S IS AL IMPORTANT1 ESPECI,Y = ELD]LY WOM54 .,PRESCRIP;N .!RAPIES4 ,S"EAL TYPES ( E6ECTIVE 8B"O DRUGS0 >E AVAILA#1 ALL[+ H1L?C>E PROVID]S 6RECOMM5D ! TYPE MO/ APPROPRIATE = EA* WOMAN4 ,L;G-T]M USE MAY 2 NE$$1 S9CE B"O LOSS USU,Y RESUMES AF !RAPY 5DS4 ,H["E1 /UDIES H N EVALUAT$ ! SAFETY OR E6ECTIVE;S ( AVAILA# !RAPIES OV] _M YE>S ( USE4 ,KEEP 9 M9D T A B"O-H1L?Y LIFE/YLE W AL 5H.E ! POSITIVE E6ECTS ( PRESCRIP;N !RAPIES = WOM5 :O REQUIRE !M4 ,! FOLL[+ >E ! PRIM>Y PRESCRIP;N M$IC,NS AVAILA# = O/EOPOROSIS MANAGE;T4 -- ,BISPHOSPHONATES4 ,^! >E NONHORMONAL1 B"O-SPECIFIC DRUGS T DECR1SE ! ACTIV;Y ( B"O-4SOLV+ CELLS4 ,^! DRUGS PRES]VE B"O D5S;Y & B"O /R5G? Z WELL Z REDUCE FRACTURE RISK4 ,!Y >E 3SID]$ 0_M 6BE ! F/ *OICE = TR1T+ O/EOPOROSIS4 ,H["E1 2C FOOD REDUCES _! ABSORP;N1 TA#TS ( BISPHOSPHONATES M/ 2 TAK5 ON AN EMPTY /OMA* 7USU,Y 9 ! MORN+71 ) WAT] ONLY1 AT L1/ #CJ M9UTES 2F DR9K+ O!R LIQUIDS1 EAT+1 OR TAK+ O!R M$IC9ES OR SUPPLE;TS1 9CLUD+ CALCIUM4 ,POSSI# SIDE E6ECTS 9CLUDE ESOPHAG1L IRRIT,N CAUS$ 0ACID REFLUX Z /OMA* ACIDS SPLA% ONTO ! L[] ESOPHAGUS4 ,NEW DOSAGE =MS >E AVAILA# 6MAKE TAK+ ! DRUG M MANAGEA# & REDUCE ! RISK ( GA/RIC IRRIT,N4 ,BISPHOSPHONATES 9 G5]AL USE >E3 -- ,AL5DRONATE 7,FOSAMAX TA#TS OR LIQUID7 IS APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA = PO/M5OPAUSAL O/EOPOROSIS PREV5;N & TR1T;T4 ,X SIGNIFICANTLY 9CR1SES B"O D5S;Y 9 ! SP9E & HIP1 & SIGNIFICANTLY DECR1SES ! RISK ( SP9E & NONSP9E FRACTURES4 ,AL5DRONATE IS AVAILA# 9 BO? DAILY & ONCE-WEEKLY DOSES4 -- ,RIS$RONATE 7,ACTONEL TA#TS7 #ABA IS APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA = PO/M5OPAUSAL O/EOPOROSIS PREV5;N & TR1T;T4 ,X HAS BE5 %[N 6SIGNIFICANTLY REDUCE HIP FRACTURES 9 WOM5 ) O/EOPOROSIS4 ,X AL REDUCES ! RISK ( SP9E FRACTURES AF ONLY #A YE> ( !RAPY4 ,RIS$RONATE IS AL AVAILA# 9 DAILY & ONCE-WEEKLY DOSAGES4 -- ,IB&RONATE 7,BONIVA TA#TS OR 9JEC;N7 IS APPROV$ 9 ! ,UNIT$ ,/ATES = PO/M5OPAUSAL O/EOPOROSIS & PREV5;N4 ,X IS AVAILA# 9 ONCE-A-MON? DOS+ & IS ! ONLY BISPHOSPHONATE %[N 6REDUCE V]TEBRAL FRACTURE RISK )A DRUG-FREE 9T]VAL ( M ?AN #A WEEK4 ,H["E1 L O!R OR,Y ADM9I/]$ BISPHOSPHONATES1 X MAY CAUSE UPP] GA/RO9TE/9AL SIDE E6ECTS4 -- ,ETIDRONATE 7,DIDRONEL TA#TS7 IS ,,FDA APPROV$ =! TR1T;T ( ANO!R B"O 4ORD]1 ,PAGET'S 41SE4 ,N"E!.S1 "S CL9ICIANS PRESCRIBE X 9 L[] DOSES = PO/M5OPAUSAL O/EOPOROSIS4 ,9 ,CANADA1 X IS APPROV$ = O/EOPOROSIS TR1T;T4 ,AL 9 ,CANADA1 AN ETIDRONATE PLUS CALCIUM PRODUCT IS AVAILA# 7,DIDROCAL74 ,:5 PRESCRIB$ = O/EOPOROSIS1 ETIDRONATE M/ 2 TAK5 CYCLIC,Y 7#B WEEKS \ ( E #C MON?S7 6PREV5T ABNORMALITIES 9 B"O M9]ALIZ,N4 -- ,E/ROG5-3TA9+ HORM"O !RAPY4 ,! PRIM>Y 9DIC,N = SY/EMIC E/ROG5 !RAPY 7,,ET7 IS 6TR1T M5OPAUSE SYMPTOMS S* Z HOT FLA%ES4 ,B ,,ET AL 9CR1SES B"O MASS & DECR1SES ! RISK = FRACTURES (! SP9E & HIP4 ,E/ROG5'S B5EFITS >E N REDUC$ :5 A PROGE/OG5 IS A4$ = WOM5 )A UT]US 7"KN Z E/ROG5-PROGE/OG5 !RAPY OR ,,EPT74 ,_M ,,ET & ,,EPT PRODUCTS H BE5 PROV5 E6ECTIVE & >E APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA = PREV5T+ 7AL? N = TR1T+7 PO/M5OPAUSAL O/EOPOROSIS4 ,:5 M5OPAUSE SYMPTOMS >E 3TROLL$ OR C1SE1 3T9U$ HORM"O !RAPY C / 2 3SID]$ = B"O E6ECTS1 WEI<+ XS B5EFITS & RISKS AG/ ^? ( ALT]NATE !RAPIES4 ,/UDIES H %[N A B"O M9]AL D5S;Y LOSS ( #ABC #C@3P 6#F@3P DUR+ ! F/ YE> AF /OPP+ E/ROG5 !RAPY4 7,SEE M AB HORM"O !RAPY ON PAGE #ADD47 -- ,RALOXIF5E4 ,M>KET$ Z ,EVI/A TA#TS1 RALOXIF5E IS APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA =! PREV5;N & TR1T;T ( O/EOPOROSIS4 ,RALOXIF5E 2L;GS 6A CLASS ( DRUGS CALL$ ,,SERM'S 7SELECTIVE E/ROG5-RECEPTOR MODULATORS71 : ACT L E/ROG5 9 "S "PS (! BODY & L AN ANTIE/ROG5 9 O!R "PS4 ,RALOXIF5E PREV5TS B"O LOSS & REDUCES ! RISK ( SP9E FRACTURES1 B XS E6ECTIVE;S 9 REDUC+ HIP & O!R FRACTURES IS UNC]TA94 ,UNLIKE E/ROG51 RALOXIF5E DOES N HELP ) %ORT-T]M M5OPAUSE SYMPTOMS1 & MAY ACTU,Y 9CR1SE HOT FLA%ES 9 "S WOM54 ,AL UNLIKE E/ROG51 X DOES N APPE> 6A6ECT ! UT]US1 & MAY DECR1SE ! RISK = BR1/ C.ER4 ,L E/ROG51 RALOXIF5E 9CR1SES ! RISK ( DEVELOP+ BLOOD CLOTS & %D N 2 TAK5 0WOM5 )A HI/ORY ( OR RISKS = BLOOD CLOTS1 S* Z PROL;G$ IMMOBIL;Y4 ,ONGO+ RESE>* MAY REV1L B5EFICIAL AC;NS 2Y B"O PROTEC;N4 -- ,P>A?YROID HORM"O4 ,! NEWE/ TYPE ( O/EOPOROSIS !RAPY1 P>A?YROID HORM"O 7,,PTH71 ACTU,Y /IMULATES NEW B"O =M,N4 ,! 5D RESULT IS BETT] B"O /R5G?4 ,,PTH IS A HORM"O1 B N A HORM"O L E/ROG54 ,M>KET$ Z T]IP>ATIDE 7,=TEO71 ? DRUG IS APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA = TR1T+ O/EOPOROSIS & IS RES]V$ = WOM5 AT HI< RISK =A FRACTURE4 ,,PTH IMPROVES ,,BMD & REDUCES ! RISK ( SP9E & NONSP9E FRACTURES4 ,MO/ SIDE E6ECTS1 S* Z NAUSEA1 DIZZI;S1 & LEG CRAMPS1 >E MILD4 ,H["E1 WOM5 NE$ 6TAKE DAILY 9JEC;NS &! CO/ ( !RAPY IS HI<4 ,A SMALL RISK =A R>E B S]I\S B"O C.ER HAS BE5 F.D 9 "S ANIMAL /UDIES ( ,,PTH1 B ! SIGNIFIC.E ( ? F9D+ 9 HUMANS IS UNC]TA94 ,!RAPY IS 9DICAT$ = NO L;G] ?AN #AH 6#BD MON?S1 B--Z )! O!R AG5TS--B"O LOSS RESUMES :5 X IS /OPP$4 -- ,CALCITON94 ,? AG5T IS AL A HORM"O1 B N L E/ROG54 ,CALCITON9 IS AN O/EOPOROSIS DRUG AVAILA# Z A NASAL SPRAY 9 ! ,UNIT$ ,/ATES 7M>KET$ #ABE Z ,MIACALC9 ,NASAL ,SPRAY1 ,=TICAL ,NASAL ,SPRAY7 & AN 9JEC;N 7,MIACALC9 ,9JEC;N74 ,AVAILA# 9 ,CANADA >E A NASAL SPRAY 7,MIACALC9 ,NASAL ,SPRAY7 & AN 9JEC;N 7,CALCIM> ,SOLU;N1 ,CALT9E71 B ^! 