Menopause care for obese and diabetic women.

Women with obesity or/and diabetes form an increasing part of the peri- and post-menopausal women cared for by general practicioners and gynaecologists. Menopausal obese/diabetic women have a different hormonal milieu than lean women, with increased exposure to androgens and oestrogens. In spite of this, obese women experience more menopause-related symptoms, particularly vasomotor symptoms and urinary incontinence. Obese and diabetic women also have a higher risk of breast and endometrial cancer, dementia, coronary heart disease (CHD) and venous and arterial thromboembolism. Bone mineral density loss is variable yet diabetic women show a uniformly higher rate of fractures, partly through a greater likelihood of falls. Although oestrogen-progestagen-type hormone therapy (HT) -improves glycaemic control and the lipoprotein profile in diabetic women, HT should be used very cautiously in obese and diabetic postmenopausal women because of accrued risks of thrombosis and CHD. Instead, the primary goal is to stimulate physical activity which improves general fitness and body weight control during the menopause transition, and which reduces the risk of breast cancer and osteoporosis. Also, vitamin D sufficiency should be ensured together with a healthy calcium intake, but anti-osteoporosis drugs which strongly suppress bone remodelling should be used with caution.