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Menopause & Postmenopause

Menopause is the final menstrual period, confirmed after 12 months without one (average age 51). The post-reproductive phase that follows lasts 30+ years and is shaped fundamentally by the sustained low-estrogen state. Nutrition, movement and medical care can all help protect health through these decades.

Hormonal & Women's Health Evidence-Based

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Definition

What Is Menopause?

Menopause is the permanent cessation of menstruation, retrospectively diagnosed after 12 consecutive months without a period. The average age in the US is 51 (range 45 to 55). The remaining 30+ years of post-reproductive life are referred to as postmenopause.

After menopause, the ovaries make very low levels of estrogen and progesterone14. The adrenal glands and adipose tissue continue producing small amounts of estrogen (estrone, primarily), but the dominant hormonal state is one of estrogen deficiency. Progesterone is essentially absent without external supplementation.

This sustained low-estrogen state drives most of the long-term changes: bone density loss, cardiovascular shifts, urogenital atrophy, body composition changes and accelerated brain aging. Exercise, nutrition and, where needed, medical treatment can reduce several of these risks.

โš ๏ธ "Early" menopause (before age 45) and "premature" menopause (before age 40) carry significantly higher long-term health risks and warrant earlier and more aggressive bone and cardiovascular protection.
A calm woman surrounded by six icons for hot flashes, night sweats, sleep problems, mood changes, bone loss and vaginal dryness

Stages of the Menopausal Continuum

Early Postmenopause

The first 1 to 3 years after the final menstrual period. Vasomotor symptoms typically peak in intensity and frequency here. Sleep, mood and cognitive symptoms are often most disruptive. Highest leverage period for intervention.

Mid Postmenopause

Years 3 to 10 after menopause. Vasomotor symptoms gradually decline, though among women with frequent hot flashes they last a median of 4.5 years after the final period2. Genitourinary symptoms typically worsen. Bone loss continues; cardiovascular risk rises.

Late Postmenopause

10+ years postmenopause. Vasomotor symptoms uncommon. Long-term health risks (osteoporosis, atherosclerosis, neurodegeneration) become primary clinical concerns. Maintenance of muscle, bone and brain health is the focus.

By the Numbers

Menopause by the Numbers

51
average age of natural menopause in the US1
~75%
of women experience vasomotor symptoms during the transition1
7.4
median years symptoms persist among women with frequent hot flashes, about 4.5 of them after the final period (SWAN)2
1 in 2
women over 50 will break a bone because of osteoporosis3
88%
fall in moderate-to-severe hot flashes on a low-fat plant-based diet with daily soybeans, in one 12-⁠week randomized trial8
65
the age by which every woman is advised to have a bone density test, sooner with risk factors12
Signs & Symptoms

Symptoms of Menopause

Menopausal symptoms cluster into four physiological categories. Hot flashes and mood symptoms often ease within years; genitourinary symptoms tend to progress without treatment.

SymptomWhat happens
Vasomotor
Hot FlashesThe most common symptom (see the figures above). Severity ranges from brief warmth to drenching episodes several times a day.
Night SweatsDrenching night episodes that break up sleep and worsen daytime fatigue and mood.
Facial FlushingPersistent or intermittent flushing of the face, neck and upper chest. Triggered by alcohol, caffeine, spicy food and emotional stress.
Heart PalpitationsPounding, racing or skipped heartbeats, often during hot flashes or at rest. Should be evaluated when frequent to rule out atrial fibrillation, which becomes more common in postmenopause.
Genitourinary
Vaginal & Vulvar AtrophyEstrogen-deficient vaginal tissue thins, loses elasticity and produces less lubrication. Causes dryness, burning, itching and discomfort. Affects an estimated 27 to 84% of postmenopausal women and, unlike hot flashes, tends to persist without treatment15.
Painful Intercourse (Dyspareunia)Thinning epithelium plus narrowed/​shortened vaginal canal causes friction pain. Vaginal estrogen is effective; after breast cancer its safety is not yet confirmed, so decide with your oncologist15.
Urinary Urgency, Frequency, IncontinenceBladder and urethral tissues become thinner and less elastic. Urgency, leaking with cough/​sneeze and frequent nighttime urination. Pelvic floor physical therapy plus vaginal estrogen often helps.
Recurrent UTIsLoss of vaginal Lactobacillus allows pathogen colonization. Vaginal estrogen reduces recurrence in postmenopausal women.
Psychological
InsomniaDifficulty falling asleep, frequent waking and unrefreshing sleep, often driven by night sweats. Lost sleep worsens fatigue, mood and concentration.
Brain Fog & Cognitive ChangesWord-finding difficulty, slower processing and reduced multitasking, which for most women improve later in postmenopause.
Mood Changes & DepressionIncreased vulnerability to depression, particularly in women with prior depressive history or those who experienced PMS/PMDD.
Irritability & Reduced Stress TolerancePatience and stress tolerance often drop, which can strain relationships.
Long-Term Health Risks
Osteoporosis & FracturesBone loss speeds up after menopause as estrogen falls14. In older adults, the risk of death is 5 to 8 times higher in the 3 months after a hip fracture16. A DXA scan, and treatment where indicated, are important.
Cardiovascular DiseaseHeart disease is the leading cause of death for women in the US17. Arterial stiffness, blood pressure and metabolic syndrome risk all climb.
Sarcopenia & Metabolic ShiftMuscle mass, strength and function decline with age (sarcopenia), which impairs physical function and can lead to disability18.
Alzheimer's & Dementia RiskAmong the factors you can change for brain health are sleep, exercise, diet and social engagement.
Causes

Causes of Menopause

Natural menopause happens as the ovaries stop working and make very little estrogen and progesterone; surgery, cancer treatment, smoking and some health conditions can bring it earlier12.