9JECTA#S >E N APPROV$ = O/EOPOROSIS4 ,2C XS E6ECTIVE;S HAS N BE5 OBS]V$ 9 WOM5 J PA/ M5OPAUSE1 CALCITON9 USE IS RES]V$ = WOM5 ) O/EOPOROSIS :O >E AT L1/ #E YE>S 2Y M5OPAUSE4 ,CALCITON9 IS LESS POT5T ?AN ! O!R AG5TS1 B X IS "S"TS PRESCRIB$ 6REDUCE PA9 F SP9E FRACTURES4 ,CALCITON9 IS RELATIVELY SAFE & HAS NO S]I\S SIDE E6ECTS4 ,H["E1 ! NASAL SPRAY MAY CAUSE "S M9OR NOSE IRRIT,N4 ,US+ EA* M$IC,N ! WAY X HAS BE5 PRESCRIB$ IS ESS5TIAL = AVOID+ FRACTURE4 ,O!R DRUGS >E "S"TS PRESCRIB$ 0CL9ICIANS = TR1T+ B"O LOSS1 B N"O >E GOV]N;T APPROV$ = ? USE1 & RESE>* DOCU;T+ E6ECTIVE;S IS LACK+4 ,NEW !RAPIES >E 2+ /UDI$ & MAY 2 APPROV$ 9 ! NE> FUTURE4 ,! TR1T;T ( O/EOPOROSIS NE$S 6BE L;G T]M 9 MO/ WOM54 ,GIV5 ! UNC]TA9TIES ( L;G-T]M SAFETY ) ^! !RAPIES1 C>E;L MONITOR+ IS REQUIR$4 ,DUR+ !RAPY1 X IS APPROPRIATE 6REEVALUATE ! TR1T;T GOALS &! *OICE ( M$IC,N ON AN ONGO+ BASIS "? P]IODIC *ECKUPS & FOLL[-UP ,,BMD TE/+4 ,AN APPROPRIATE 9T]VAL = REP1T ,,BMD TE/+ ) ,,DXA IS #B YE>S OR M4 ,,C.ER ,M5OPAUSE IS N ASSOCIAT$ ) 9CR1S$ C.ER RISK4 ,H["E1 "S C.ER RATES TYPIC,Y 9CR1SE ) AGE1 S PO/M5OPAUSAL WOM5 %D 2 9=M$ AB ! MO/ -MON C.ERS T MAY A6ECT !M4 ,AL1 "S (! !RAPIES US$ 6TR1T M5OPAUSE SYMPTOMS >E ASSOCIAT$ ) AN 9CR1S$ OR A DECR1S$ RISK = C]TA9 TYPES ( C.ER4 ,EA* YE>1 ?\S&S ( WOM5 >E CUR$ ( C.ER1 & ^? DIAGNOS$ TD H A M* BETT] *.E ( LIV+ L;G] ?AN 9 ! PA/4 ,9 ,NOR? ,AM]ICA1 AB TWO \ ( E FIVE WOM5 DIAGNOS$ ) C.ER W 2 ALIVE #E YE>S AF DIAGNOSIS4 ,EV5 M WOM5 >E REDUC+ _! RISK 0LE>N+ 6BE 8C.ER SM>T40 #ABG ,2+ 9=M$ & 4CUSS+ 3C]NS )A H1L?C>E PROVID] >E KEY /EPS T[>D OPTIMAL H1L?4 ,! MO/ -MON TYPES ( C.ER = WOM5 >E PRES5T$ 9 ! FOLL[+ SEC;NS4 ,BR1/ ,C.ER ,BR1/ C.ER IS P]H ! C.ER WOM5 FE> MO/4 ,? FE> -ES N ONLY F ! POSSIBIL;Y ( DY+ F ! 41SE1 B AL F ! RIGOR\S DEM&S ( TR1T;T &! PROBABIL;Y ( C.ER RECURR;E4 ,MOREOV]1 _M MIDLIFE WOM5 H P]SON,Y SE5 RELATIVES OR FRS G "? BR1/ C.ER TR1T;T OR H LO/ LOV$ "OS 6! 41SE4 ,BR1/ C.ER IS ! MO/ FREQU5TLY DIAGNOS$ C.ER 9 WOM5 & IS ! SECOND-HIT$ 6DECL9E 9 REC5T YE>S4 ,SMALL]1 LESS-ADV.ED C.ERS C N[ 2 DETECT$ E>LI] ) MAMMOGRAPHY4 ,U4,S4 /ATI/ICS %[ T IF BR1/ C.ER IS DETECT$ :ILE / LOCALIZ$ 7N SPR1D 6\TSIDE ! BR1/71 ! #E-YE> SURVIVAL RATE IS #IH@3P1 A DRAMATIC IMPROVE;T F #HJ@3P 9 ! #AIEJ'S4 ,! SAME IMPROVE;TS 9 C.ER SURVIVAL H AL BE5 SE5 9 ,CANADIAN WOM54 ,S"EAL RISK FACTORS = BR1/ C.ER H BE5 ID5TIFI$ 7SEE 2L74 ,FACTORS ,T ,9CR1SE ,BR1/ ,C.ER ,RISK -- ,ADVANC+ AGE3 ,NE>LY HALF ( ALL CASES O3UR 9 WOM5 #FE YE>S OLD & OLD]4 ,CURR5T E/IMATES PREDICT T 0AGE #EJ1 #B@3P ( ,U4,S4 & ,CANADIAN WOM5 W H DEVELOP$ BR1/ C.ER--0#FJ1 AB #E@3P2 0#GJ1 AB #G@3P2 & 0#HJ1 AB #AJ@3P4 -- ,P]SONAL HI/ORY ( FEMALE C.ER 7S* Z BR1/ OR UT]US7 OR1 POSSIBLY1 COLON C.ER4 -- ,G5ETICS3 A WOMAN'S RISK ( DEVELOP+ BR1/ C.ER IS AL 9CR1S$ IF H] "M1 SI/]1 OR DAUT$ E>LY &/OR 5D$ LATE 9 #ABI LIFE74 -- ,N"E HAV+ _H *N OR HAV+ A F/ * AF AGE #CJ4 -- ,HI< BR1/ TISSUE D5S;Y 7A MAMMOGRAPHIC M1SURE;T (! AM.T ( GL&UL> BR1/ TISSUE RELATIVE 6FATTY TISSUE 9 ! BR1/74 -- ,HAV+ _H "O OR M PREVI\S BR1/ BIOPSIES1 ESPECI,Y IF ANY %[$ A *ANGE 9 CELL TISSUE "KN Z ATYPICAL HYP]PLASIA 7! BR1/ BIOPSY XF DOES N 9CR1SE C.ER RISK74 -- ,LATE M5OPAUSE 7AF AGE #EE74 -- ,2+ M ?AN #BJ@3P OV] ID1L WEIE AL M LIKELY 6DIE F _! 41SE4 -- ,DR9K+ M ?AN "O ALCOHOLIC DR9K P] "D4 -- ,LACK ( EX]CISE4 -- ,DIET L[ 9 VEGETA#S & FRUIT4 -- ,RADI,N TR1T;T = C.ER4 -- ,USE ( PO/M5OPAUSAL HORM"O !RAPY ) E/ROG5-PROGE/OG5 7E/ROG5 AL"O IS N ASSOCIAT$ ) 9CR1S$ RISK74 -- ,N"E HAV+ BR1/F$ 7BR1/FE$+ HAS BE5 %[N 6H A PROTECTIVE E6ECT = BR1/ C.ER74 ..,ROLE ( ,,ET/.,,EPT4 ,CURR5T DATA SUPPORT A L9K 2T AN 9CR1S$ RISK ( BR1/ C.ER & US+ "O TYPE ( HORM"O !RAPY-- E/ROG5 -B9$ )A PROGE/OG5 7,,EPT7-- "PICUL>LY AF S"EAL YE>S ( USE4 ,WOM5 )\T A UT]US :O USE E/ROG5 !RAPY 7,,ET7 AL"O MAY N H ? RISK4 ,%ORT] T]M USE ( ,,ET OR ,,EPT DUR+ P]IM5OPAUSE 6RELIEVE HOT FLA%ES & O!R M5OPAUSE-RELAT$ SYMPTOMS DOES N APPE> 69CR1SE BR1/ C.ER RISK4 ,ALL ,,ET & ,,EPT PRODUCTS >E 3TRA9DICAT$ 9 WOM5 ) "KN OR SUSPECT$ BR1/ C.ER Z WELL Z 9 ^? )A HI/ORY ( BR1/ C.ER4 7,SEE M AB HORM"O !RAPY ON PAGE #ADD47 .,E>LY .DETEC;N4 ,S9CE _M BR1/ C.ER RISK FACTORS _C 2 ALT]$1 E>LY DETEC;N IS ! BE/ /RATEGY4 ,ONCE A WOMAN R1*ES ADULTHOOD1 MON?LY BR1/ SELF-EXAM9,N & AN ANNUAL EXAM9,N 0A H1L?C>E #ACA PROVID] DUR+ REGUL> PHYSICAL *ECKUPS >E RECOMM5D$4 ,IF ANY?