Chronic dysfunction, disabilities and complex diseases such as cardiovascular disease, Diabetes Mellitus Type 2, osteoporosis and certain cancers among other burdens emerge and accelerate in midlife women. Previously in Part l we have described clinical and laboratory research findings which more readily explain and clarify the underlying pathogenetic mechanisms driving these clinical burdens. Included were new findings on how in particular visceral obesity and the emergence and acceleration of various components of the Metabolic Syndrome – glucotoxicity, lipotoxicity and a chronic systemic inflammatory state abetted by loss of ovarian production of estradiol and the inevitable inroads of aging generate this spectrum of clinical problems. These research insights translate into opportunities for effective care strategies leading to prevention, amelioration, possible correction and enhanced quality of life. To achieve these goals, updated detailed diagnostic, management and therapeutic guidelines implemented by a reprogrammed, repurposed “menopause” office visit is described. A triage mechanism-when to refer other specialists for further care is emphasized. The formerly polarized views of Menopausal Hormone Therapy (MHT) have narrowed significantly leading to construction of a more confident, unified and wider clinical application. Accordingly, a MHT program providing maximum benefit and minimum risk, accompanied by an algorithm for enhanced shared decision-making is included.
Copyright © 2020. Published by Elsevier Inc.