CauseHow It Contributes to MenopauseWhat Helps
Natural ovarian agingWith age the ovaries make far less estrogen and progesterone, and the changing hormone levels bring on the symptoms12.Hormone therapy for bothersome symptoms when started before 60 or within 10 years of menopause, without contraindications10 (conventional care); a plant-based diet with daily soybeans8 and resistance training (Treatment Comparison)
Removal of both ovariesSurgery that removes both ovaries brings menopause at once, and its symptoms can start more suddenly and be more severe12.Discuss hormone therapy and bone and heart protection with the surgical team before and after the operation (conventional care); the Definition's advice on earlier bone and cardiovascular protection applies
Cancer treatmentBreast cancer hormone therapy that suppresses the ovaries can sharply lower estrogen, and hot flashes and night sweats are its most common side effects21; chemotherapy or pelvic radiation can stop periods for good or for a while12.Plan symptom care with the oncology team; non-hormonal prescription options exist, and vaginal estrogen is discussed with the oncologist (Treatment Comparison and Signs & Symptoms)
Primary ovarian insufficiencyIn most cases of early loss of ovarian function the cause is unknown; known causes include genetic conditions such as Fragile X and Turner syndrome, and autoimmune disease, present in about one in five women with it13.Medical assessment and hormone care from a clinician (conventional care); earlier bone and cardiovascular protection, as the Definition section advises
SmokingSmoking is linked to earlier menopause and more severe symptoms12.Stopping smoking, with support from a clinician (conventional care)
Diagnosis

How Menopause Is Diagnosed

TestWhat it shows
Clinical Diagnosis
12 Months AmenorrheaMenopause is retrospectively diagnosed after 12 consecutive months without menstruation in the absence of other causes (hysterectomy, contraception, pregnancy). No lab confirmation needed when this criterion is met.
FSH (If Hysterectomy or Uncertainty)After hysterectomy (without ovary removal), FSH >30 mIU/mL on two separate occasions confirms menopause. Otherwise rarely needed.
Health Monitoring Baseline
DXA Bone DensityBaseline by 65, or earlier after menopause if you have risk factors; repeat at an interval your clinician sets from the result. A T-score of -1.0 or higher is normal; below -1.0 but above -2.5 is osteopenia; -2.5 or lower is osteoporosis. If you have osteopenia, ask for a fracture-risk assessment: treatment depends on your overall risk, and lost bone is hard to rebuild.
Cardiovascular WorkupLipid panel with particle size (LDL-P, sdLDL), ApoB, Lp(a), hs-CRP, fasting insulin, HbA1c, homocysteine. A coronary calcium score (CAC) can help some women and their clinician decide on treatment; ask whether it suits you.
Metabolic & Nutrient PanelVitamin D 25-⁠OH-D where deficiency is suspected, B12, ferritin, magnesium (serum is the standard test), comprehensive thyroid (TSH, free T3, free T4, TPO). Thyroid problems can mimic menopausal symptoms.
Cognitive & Cancer ScreeningMammography and colorectal cancer screening on the schedule your clinician recommends, and baseline cognitive testing (MoCA or similar). Stay current with cancer screenings: risk for many cancers rises in postmenopause.
Treatment Comparison

Conventional and Holistic Treatment for Menopause

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Strength training, phytoestrogens, dietary pattern, blood sugar control, sleep optimization, adaptogens

Symptom Reduction
In a randomized trial of a plant-based dietary pattern with daily soybeans, moderate-to-severe hot flashes fell by about 88%, and half of those who completed it reported none at all by 12 weeks8. Weight loss helps most earlier in the transition; exercise evidence is more mixed
Bone Protection
Resistance + impact training can maintain or even modestly increase bone density postmenopause
Timeline
Sleep and energy changes build gradually; bone and cardiovascular markers change over months rather than weeks
Advantage
Simultaneously addresses symptoms and the major long-term postmenopausal health risks