+ UNUSUAL IS F.D1 S* Z A LUMP OR NIPPLE 4*>GE1 BO? A MAMMOGRAM 7BR1/ ;X-RAY7 & FOLL[-UP )A CL9ICIAN >E APPROPRIATE4 ,MAMMOGRAMS >E G5],Y RECOMM5D$ Z A SCRE5+ TE/1 EV5 :5 NO?+ UNUSUAL IS F.D4 ,RECOMM5D,NS = MAMMOGRAPHY SCRE5+ 9T]VALS V>Y4 ,"S EXP]TS RECOMM5D ANNUAL MAMMOGRAMS 2G9N+ AT AGE #DJ1 Z WELL Z 2F />T+ HORM"O !RAPY1 :ILE O!RS RECOMM5D L;G] 9T]VALS4 ,ALL AGREE T WOM5 OV] #EJ %D H A MAMMOGRAM E #A 6#B YE>S4 ,! VALUE ( MAMMOGRAMS 9 DETECT+ BR1/ C.ER IS A6ECT$ 0S"EAL FACTORS4 ,= EXAMPLE1 HI< HORM"O LEVELS CAUSE BR1/S 6APPE> M 8D5SE0 7OR CL\DY7 ON A MAMMOGRAM1 MAK+ ! TE/ M DI6ICULT 69T]PRET4 ,9 WOM5 2F M5OPAUSE1 :5 HORM"O LEVELS >E HI<1 MAMMOGRAMS >E H>D] 6R1D & H M FALSE POSITIVES4 ,= ^! WOM51 ! BE/ "T =A MANUAL EXAM & MAMMOGRAM IS IMMLY AF _! MON?LY P]IOD :5 HORM"O LEVELS >E L[4 ,HORM"O !RAPY AL MAKES BR1/S APPE> D5S] ON A MAMMOGRAM4 ,= PO/M5OPAUSAL WOM5 US+ ,,EPT1 ! BE/ "T =A MANUAL EXAM & MAMMOGRAM IS IMMLY AF !RAPY-9DUC$ UT]9E BLE$+ /OPS4 ,BR1/ D5S;Y REMA9S 3SI/5TLY HI< = WOM5 ON 3T9U\S -B9$ ,,EPT OR = ^? US+ E/ROG5 AL"O1 AL? D5S;Y IS LESS ! M YE>S 2Y M5OPAUSE4 ,WOM5 ) FIBROCY/IC 7LUMPY7 BR1/S OR BR1/ IMPLANTS AL H D5S] BR1/S1 MAK+ ABNORMALITIES M DI6ICULT 6DETECT4 ,ULTRAS.D IS "S"TS US$ 6FUR!R 9VE/IGATE SUSPICI\S MAMMOGRAM F9D+S4 ,,MRI & DIGITAL MAMMOGRAPHY >E NEW SCRE5+ TE*NIQUES T MAY 2 HELP;L 9 "S WOM54 ,AL? MO/ BR1/ LUMPS >E NONC.ER\S1 ALL LUMPS %D 2 EVALUAT$ EV5 IF A MAMMOGRAM IS NEGATIVE4 ,A BIOPSY 7SMALL TISSUE SPECIM57 MAY 2 NEC 6RULE \ C.ER4 ,/UDIES REP1T$LY %[ T E>LY DIAGNOSIS ( BR1/ C.ER IS L9K$ 6HI<] CURE RATES4 #ACC ,5DOMETRIAL 7,UT]9E7 ,C.ER ,C.ER C DEVELOP ON ! 9SIDE L9+ (! UT]US1 CALL$ ! 5DOMETRIUM4 ,FEW] ?AN #C 9 #AJJ WOM5 PA/ AGE #EJ W DEVELOP 5DOMETRIAL C.ER 9 _! REMA9+ LIFE"T1 & F> FEW] W DIE F ! 41SE4 ,:5 DETECT$ :ILE ! C.ER IS / LOCALIZ$1 :ITE WOM5 ) 5DOMETRIAL C.ER H A #E-YE> SURVIVAL RATE ( #IF@3P & BLACK WOM5 AB #HF@3P4 7,NATUR,Y1 WOM5 :O H "UG"O HY/]ECTOMY H NO RISK = 5DOMETRIAL C.ER47 ,RISK FACTORS = DEVELOP+ 5DOMETRIAL C.ER 9CLUDE USE ( E/ROG5 )\T PROGE/OG51 USE ( TAMOXIF5 7= BR1/ C.ER !RAPY71 M5>*E 7/>T+ P]IODS7 E>LI] ?AN AGE #AB1 LATE M5OPAUSE 7AF AGE #EA71 N OVULAT+ REGUL>LY DUR+ M5/RUAL YE>S 7EXCLUD+ PREGNANCY & LACT,N71 9F]TIL;Y OR N"E 2+ PREGNANT1 OBES;Y1 DIABETES1 GALLBLA4] 41SE1 &1 P]H1 HI< BLOOD PRESSURE & H]$IT>Y COLON C.ER4 ,PREVI\S PREGNANCY & ORAL 3TRACEPTIVE USE APPE> 6PROVIDE "S PROTEC;N AG/ 5DOMETRIAL C.ER4 ,ANNUAL PELVIC EXAMS >E RECOMM5D$ = ALL WOM54 ,IF A WOMAN HAS RISK FACTORS = 5DOMETRIAL C.ER1 9CLUD+ UNEXPLA9$ ABNORMAL UT]9E BLE$+1 AN 5DOMETRIAL BIOPSY MAY 2 RECOMM5D$ Z WELL4 ,! ,PAP SME>1 : IS S E6ECTIVE 9 DETECT+ C]VICAL C.ER1 IS N A RELIA# TE/ 6DETECT UT]9E C.ER4 ,TRANSVAG9AL ULTRAS.D & SONOHY/]OGRAPHY 7AN ULTRAS.D VIEW (! UT]US1 "S"TS )! UT]US FILL$ ) SALT WAT]7 >E 2+ US$ 0"S CL9ICIANS 6DET]M9E ! ?ICK;S (! 5DOMETRIUM & 6LOOK = 5DOMETRIAL C.ER & O!R CAUSES ( PO/M5OPAUSAL OR ABNORMAL UT]9E BLE$+4 ..,ROLE ( ,,ET/.,,EPT4 ,US+ E/ROG5 )\T A PROGE/OG5--AL CALL$ 8UNOPPOS$0 E/ROG5 !RAPY OR ,,ET--= #C YE>S OR M HAS BE5 ASSOCIAT$ )A M>K$ 9CR1SE 9 5DOMETRIAL C.ER4 ,MO/ 5DOMETRIAL C.ERS T O3UR :ILE TAK+ UNOPPOS$ ,,ET >E L[-GRADE C.ERS & D N REDUCE A WOMAN'S LIFESPAN IF DETECT$ E>LY & TR1T$ ) HY/]ECTOMY4 ,A4+ ! PROP] TYPE & AM.T ( PROGE/OG5 6E/ROG5 C.T]ACTS ! 9CR1S$ RISK ( 5DOMETRIAL C.ER1 REDUC+ #ACE ! RISK 6! LEVEL ( TAK+ NO HORM"OS AT ALL4 ,Z A RESULT1 MO/ EXP]TS RECOMM5D T ALL WOM5 ) AN 9TACT UT]US %D USE A PROGE/OG5 ) ,,ET4 7,SEE M AB HORM"O !RAPY ON PAGE #ADD47 ,C]VICAL ,C.ER ,! D1? RATE F C.ER (! C]VIX 7! OP5+ 6! UT]US 9SIDE ! VAG9A7 HAS DROPP$ %>PLY AM;G :ITE & BLACK WOM5 9 ! ,UNIT$ ,/ATES & ,CANADA1 B X REMA9S A S]I\S 3C]N4 ,9 ! ,UNIT$ ,/ATES1 ALM #AJ1DJJ CASES ( C]VICAL C.ER >E DIAGNOS$ YE>LY1 & #C1GAJ D1?S P] YE> >E EXPECT$ F ! 41SE4 ,IF DIAGNOS$ E>LY1 9VASIVE C]VICAL C.ER IS HI SURVIVAL RATE = ,U4,S4 WOM5 IS #GC@3P4 ,NEI M5OPAUSE NOR HORM"O !RAPY US$ = M5OPAUSE SYMPTOMS HAS BE5 L9K$ 69CR1S$ C]VICAL C.ER RISK4 ,! PRIM>Y CAUSES ( C]VICAL C.ER >E SPECIFIC TYPES ( HUMAN PAPILLOMAVIRUS 7,,HPV71 AN 9FEC;N ACQUIR$ PRIM>ILY "? SEXUAL REL,NS4 ,WOM5 :O 2GAN HAV+ SEXUAL 9T]C\RSE AT AN E>LY AGE OR :O H _M SEXUAL "PN]S >E AT 9CR1S$ RISK4 ,H["E1 A WOMAN MAY 2 9FECT$ ) ,,HPV EV5 IF %E HAS ONLY "O SEXUAL "PN]4 ,IMPORTANTLY1 ,,HPV 9FEC;NS >E -MON 9 H1L?Y1 SEXU,Y ACTIVE WOM5 & ONLY R>ELY RESULT 9 C]VICAL C.ER4 ,P]SI/;E (! 