PRIMARY AND SECONDARY PREVENTION STRATEGIES AMONG OLDER POSTMENOPAUSAL WOMEN

Women may choose to initiate, reinitiate, or discontinue hormone repla cement therapy (HRT) at any time beyond the perimenopausal period. HRT , exercise, and nutrition are reviewed in terms of their potential ben efits as primary and secondary preventive therapies against coronary h eart disease; osteoporosis, breast and genital cancers, and the mainte nance of cognitive function among older postmenopausal women. Lifestyl e alternatives involving nutrition and exercise that offer many of the same benefits as HRT are discussed. Since both pharmacologic and life style interventions offer significant benefit for primary and secondar y prevention of disease and disability, each should be offered to wome n for consideration as they enter the perimenopausal period. Additiona lly, each can be recommended for initiation even at much older ages an d subsequent to adverse health occurrences, such as the experience of breast or genital cancer or a cardiac event. Each should be sustained over the long term. The decision whether to discontinue these interven tions among the most elderly will be influenced by other quality of li fe considerations. (C) 1998 by the American College of Nurse-Midwives.