9FEC;N & PROGRES.N 6C.ER MAY 2 9FLU;ED 0_M FACTORS1 S* Z SMOK+1 POOR NUTRI;N1 &A W1K IMMUNE SY/EM 7S* Z F ,,HIV 9FEC;N74 ,9 BO? M5 & WOM51 ,,HPV 9FEC;N IS "S"TS ASSOCIAT$ ) 2NIGN 7NONC.ER\S7 GR[?S 9 ! G5ITAL >EA1 CALL$ 3DYLOMATA OR G5ITAL W>TS4 ,MO/ WOM5 :O C>RY ! VIRUS H NO SIGNS OR SYMPTOMS ( ,,HPV4 ,A VA39E 6PREV5T C.ER-RELAT$ TYPES ( ,,HPV HAS BE5 APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA = USE 9 ADOLESC5TS4 ,/UDIES >E "UWAY 9 OLD] WOM5 6DET]M9E IF ! VA39E W B5EFIT !M4 ,! ,PAP SME> IS A SCRE5+ TE/ 6DETECT ABNORMAL *ANGE 9 ! CELLS (! C]VIX4 ,X IS A SIMPLE (FICE PROC$URE 9 : CELLS >E SWA2$ F ! C]VIX & ANALYZ$ "U A MICROSCOPE4 ,PROP]LY P]=M$1 ! #ACG TE/ C DETECT ABNORMAL CELLS 2F !Y 2COME C.ER\S4 ,! CURE RATE 9 WOM5 ) PREC.ER\S LE.NS IS NE>LY #AJJ@3P4 ,"S"TS1 A WOMAN W NE$ A CLOS] LOOK AT ! C]VIX "? AN 9/RU;T CALL$ A COLPOSCOPE & BIOPSY ( ANY ABNORMALITIES PRIOR 6TR1T;T4 ,DESPITE ! IMPORT.E (! ,PAP SME>1 AB #EJ@3P ( ,U4,S4 WOM5 DIAGNOS$ ) C]VICAL C.ER H N"E _H ! TE/4 ,AN ANNUAL PELVIC EXAM & ,PAP SME> >E RECOMM5D$ 6*ECK = C]VICAL *ANGES4 ,WOM5 )\T C]VICAL C.ER RISK FACTORS :O H _H ?REE 3SECUTIVE NORMAL ,PAP SME>S MAY 2 TE/$ LESS (T51 B !Y %D 3T9UE 6H YE>LY PELVIC & BR1/ EXAMS4 ,IF A ,PAP SME> %[S ABNORMALITIES OR IF ! WOMAN HAS A HI/ORY ( C.ER OR A W1K IMMUNE SY/EM1 TE/+ MAY 2 NE$$ M (T54 ,WOM5 :O H _H A HY/]ECTOMY G5],Y DON'T NE$ A ,PAP SME> UN.S ! UT]US 0 REMOV$ 2C ( C]VICAL C.ER OR PREC.ER1 OR %E HAS A HI/ORY ( EXPOSURE 6,,DES 7DIE?YL/ILBE/ROL1 A HORM"O PRESCRIB$ 2T #AICH & #AIGA 6PREV5T MISC>RIAGES & O!R PREGNANCY-RELAT$ PRO#MS74 ,IF ! C]VIX 0 N REMOV$ DUR+ ! HY/]ECTOMY1 A WOMAN / NE$S A REGUL> ,PAP TE/4 ,OV>IAN ,C.ER ,/ATI/ICS %[ T ,U4,S4 & ,CANADIAN WOM5 H A L[ 9CID;E ( C.ER (! OV>IES4 ,OV>IAN C.ER REPRES5TS AB #C@3P ( ALL C.ERS 9 ! ,UNIT$ ,/ATES & ,CANADA1 YET X CAUSES M D1?S ?AN ANY O!R C.ER (! REPRODUCTIVE SY/EM1 PRIM>ILY 2C X IS USU,Y DIAGNOS$ AT AN ADV.ED & LESS CURA# /AGE4 ,:5 OV>IAN C.ER IS DETECT$ E>LY1 #ID@3P ( WOM5 SURVIVE AT L1/ #E YE>S4 ,H["E1 ONLY AB #AI@3P ( ALL CASES >E DIAGNOS$ AT ? /AGE4 ,OV>IAN C.ER RISK IS N A6ECT$ 0M5OPAUSE1 B ! RISK DOES 9CR1SE ) AGE1 "PICUL>LY 9 WOM5 )\T *N OR 9 ^? )A FAMILY HI/ORY ( BR1/ OR OV>IAN C.ER4 ,L[]$ RISK ( OV>IAN C.ER IS ASSOCIAT$ ) PREVI\S PREGNANCY1 PA/ USE ( BIR? 3TROL PILLS1 & BILAT]AL TUBAL LIG,N 7BO? FALLOPIAN TUBES SURGIC,Y CLOS$ OR 8TI$0 6PREV5T PREGNANCY74 ,! #ACI L>GE ,WOM5'S ,H1L? ,9ITIATIVE 7,,WHI7 /UDY SU7E/S T US+ HORM"O !RAPY1 EI Z ,,ET OR ,,EPT1 DOES N 9CR1SE OV>IAN C.ER RISK1 AL? O!R /UDIES H RAIS$ ? 3C]N4 ,NO SATISFACTORY SCRE5+ TE/S = OV>IAN C.ER >E CURR5TLY AVAILA#4 ,PAP SME>S R>ELY DETECT OV>IAN C.ER4 ,TRANSVAG9AL ULTRAS.D &A BLOOD TE/ =! TUMOR M>K] ,,CA#ABE H BE5 US$ 6SCRE5 WOM5 AT HI< RISK = OV>IAN C.ER1 B /UDIES H N PROV5 ! VALUE ( ? APPROA*4 ,6HELP DETECT *ANGES 9 ! OV>IES1 AN ANNUAL PELVIC EXAM IS RECOMM5D$1 ESPECI,Y = WOM5 OV] AGE #DJ4 ,2C ( OV>IAN C.ER RISK1 "S H1L?C>E PROVID]S ADVOCATE REMOVAL (! OV>IES :5 A HY/]ECTOMY IS P]=M$1 ESPECI,Y Z WOM5 APPROA* ! AGE ( M5OPAUSE4 ,H["E1 S9CE REMOV+ ! OV>IES RESULTS 9 SURGICAL M5OPAUSE1 ? DECI.N %D 2 MADE C>E;LLY AF A FULL 4CUS.N (! PROS & CONS4 ,LUNG ,C.ER ,TD1 LUNG C.ER HAS SURPASS$ BR1/ C.ER Z ! L1D+ CAUSE ( C.ER D1? 9 ,NOR? ,AM]ICAN WOM54 ,! NUMB] ( NEWLY DIAGNOS$ CASES 3T9UES 6RISE4 ,^! AL>M+ /ATI/ICS REFLECT ! 9CR1S+ NUMB]S ( WOM5 :O SMOKE CIG>ETTES1 0F> ! MO/ IMPORTANT RISK FACTOR 9 DEVELOP+ ? 41SE4 ,UN=TUNATELY1 "! IS NO E6ECTIVE SCRE5+ TE/ = LUNG C.ER4 ,( ALL ! LIFE/YLE-RELAT$ RISK FACTORS T C 2 *ANG$1 SMOK+ CESS,N HAS ! GRTE/ IMPACT ON REDUC+ LUNG C.ER D1?S4 ,EXPOSURE 6SECONDH& TOBA3O SMOKE AL POSES H1L? RISKS4 ,"O /UDY REPORTS T ! RISK ( LUNG C.ER IS APPROXIMATELY #CJ@3P HI<] = WIVES ( SMOK]S ?AN = WIVES ( NONSMOK]S4 ,COLON & ,RECTAL ,C.ER ,AF LUNG & BR1/ C.ER1 COLORECTAL C.ER IS ! NEXT MO/ -MON CAUSE ( C.ER D1? 9 ,U4,S4 & ,CANADIAN WOM54 ,X 9CLUDES C.ERS (! COLON 7! L[] "P (! 9TE/9E7 &! RECTUM 7! "P (! 9TE/9E T L1DS F ! COLON 6! ANUS74 #ADA ,COLORECTAL C.ER IS N ASSOCIAT$ ) M5OPAUSE B ) AGE2 M ?AN #IJ@3P ( COLORECTAL CASES O3UR 9 ^? #EJ & OLD]4 ,O!R NONMODIFIA# RISK FACTORS 9CLUDE A FAMILY HI/ORY ( COLORECTAL C.ER OR HAV+ COLORECTAL POLYPS OR 9FLAMMATORY B[EL 41SE4 ,COLORECTAL C.ER RISK MAY 2 L[]$ "? SMOK+ CESS,N1 EX]CISE1 H1L?Y DIET 7HI< 9 FRUITS & VEGETA#S1 L[ 9 FATS71 ADEQUATE CALCIUM 9TAKE1 OR TAK+ DAILY ASPIR9 OR A NON/]OIDAL ANTI-9FLAMMATORY DRUG 7S* Z IBUPR(574 ,/UDIES H SU7E/$ T ,,EPT USE MAY 2 PROTECTIVE AG/ COLORECTAL C.ER4 ,H["E1 HORM"O !RAPY %D N 2 US$ SOLELY = ? PURPOSE 2C H>M LIKELY EXCE$S B5EFITS4 ,COLON C.ER TYPIC,Y 2G9S Z PREC.ER\S COLON POLYPS & C 2 PREV5T$ IF ! POLYPS >E DETECT$ & REMOV$4 ,:5 COLORECTAL C.ER IS F.D E>LY1 #IJ@3P ( ^? TR1T$ W SURVIVE AT L1/ #E YE>S4 ,H["E1 ONLY #CI@3P ( COLORECTAL C.ERS >E F.D AT ? /AGE1 PRIM>ILY 2C ( L[ RATES ( SCRE5+4 ,WOM5 AT AV]AGE RISK ( COLORECTAL C.ER %D 2 SCRE5$ AT OR AF ! AGE ( #EJ YE>S4 ,! ,U4,S4 GUIDEL9ES = SCRE5+ WOM5 AT AV]AGE RISK 9CLUDE ! FOLL[+3 ANNUAL TE/+ ( /OOL = BLOOD 7CALL$ A FECAL O3ULT BLOOD TE/7 -B9$ )A FLEXI# SIGMOIDOSCOPY 7A TE/ 6VIEW 9SIDE ! RECTUM & L[] COLON7 E #E YE>S2 D\#-3TRA/ B>IUM 5EMA E #E YE>S2 OR A COLONOSCOPY 7: VIEWS ! 5TIRE COLON1 9CLUD+ >1S 2Y ! R1* (! SIGMOIDOSCOPE7 E #AJ YE>S4 ,CANADIAN GUIDEL9ES = POPUL,N-BAS$ SCRE5+ = COLORECTAL C.ER >E / "U 3SID],N4 ,PILOT PROJECTS >E "UWAY 6DET]M9E ! MO/ E6ECTIVE SCRE5+ ME?ODS4 ,9DIVIDUAL C5T]S T H ALR IMPLE;T$ SCRE5+ T5D 6USE GUIDEL9ES SIMIL> 6^? RECOMM5D$ 9 ! ,UNIT$ ,/ATES4 ,COLONOSCOPY IS ! MO/ ?OR\< ( ALL ^! OP;NS1 EVALUAT+ ! 5TIRE COLON & ALL[+ BIOPSIES & -PLETE REMOVAL ( PREC.ER\S POLYPS 9 A S+LE PROC$URE4 ,H["E1 X REQUIRES SED,N1 IS ! MO/ CO/LY (! TE/S AVAILA#1 & HAS A GRT] RISK ?AN #ADC ! ALT]NATIVES4 ,B>IUM 5EMA IS L1/ E6ECTIVE 2C ( XS 9F]IOR QUAL;Y Z A DIAGNO/IC PROC$URE4 ,?US1 B>IUM 5EMA %D PROBABLY 2 RECOMM5D$ ONLY = ^? :O _C TOL]ATE SED,N4 ,9 ^? CASES1 VIRTUAL COLONOSCOPY 7US+ A SPECIAL ;X-RAY ME?OD CALL$ A ,,CT SCAN 6EXAM9E ! COLON7 MAY 2 PREF]R$4 ,:ILE X DOES N REQUIRE SED,N & IS SAF] ?AN 3V5;NAL COLONOSCOPY1 X / REQUIRES ?OR\< LAXATIVE PREP>,N & MAY 2 2Y F9ANCIAL R1*1 Z X IS MO/ LIKELY N COV]$ 09SUR.E4 ,REG>D.S (! SCRE5+ OP;N SELECT$1 A DIGITAL RECTAL EXAM9,N %D 2 "P ( E WOMAN'S ANNUAL PHYSICAL EXAM4 ,WOM5 AT HI< RISK 72C ( _! HI/ORY ( COLORECTAL C.ER OR PREC.ER\S POLYPS1 OR 2C ( AN IMM FAMILY MEMB] ) ? HI/ORY7 REQUIRE M FREQU5T TE/+4 ,SCRE5+ %D 2G9 AT A "Y] AGE ?AN #EJ = WOM5 :O H AN IMM FAMILY MEMB] )A HI/ORY ( COLORECTAL C.ER OR PREC.ER\S POLYPS4 ,A WOMAN DIAGNOS$ ) BR1/ C.ER IS N 3SID]$ 6BE AT 9CR1S$ RISK ( DEVELOP+ COLORECTAL C.ER4 ,! ,HORM"O ,!RAPY ,/ORY ,S"EAL PRESCRIP;N DRUGS >E AVAILA# 6HELP RELIEVE M5OPAUSE-RELAT$ SYMPTOMS & DECR1SE L;G-T]M H1L? RISKS ACR ! M5OPAUSE TRANSI;N & 2Y4 ,? SEC;N FOCUSES ON HORM"O !RAPIES--! PRESCRIP;N DRUGS US$ MO/ (T5 :5 TR1T+ M5OPAUSE SYMPTOMS4 ,V>I\S T]MS & AN 8ALPHABET S\P0 ( ACRONYMS >E US$ 6DESCRIBE HORM"O !RAPY & !Y C "S"TS 2 3FUS+4 ,"H IS A BRIEF PRIM]3 -- ,,ET M1NS E/ROG5 !RAPY4 ,TR1T;T ( M5OPAUSE-RELAT$ 3DI;NS ) E/ROG5 0 ONCE CALL$ E/ROG5 REPLACE;T !RAPY 7,,ERT74 ,H["E1 ! T]M 8REPLACE;T0 IS A MISNOM] 2C ? !RAPY PROVIDES ONLY A FRAC;N (! E/ROG5 ONCE PRODUC$ 0! OV>IES2 E/ROG5 SUPPLE;T,N IS A M A3URATE DESCRIP;N4 ,! ,,FDA N[ M&ATES USE (! T]M E/ROG5 !RAPY 7,,ET74 -- ,,EPT M1NS -B9$ E/ROG5 PLUS PROGE/OG5 !RAPY4 ,E/ROG5 IS ! #ADE HORM"O 9 ? DUO T PROVIDES ! MO/ SYMPTOM RELIEF4 ,PROGE/OG5 IS A4$ 6PROTECT ! UT]US F E/ROG5 /IMUL,N4 -- ,,HT M1NS HORM"O !RAPY1 TE*NIC,Y 5COMPASS+ BO? ,,ET & ,,EPT4 ,! ,,FDA1 H["E1 REF]S 6,,EPT Z ,,HT4 ,A WIDE V>IETY ( ,,ET & ,,EPT PRODUCTS >E GOV]N;T APPROV$ 9 ! ,UNIT$ ,/ATES & ,CANADA =! TR1T;T ( MOD]ATE 6SEV]E HOT FLA%ES & VAG9AL ATROPHY1 SYMPTOMS 4CUSS$ E>LI] 9 ? 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REC5TLY PA/ M5OPAUSE1 D H UT]9E BLE$+ OR SPOTT+ DUR+ ! F/ #F MON?S OR M ( ^! REGIM5S4 ,A WOMAN %D REPORT ANY P]SI/5T IRREGUL> BLE$+ 6H] CL9ICIAN "R AWAY4 #AEE ,,EPT ,REGIM5S ,V>I\S ,,EPT DOS+ S*$ULES 7(T5 CALL$ 8REGIM5S07 C 2 US$4 ,^! REGIM5S 9CLUDE TAK+ E/ROG5 & PROGE/OG5 SEP>ATELY OR "? 3V5I5T -B9,N ,,EPT PRODUCTS 7SEE PAGE #AEG74 ,EA* WOMAN %D FEEL -=TA# EXPLOR+ DI6]5T OP;NS ) H] CL9ICIAN 6DET]M9E : IS BE/ = H]4 ,! MO/ -MON ,,EPT REGIM5S >E ! FOLL[+3 -- ,CYCLIC ,,EPT PROVIDES E/ROG5 = #BE "DS EA* MON?1 A4+ PROGE/OG5 ON ! LA/ #AJ 6#AD "DS1 FOLL[$ 0#C 6#F "DS ( NO !RAPY4 ,?US1 BO? HORM"OS >E 8CYCL$40 ,! POPUL>;Y ( ? REGIM5 HAS WAN$ 2C ( UT]9E BLE$+ EA* MON? :5 ! PROGE/OG5 CYCLE 5DS 7CALL$ 8)DRAWAL BLE$+07 &! POSSIBIL;Y ( HOT FLA%ES RETURN+ DUR+ ! E/ROG5-FREE 9T]VAL4 -- ,3T9U\S-CYCLIC ,,EPT 7"S"TS CALL$ SEQU5TIAL ,,EPT7 PROVIDES E/ROG5 E "D1 ) PROGE/OG5 A4$ = #AJ 6#AD "DS EA* MON?4 ,Z ) CYCLIC ,,EPT1 ? REGIM5 CAUSES UT]9E BLE$+ 9 AB #HJ@3P ( WOM5 :5 ! PROGE/OG5 CYCLE 5DS EA* MON?4 ,H["E1 BLE$+ GRADU,Y DECL9ES & /OPS 9 _M WOM5 AF A YE> OR M4 -- ,3T9U\S-COMB9$ ,,EPT PROVIDES BO? E/ROG5 & PROGE/OG5 E "D4 ,) ? ,,EPT REGIM51 LESS UT]9E BLE$+ O3URS 7#DJ@3P ( WOM5 DUR+ ! F/ #F MON?S71 B ! TIM+ IS LESS PREDICTA#4 ,AF A YE> ( !RAPY1 UT]9E BLE$+ /OPS 9 NE>LY #IJ@3P ( WOM54 -- ,9T]MITT5T-COMB9$ ,,EPT 7PROVID$ 0! BR& ,PREFE/7 PROVIDES E/ROG5 E "D1 !N A4S PROGE/OG5 9T]MITT5TLY 9 CYCLES ( #C "DS ON1 #C "DS (F4 ,BLE$+ & 5DOMETRIAL PROTEC;N >E SIMIL> 6T )A 3T9U\S-COMB9$ REGIM54 -- ,A FEW H1L?C>E PROVID]S >E N[ PRESCRIB+ E/ROG5 E "D1 A4+ PROGE/OG5 AT L;G] 9T]VALS 6L[] EXPOSURE 6PROGE/OG54 ,? 8L;G-CYCLE0 REGIM5 NE$S FUR!R TE/+ 63FIRM T X ADEQUATELY PROTECTS ! UT]9E L9+4 ,-B9,N ,,EPT ,PRODUCTS ,US$ #AEG = ,M5OPAUSE 9 ! ,UNIT$ ,/ATES & ,CANADA ,',IN ? *>T1 COLUMNS FOLL[ EA* O!R 9 ? 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HAS BE5 9CR1S$ 9T]E/ 9 CU/OM-MIX$ 78CU/OM-COMP.D$07 HORM"O PRODUCTS--RECIPES 3TA9+ "O OR M #AEI ( V>I\S HORM"OS 9 DI6]+ AM.TS1 DEP5D+ ON ! 9DIVIDUAL PRESCRIB]'S ORD]4 ,! RECIPE 3TA9S N ONLY ! ACTIVE HORM"O 7OR HORM"OS71 B AL O!R 9GR$I5TS T EI HOLD "EY?+ TGR 7IN ! CASE (A RECTAL SUPPOSITORY1 AN "U-!-T;GUE TA#T1 OR AN "U-!-SK9 PELLET7 OR PROVIDE A VEHICLE = APPLY+ ! PRODUCT ONTO ! SK9 7S* Z A CR1M OR GEL7 OR 96! BODY 7S* Z A LIQUID =A NASAL SPRAY74 ,^! CU/OM PRODUCTS H ! B5EFIT ( 9DIVIDUALIZ$ DOSES & MIXTURES ( PRODUCTS T >E N AVAILA# -M]CI,Y4 ,H["E1 RISKS H AL BE5 ID5TIFI$4 ,AL? ! 8ACTIVE 9GR$I5TS0 7! RAW E/ROG5 &/OR PROGE/OG5 -PON5TS7 >E GOV]N;T APPROV$1 ! MIXTURES >E N1 2C !Y H N BE5 /UDI$ 63FIRM T !Y >E ABSORB$ APPROPRIATELY OR PROVIDE PREDICTA# LEVELS 9 BLOOD & TISSUE4 ,?US1 "! IS LL OR NO SCI5TIFIC EVID;E AB ! E6ECTS ( ^! HORM"OS ON ! 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C 2 BAT*-TO-BAT* #AFA DI6];ES4 ,RELIA# /]IL;Y & FREEDOM F UNDESIR$ 3TAM9ANTS >E AL 3C]NS4 ,EXP5SE IS AL AN ISSUE1 Z "S CU/OM-COMP.D$ PREP>,NS T5D 6BE M EXP5SIVE & >E N COV]$ 09SUR.E PLANS4 ,! BOTTOM L9E3 ,CU/OM-COMP.D$ HORM"OS MAY RELIEVE M5OPAUSE SYMPTOMS1 B %D 2 US$ ONLY 0WOM5 :O _C TOL]ATE -M]CI,Y AVAILA# PREP>,NS & :O A3EPT ! RISKS4 ,!Y %D N 2 US$ 6PREV5T O/EOPOROSIS4 ,,BIOID5TICAL ,,HORM"OS ,"S"TS CU/OM-COMP.D$ HORM"OS >E REF]R$ 6Z 8BIOID5TICAL HORM"OS0 OR 8NATURAL HORM"OS40 ,^! T]MS M1N DI6]5T ?+S 6DI6]5T P4 ,6SCI5TI/S & H1L?C>E PROVID]S1 BIOID5TICAL HORM"OS >E ^? T >E *EMIC,Y ID5TICAL 6! HORM"OS PRODUC$ 0WOM5 7PRIM>ILY 9 ! OV>IES7 DUR+ _! REPRODUCTIVE YE>S4 ,A WOMAN'S BODY C MAKE V>I\S E/ROG5S 7S* Z #AG;BETA-E/RADIOL1 E/R"O1 & E/RIOL7 Z WELL Z PROGE/]"O1 TE/O/]"O1 & O!R HORM"OS4 ,?US1 BIOID5TICAL HORM"O !RAPY C M1N A M$IC,N T PROVIDES "O OR M ( ^! HORM"OS Z ! ACTIVE 9GR$I5T4 ,BIOI5TICAL HORM"OS H BE5 PRODUC$ -M]CI,Y 6BE *EMIC,Y EXACT DUPLICATES ( NATUR,Y O3URR+ HORM"OS4 ,"S ( ^! HORM"OS >E MADE AVAILA# 9 WELL-TE/$1 GOV]N;T-APPROV$1 BR&-"N PRESCRIP;N DRUGS4 ,S"EAL ,,FDA,'-APPROV$ DRUGS 3TA9 #AG;BETA-E/RADIOL 7SEE ,*>TS ON PAGES #AEC & #AEG71 & ^? T >E N TAK5 OR,Y REMA9 9 ! BODY Z #AG;BETA-E/RADIOL4 ,ORAL PRODUCTS BR1K D[N 96ANO!R E/ROG5 TYPE T IS N BIOID5TICAL4 ,"! IS "O GOV]N;T-APPROV$ BIOID5TICAL PROGE/]"O PRODUCT 7SEE ,*>T ON PAGE #AEC4 ,X IS N NEC 6CU/OM-MAKE A HORM"O PRODUCT 6H "O T IS BIOID5TICAL OR NATURAL4 ,,3TRA9DIC,NS ,S-CALL$ 8NATURAL0 !RAPIES >E N )\T RISK4 ,"S WOM5 H 3TRA9DIC,NS 6US+ E/ROG5 OR E/ROG5-PROGE/OG5 ,,ET/,,EPT4 ,^! >E R1SONS N 6USE ! TR1T;T4 ,9 A #AFC FEW CASES1 ! POT5TIAL B5EFITS MAY \TWEI< ! POT5TIAL RISKS1 L1D+ WOM5 ) S* 3TRA9DIC,NS 6A3EPT !RAPY AF C>E;L 3SID],N4 ,GOV]N;T GUIDEL9ES 9DICATE T1 9 G5]AL1 WOM5 :O H ! FOLL[+ 3DI;NS %D N USE ,,ET/,,EPT4 ,! GUIDEL9ES D N MAKE A 4T9C;N 2T SY/EMIC & LOCAL !RAPY1 & ADVISE T EV5 LOCAL VAG9AL HORM"OS %D N 2 US$ 9 ^! 9/.ES4 ,H["E1 _M EXP]TS ?9K SY/EMIC & LOCAL HORM"O !RAPIES H DI6]5T RISK PROFILES4 -- ,"KN OR SUSPECT$ PREGNANCY -- ,HI/ORY ( BR1/ C.ER -- ,HI/ORY ( HORM"O-S5SITIVE C.ER -- ,UNEXPLA9$ UT]9E BLE$+ -- ,LIV] 41SE 7? ESPECI,Y APPLIES 6ORAL ,,ET7 -- ,HI/ORY ( BLOOD CLOTS -- ,3FIRM$ C>DIOVASCUL> 41SE ,CIG>ETTE SMOK+ IS N A 3TRA9DIC,N = ,,ET/,,EPT1 Z X IS ) ORAL 3TRACEPTIVE USE 9 WOM5 OV] AGE #CE1 B SMOK]S >E URG$ 6/OP 2F TR1T;T />TS = G5]AL H1L? R1SONS4 ,,SIDE ,,E6ECTS ,POT5TIAL ADV]SE SIDE E6ECTS ( SY/EMIC E/ROG5 !RAPY >E LI/$ 2L4 -- ,UT]9E BLE$+ 7/>T+ OR RETURN+7 -- ,BR1/ T5D];S OR PA9 79CR1S$ D5S;Y & "S"TS 5L>GE;T7 -- ,NAUSEA -- ,ABDOM9AL BLOAT+ -- ,FLUID RET5;N 9 EXTREMITIES -- ,*ANGES 9 ! %APE (! CORNEA (! EYE 7"S"TS L1D+ 63TACT L5S 9TOL].E7 -- ,H1DA*E 7"S"TS MIGRA9E7 -- ,DIZZI;S -- ,HAIR LOSS ,L[-DOSE LOCAL VAG9AL E/ROG5 !RAPY HAS A SIMIL> SET ( POSSI# SIDE E6ECTS1 & EA* TYPE 7CR1M1 TA#T1 OR R+7 DI6]S SLIGE OR IT*+1 BR1/ T5D];S1 & NAUSEA--: #AFE IMPLY T ^! HORM"OS MI 6^? ( ,,PMS1 9CLUD+ FLUID RET5;N1 H1DA*E1 BR1/ T5D];S1 & MOOD *ANGES1 "PICUL>LY )! SYN!TIC PROGE/9S4 ,SY/EMIC ,,ET/,,EPT DOES N CAUSE WEIY WEIILY L>G]4 ,"! IS "O 8SIDE E6ECT0 ISSUE T IS IMPORTANT 6KEEP 9 M9D :5 SY/EMIC ,,ET/,,EPT IS 6BE 4CONT9U$3 /OPP+ ALL AT ONCE (T5 RESULTS 9 HOT FLA%ES4 ,GRADU,Y TAP]+ ! DOSE MAY 2 HELP;L1 AL? ? HAS N BE5 PROV54 ,EXP]TS DON'T AGREE ON ! BE/ WAY 6/OP ,,ET/,,EPT4 ,LOCAL VAG9AL ,,ET MAY 2 4CONT9U$ ABRUPTLY )\T ANY ADV]SE E6ECTS4 ..,D1L+ ) ,,ET/,,EPT SIDE .E6ECTS4 ,"! >E V>I\S /RATEGIES T WOM5 & _! CL9ICIANS (T5 USE 6D1L ) UNWANT$ SIDE E6ECTS ( ,,ET OR ,,EPT 7SEE PAGE #AFF74 ,H["E1 9 G5]AL1 !Y H N BE5 EVALUAT$ 9 CL9ICAL TRIALS4 ,_M SIDE E6ECTS ( !RAPY >E TEMPOR>Y UNTIL A WOMAN ADJU/S 6! HORMONAL *ANGES4 ,UN.S SIDE E6ECTS >E SEV]E1 A TRIAL ( #C MON?S ( ANY HORM"O !RAPY IS ADVIS$ 6SEE IF !Y RESOLVE4 ,"O /RATEGY IS APPROPRIATE = ANY SIDE E6ECT--/OP HORM"OS 6SEE IF HORM"OS >E ! CAUSE4 ,/RATEGIES 6,HELP ,RELIEVE ,,ET/,,EPT ,SIDE ,E6ECTS ,9 G5]AL1 ALL ,,ET/,,EPT SIDE E6ECTS MAY 2 RELIEV$ 0L[]+ ! DOSE ( E/ROG5 &/OR PROGE/OG51 SWIT*+ 6ANO!R E/ROG5 &/OR PROGE/OG5 79CLUD+ PROGE/]"O71 OR *ANG+ 6A 3T9U\S DOSAGE S*$ULE OR A SK9 DELIV]Y SY/EM 6AVOID HORM"O FLUCTU,NS4 ,O!R SPECIFIC /RATEGIES 9CLUDE ! FOLL[+3 #AFG ,,FLUID ,,RET5;N4 ,RE/RICT SALT 9TAKE1 MA9TA9 ADEQUATE WAT] 9TAKE1 EX]CISE1 TRY A MILD DIURETIC 7EI H]BAL OR PRESCRIP;N74 ,,BLOAT+4 ,RE/RICT SALT 9TAKE1 MA9TA9 ADEQUATE WAT] 9TAKE1 EX]CISE1 TRY A MILD DIURETIC 7EI H]BAL OR PRESCRIP;N74 ,,BR1/ ,,T5D];S4 ,RE/RICT SALT 9TAKE1 CUT D[N ON CA6E9E & *OCOLATE4 ,,H1DA*ES4 ,RE/RICT SALT1 CA6E9E1 & ALCOHOL 9TAKE1 5SURE ADEQUATE WAT] 9TAKE4 ,,MOOD ,,*ANGES4 ,RE/RICT SALT1 CA6E9E1 & ALCOHOL 9TAKE1 5SURE ADEQUATE WAT] 9TAKE1 EX]CISE REGUL>LY4 ,,NAUSEA4 ,TAKE ORAL E/ROG5 TA#TS ) M1LS OR 9 ! EV5+ )A SNACK4 ,,SK9 ,,IRRIT,N ,,"U ,,PAT*4 ,KEEP SITE V CL1N1 SWIT* 6A PAT* )A DI6]5T ADHESIVE1 APPLY PAT* 6A DI6]5T >EA1 *ANGE 6ORAL E/ROG54 ,,RISKS ,LIT],Y HUNDR$S ( CL9ICAL /UDIES H PROVID$ EVID;E T SY/EMIC E/ROG5 !RAPY 7) OR )\T PROGE/OG57 RELIEVES M5OPAUSE SYMPTOMS4 ,USE ( HORM"O !RAPY %D ALW 2 AT ! L[E/ E6ECTIVE DOSE &=! %ORTE/ AM.T ( "T 3SI/5T ) TR1T;T GOALS4 ,? IS 6M9IMIZE EXPOSURE 6! HORM"OS1 : H BE5 ASSOCIAT$ ) "S S]I\S RISKS4 ,X HAS BE5 WELL DOCU;T$ = DECADES T US+ SY/EMIC ,,ET AL"O C DRAMATIC,Y 9CR1SE ! RISK ( DEVELOP+ C.ER (! UT]US4 ,H["E1 X IS AL WELL "KN T US+ ANO!R PRESCRIP;N HORM"O--PROGE/OG5--) E/ROG5 !RAPY 7Z ,,EPT7 REDUCES T RISK 6! LEVEL ( TAK+ NO HORM"OS4 ,?US1 ALL WOM5 )A UT]US :O USE SY/EMIC ,,ET >E ADVIS$ 6USE PROGE/OG5 7Z ,,EPT7 Z WELL1 EV5 :5 US+ E/ROG5 !RAPY %ORT T]M4 ,L[-DOSE1 LOCAL ,,ET = VAG9AL ATROPHY IS ASSOCIAT$ ) V FEW RISKS1 EV5 :5 US$ L;G T]M OR 9ITIAT$ YE>S AF M5OPAUSE4 ,H["E1 SAFETY DATA ON L;G-T]M USE >E N AVAILA#4 ,HI<] DOSES CD RESULT 9 SY/EMIC LEVELS1 #AFI REQUIR+ 3SID],N ( PROGE/OG5 !RAPY 6PROTECT ! UT]US4 ,! R1L 3C]N AB HORM"O SAFETY IS ) L;G-T]M USE ( SY/EMIC ,,ET OR ,,EPT--& 3C]N AB ! RISK = BR1/ C.ER IS AT ! TOP (! LI/4 ,CURR5T SCI5TIFIC EVID;E SUPPORTS A L9K 2T AN 9CR1S$ RISK ( BR1/ C.ER & ,,EPT1 "PICUL>LY AF S"EAL YE>S ( USE4 ,= EXAMPLE1 9 ! L>GE ,WOM5'S ,H1L? ,9ITIATIVE 7,,WHI7 /UDY1 ,,EPT USE 9CR1S$ ! RISK ( BR1/ C.ER 0#BD@3P AF #E YE>S ( USE4 ,9 /ATI/ICAL T]MS1 ? RISK IS SMALL1 AB #H M CASES ANNU,Y P] #AJ1JJJ WOM5 US+ HORM"OS -P>$ ) ^? N US+ HORM"OS4 ,BR1/ C.ER RISK DID N 9CR1SE 9 ! SEG;T (! TRIAL T EVALUAT$ WOM5 :O _H A HY/]ECTOMY & :O 7 US+ ,,ET AL"O4 ,9 FACT1 RISK ACTU,Y DECL9$ #BJ@3P 7#G P] #AJ1JJJ74 ,N"O!.S1 ALL ,,ET & ,,EPT PRODUCTS %D 2 3SID]$ 3TRA9DICAT$ 9 WOM5 ) "KN OR SUSPECT$ BR1/ C.ER Z WELL Z 9 ^? )A HI/ORY ( BR1/ C.ER4 ,L;G-T]M USE 7OR M ?AN ! #E-G YE>S /UDI$7 IS AL A 3C]N4 ,H["E1 %ORT] T]M USE ( ,,ET OR ,,EPT DUR+ P]IM5OPAUSE 6RELIEVE HOT FLA%ES & O!R M5OPAUSE-RELAT$ SYMPTOMS DOES N APPE> 69CR1SE BR1/ C.ER RISK4 ,PREVI\SLY1 RESE>* 9DICAT$ T US+ SY/EMIC ,,ET/,,EPT L[]$ ! RISK ( HE>T 41SE4 ,B S"EAL L>GE /UDIES H CL>IFI$ ASPECTS (! IMPACT ( HORM"O !RAPY ON HE>T H1L?4 ,X APPE>S T IF A WOMAN USES HORM"O !RAPY 2F %E HAS SIGNIFICANT DAMAGE 6H] BLOOD VESSELS 7S* Z CLOSE 6! "T ( M5OPAUSE71 H] RISK = DEVELOP+ HE>T 41SE MIT 41SE--& W PROBABLY 9CR1SE H] RISK1 "PICUL>LY ( /ROKE4 ,TIM+ ( HORM"O !RAPY IS CRUCIAL4 ,B NO WOMAN %D 3SID] US+ HORM"O !RAPY SOLELY = HE>T B5EFITS4 ,ANO!R S]I\S 3C]N :5 3SID]+ />T+ SY/EMIC HORM"O !RAPY _M YE>S AF M5OPAUSE IS T ( XS E6ECT ON MEMORY4 ,! ,,WHI /UDY F.D T />T+ SY/EMIC ,,EPT AF AGE #FE %D N 2 RECOMM5D$1 Z X MAY 9CR1SE ! RISK ( DE;TIA DUR+ #E #AGA YE>S ( USE4 ,M RESE>* IS NE$$ 6"K ! E6ECTS ( ,,ET />T$ AT V>I\S "TS AF M5OPAUSE4 ,S"EAL TRIALS H DET]M9$ T HORM"O !RAPY ) ,,ET OR ,,EPT REDUCES ! RISK ( FRAGILE B"OS & FRACTURE1 ESPECI,Y ) ADEQUATE 9TAKE ( CALCIUM & VITAM9 ;,D4 ,L;G-T]M USE IS REQUIR$1 S9CE B"O LOSS RESUMES AF /OPP+ !RAPY4 ,:5 M5OPAUSE SYMPTOMS >E 3TROLL$ OR C1SE1 3T9U$ HORM"O !RAPY C / 2 3SID]$ = B"O E6ECTS --WEI<+ XS B5EFITS & RISKS ) ALT]NATE !RAPIES4 ,Z A RESULT (! ,,WHI DATA1 ! ,,FDA & ,H1L? ,CANADA REQUIRE ALL E/ROG5-3TA9+ PRESCRIP;N !RAPIES 6C>RY A 8BLACK BOX0 W>N+ 9 _! PRESCRIB+ 9=M,N AB ! ADV]SE RISKS ( ,,ET/,,EPT4 ,AL? ONLY TWO ,,ET/,,EPT PRODUCTS 7 /UDI$ 9 ,,WHI1 ,PREM>9 & ,PREMPRO1 9 ! ABS;E ( 3TR>Y DATA ON O!R HORM"O PRODUCTS1 ! RISKS ( ALL ,,ET/,,EPT PRODUCTS %D 2 ASSUM$ 6BE SIMIL>4 ,"! IS NO EVID;E T ! USE ( 8NATURAL0 OR CU/OM-COMP.D$ E/ROG5S RESULTS 9 DI6]5T RISKS4 ,,WEI<+ ,,B5EFITS & ,,RISKS ,,( ,,ET/,,EPT ,Z ) ALL !RAPIES1 A WOMAN :O IS 3SID]+ HORM"O !RAPY M/ -P>E XS POT5TIAL B5EFITS 6XS POT5TIAL RISKS4 ,& AL? %ORT-T]M USE IS SAF] ?AN L;G-T]M USE1 "! IS NO "T P]IOD ( USE T'S 3SID]$ 8SAFE40 ,A3EPTA# RISK DEP5DS ON A WOMAN'S 9DIVIDUAL CIRCUM/.ES4 ,H] DECI.N W 2 L>GELY 9FLU;ED 0! SEV];Y ( H] M5OPAUSE-RELAT$ SYMPTOMS1 H] RISK FACTORS = 41SES S* Z O/EOPOROSIS1 HE>T 41SE1 & BR1/ C.ER1 & H] P]SONAL H1L? & PHILOSOPHY4 ,%E MAY 2 SU6]+ F HOT FLA%ES T A6ECT H] QUAL;Y ( LIFE1 MAK+ RISKS M A3EPTA# 7"PICUL>LY S9CE HOT FLA%ES >E TYPIC,Y %ORT T]M & RISKS >E L[74 ,OR %E MAY 2 A H1L?Y WOMAN 3SID]+ HORM"O USE 6/AY H1L?Y1 S* Z 0TRY+ 6PREV5T O/EOPOROSIS1 MAK+ RISKS LESS A3EPTA# 7"PICUL>LY S9CE !RAPY M/ 2 L;G T]M & SAFE1 & E6ECTIVE NONHORMONAL ALT]NATIVES >E AVAILA#74 ,OR MAYBE %E WANTS 6D #AGC BO?4 ,EA* WOMAN IS 9 A UNIQUE SITU,N4 ,& H] 3FU.N IS FUEL$ 0*ANG+ REPORTS OV] ! PA/ DECADES REG>D+ ! E6ECTS & RISKS ( HORM"O !RAPY4 ,DUR+ ^! YE>S1 M$ICAL PROFES.NALS H *ANG$ _! VIEWS AB ! ROLE ( HORM"OS Z M RESE>* HAS BE5 3DUCT$4 ,EXP]TS AGREE T "! IS M* !Y / H 6LE>N4 ,AL? REC5T /UDIES S* Z ! ,,WHI H PROVID$ "S CL>;Y = L>GE POPUL,NS1 !Y DON'T NECESS>ILY A4RESS ALL (! ISSUES AN 9DIVIDUAL WOMAN FACES4 ,ONLY %E1 )! C\NSEL ( H] H1L?C>E PROVID]S1 C D T4 ,_M FACTORS W 2 "P (A WOMAN'S DECI.N 6USE A "PICUL> HORM"O PRODUCT--H] AGE1 H] RISKS1 H] PREF];ES1 AVAILA# TR1T;T OP;NS1 &! CO/ (! PRODUCT4 ,EA* WOMAN M/ DECIDE IF H] POT5TIAL B5EFITS \TWEI< H] POT5TIAL RISKS4 ,ONLY AF EXAM9+ & "U/&+ H] [N SITU,N & AF A ?OR\< 3SULT,N ) H] H1L?C>E PROVID] C A WOMAN MAKE ! BE/ TR1T;T *OICE4 ,A WOMAN'S DECI.N AB HORM"O !RAPY MAY AL *ANGE Z M IS LE>N$ "? CL9ICAL TRIALS & Z P]SONAL SITU,NS & RISK FACTORS *ANGE4 ,,DI6]5T ,,WOM51 ,,DI6]5T ,,NE$S ,"! IS NO S+LE WAY 65SURE ! BE/ POSSI# QUAL;Y ( LIFE >.D M5OPAUSE & 2Y4 ,EA* WOMAN IS UNIQUE4 ,X IS B5EFICIAL =A WOMAN 69VE/ "T "W+ ) H] H1L?C>E PROFES.NALS 6CR1TE AN 9DIVIDUAL H1L? PLAN & 6REEVALUATE & MAKE !RAPEUTIC ADJU/;TS1 N ONLY Z NEW !RAPIES & GUIDEL9ES >E AVAILA#1 B AL ! WOMAN'S BODY 3T9UES 6*ANGE 9 XS [N 9DIVIDUAL WAY4 ,A*IEV+ ,OPTIMAL ,H1L? ,REGUL> CL9ICAL *ECKUPS W HELP A WOMAN A*IEVE OPTIMAL H1L?4 ,! *ECKUPS C ID5TIFY ANY H1? 3DI;NS T NE$ 6BE A4RESS$4 ,= EXAMPLE1 REGUL> MAMMOGRAMS >E IMPORTANT = WOM5 OV] #DJ4 ,PAP TE/S >E AL RECOMM5D$1 EV5 AF M5OPAUSE4 ,HEII\S 41SES1 S* Z DIABETES1 HE>T 41SE1 & ?YROID 41SE4 ,REGUL> CL9ICAL *ECKUPS AL PRES5T AN OPPORTUN;Y 6DEVELOP OR RE9=CE AN 9DIVIDUAL H1L? PLAN1 9CLUD+ LIFE/YLE MODIFIC,N4 ,*OOS+ H1L?Y LIFE/YLE HABITS RESULTS 9 DRAMATIC IMPROVE;T 9 H1L? & L;GEV;Y4 ,AL? GIV+ UP L;G-/&+ UNH1L?Y HABITS MAY 2 DI6ICULT1 ? 8TR1T;T0 IS USU,Y FREE1 -ES ) NO RISK1 & IS ULTIMATELY REW>D+4 ,"EY"O IS 5C\RAG$ 6A4RESS LIFE/YLE F/1 PRIOR 63SID]+ M$IC,N4 ,,LIFE/YLE ,,*ANGES ,A CU/OMIZ$ LIFE/YLE MODIFIC,N /RATEGY IS AN ESS5TIAL ELE;T 9 A -PREH5SIVE !RAPEUTIC PLAN = ANY WOMAN 6ATTA9 OPTIMAL H1L? "?\T H] LIFE4 ,M5OPAUSE PRES5TS A UNIQUE OPPORTUN;Y 6REASSESS ^! LIFE/YLE *OICES1 9CLUD+ SUB/.E USE 7S* Z SMOK+71 REGUL> EX]CISE1 ADEQUATE NUTRI;N1 WEIT >E NUM]\S4 ,SMOK+ 9CR1SES ! RISK ( HE>T & LUNG 41SE1 O/EOPOROSIS1 & _M TYPES ( C.ER1 9CLUD+ LUNG & C]VICAL C.ER4 ,X MAY D\# ! RISK = ,ALZHEIM]'S 41SE4 ,SMOK]S AL EXP]I;E M5OPAUSE UP 6#B YE>S E>LI] ?AN NONSMOK]S4 ,_M WOM5 SU3ESS;LLY QUIT SMOK+1 (T5 AF S"EAL ATTEMPTS4 ,H1L?C>E PROVID]S C (F] A V>IETY ( PRESCRIP;N SMOK+ CESS,N AIDS4 ,S"EAL OV]-!-C.T] NICOT9E PRODUCTS 7AVAILA# Z GUM1 LOZ5GE1 NASAL SPRAY1 OR SK9 PAT*7 & AT L1/ "O PRESCRIP;N ANTIDEPRESSANT >E GOV]N;T APPROV$ 6HELP 8KICK ! HABIT40 ,SUPPORT GR\PS & HYPNOSIS >E O!R OP;NS4 #AGG ,A -B9,N ( 2HAVIOR MODIFIC,N TE*NIQUES & PRESCRIP;N DRUG !RAPY APPE>S 6BE ! MO/ SU3ESS;L APPROA*4 ,_M SMOK]S :O ULTIMATELY QUIT H 6D S M ?AN ONCE1 S 3T9U+ 6TRY IS IMPORTANT4 ,ADEQUATE ,EX]CISE ,PHYSICAL 9ACTIV;Y IS A RISK FACTOR = _M S]I\S 41SES4 ,ADEQUATE EX]CISE IS A CRUCIAL 9GR$I5T (T5 MISS+ F DAILY LIFE4 ,BRISK WALK+1 RUNN+1 AEROBICS1 DANC+1 T5NIS1 & WEIE ACTIVITIES T HELP ! HE>T1 B"OS1 MUSCLES1 BAL.E1 BODY WEILY4 ,EX]CISE C HELP PREV5T S]I\S 41SES1 9CLUD+ HE>T 41SE1 DIABETES1 & O/EOPOROSIS4 ,A KEY F/ /EP IS 6DEVELOP A PRACTICAL1 L;G-T]M1 9DIVIDUALIZ$ EX]CISE PLAN4 ,? REQUIRES M5TAL EF=T4 ,! NEXT /EP IS 6-MIT 6! PLAN = S"EAL MON?S4 ,!N1 MO/ WOM5 WON'T WANT 6/OP4 ,"! >E ?REE TYPES ( EX]CISES-- AEROBIC1 WEI+1 & FLEXIBIL;Y--& ALL >E IMPORTANT4 ,A MOD]ATE AEROBIC EX]CISE REGIM5 ( AT L1/ #CJ M9UTES EA* "D HAS ! GRTE/ E6ECT ON HE>T & LUNG H1L?4 ,A BRISK #B-MILE WALK IS A GD AEROBIC EX]CISE4 ,WEI+ EX]CISE1 S* Z FA/ WALK+ OR "W+ ) WEILY 9 LIFE1 WEI+ EX]CISE PROMOTES HI<] B"O MASS2 LAT] 9 LIFE1 X C H A MODE/ IMPACT ON SL[+ B"O LOSS4 ,FLEXIBIL;Y EX]CISES1 S* Z YOGA & /RET*+1 HELP MA9TA9 MUSCLE FUNC;N & JO9T FLEXIBIL;Y :ILE AG+4 ,^! EX]CISES MAY AL IMPROVE BAL.E1 : C DECR1SE ! RISK ( FRACTURES CAUS$ 0FALLS4 ,A H1L?C>E PROVID] C HELP DET]M9E ! 9ITIAL LEVEL ( EX]CISE APPROPRIATE = 9DIVIDUAL NE$S4 ,F9D+ WAYS #AGI 6MAKE EX]CISE A P]MAN5T "P ( DAILY LIFE W HELP 5SURE A H1L?I] FUTURE4 ,"O WAY IS 6"PN] )A FR = REGUL> WALKS OR O!R PHYSICAL ACTIVITIES4 ,H1L?Y ,DIET 8,Y >E :AT Y EAT0 MAY S.D TRITE1 B X'S TRUE4 ,A BAL.ED DIET L[ 9 SATURAT$ FAT & HI< 9 :OLE GRA9S1 FRUITS1 & VEGETA#S1 ) ADEQUATE WAT]1 VITAM9S1 & M9]ALS1 3TRIBUTES 6GD H1L?4 ,UN.S A WOMAN HAS A 3DI;N T CALLS = ANO!R DIET>Y PLAN1 DAILY DIET>Y GOALS = WOM5 AT M5OPAUSE & 2Y 9CLUDE ! 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