Full Holistic Approach Includes

  • Heavy resistance training 3 to 4x/week, among the highest-value interventions in this list; builds muscle and bone, supports metabolic health, and reduces fall and fracture risk
  • Impact loading (jumping, plyometrics) 2x/week if joints tolerate: bone responds specifically to ground-reaction forces, not just resistance
  • Phytoestrogen-rich foods daily (flaxseed, 2 tbsp ground; organic soy such as tempeh, edamame, miso; legumes): modest vasomotor symptom reduction without systemic estrogen effects
  • Mediterranean-style anti-inflammatory diet, extensively studied for postmenopausal CV protection
  • Protein about 0.6 to 0.7 g per pound (1.4 to 1.6 g/kg) of body weight daily, distributed across meals, critical for combating sarcopenia
  • Vitamin D3 + K2 + magnesium + calcium (food-first), bone health cofactor stack
  • Adaptogenic herbs (ashwagandha, rhodiola, maca), studied in small trials for stress, energy and libido; ashwagandha has been linked to rare liver injury and can affect thyroid levels, so check with your clinician first
  • Fiber and fermented foods: the gut microbiome changes after menopause, and a varied, fiber-rich diet supports microbial diversity
  • Strict sleep hygiene + cool sleep environment + magnesium glycinate at night; sleep is the foundation of everything else
  • Social connection, purposeful activity and cognitive challenge: among the strongest protective factors against postmenopausal depression and dementia
โš ๏ธ Important: The holistic approach works best as a complement to, not a replacement for, appropriate medical care. Bone density, cardiovascular markers and cancer screenings should remain on schedule with a healthcare provider.
Supplement Protocol

Evidence-Based Supplements for Menopause

The postmenopausal supplement priorities shift toward bone, brain, cardiovascular and muscle protection alongside vasomotor symptom management.

SupplementWhat it is forTypical rangeTimingNotes & cautions
Vitamin D3 + K2Both required for bone formation and calcium homeostasis. K2 (MK-⁠7) is being studied for keeping calcium out of arteries; that benefit is not established. Vitamin D deficiency is common after menopause. In a large trial of adults not selected for deficiency, vitamin D3 did not lower fractures19.D3: Set the dose with your clinician; most adults need no blood test first; K2 MK-⁠7: 200 mcg/dayWith largest fat mealIf you take a blood thinner, clear any vitamin K supplement with the clinician managing it before you start or stop: vitamin K interferes with some anticoagulant medicines, and changing your intake can destabilize your monitoring results. Keeping intake consistent matters more than avoiding it. Not all blood thinners are affected the same way, which is why this is a conversation with your prescriber.
Magnesium GlycinateNeeded for bone mineralization, nerve function, sleep and blood pressure regulation. Serum magnesium is the standard test, though it does not reflect total body stores well. In small trials in older adults it shortened the time to fall asleep (on low-quality evidence), but a placebo-controlled trial found it did not reduce hot flashes20.400 mg elemental/​nightBefore bedGlycinate or threonate forms. Avoid magnesium oxide (poorly absorbed). This dose is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
Omega-⁠3 EPA/DHAAnti-inflammatory; supports cardiovascular health and mood. Evidence specifically for hot flashes is weak and inconsistent, so do not choose it for that reason alone.52 g combined EPA+DHA/dayWith meal containing fatTriglyceride form best absorbed. Third-party tested for purity. Especially important if not eating fatty fish 3x/week. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day22, so check this dose with your clinician first.
Creatine MonohydrateOne of the better-evidenced supplements in this list. In older adults, creatine combined with resistance training increases lean mass and strength more than training alone, and postmenopausal women are a population where that matters for both function and bone loading. Effects depend on actually doing the resistance training.65 g/dayAny time (consistency matters more than timing)Monohydrate is the most studied form. Combine with resistance training for maximum benefit.
Black CohoshThe evidence does not support it, and there is a liver-safety warning attached, so read this one carefully. A Cochrane review found no significant effect on hot flashes or on self-reported menopausal symptom scales, and judged the safety evidence inconclusive because of poor reporting. A separate meta-analysis restricted to one standardized isopropanolic extract reports benefit, but the overall evidence does not establish it. On safety: case reports describe liver injury, including cases requiring transplantation, and the US Pharmacopeia recommends black cohosh products carry a hepatotoxicity warning. Controlled trials have not shown liver enzyme changes, so the reaction appears to be idiosyncratic rather than dose-related, which means it is rare but not predictable.4 If you already take it, stop at once if you develop jaundice, dark urine, unusual fatigue or right upper abdominal pain.Not recommended for hot flashes (a Cochrane review found no significant effect)Not applicableAny benefit is uncertain4. Stop if liver tests are abnormal.
CoQ10 (Ubiquinol)Mitochondrial cofactor; cellular energy production. Levels decline with age. Statins lower blood CoQ10, but a benefit from supplementing, for the heart or the brain, is not established.100 to 200 mg/day (ubiquinol form)With meal containing fatUbiquinol form better absorbed than ubiquinone, especially after 50.
B-ComplexB12, folate and B6 support cognition, energy, mood and homocysteine metabolism (a CV risk factor). Postmenopausal B12 absorption declines; supplementation often needed.One "B-⁠50" B-complex a day (about 50 mg of most B vitamins), with no more than 35 mg niacinMorning with breakfastA "B-⁠50" product often holds 50 mg of niacin, above the upper limit of 35 mg a day for supplemental niacin, which is set by the flushing it causes, so choose one with no more than 35 mg niacin or set the dose with your clinician. Standard or methylated forms both work for most people; keep vitamin B6 under 100 mg a day. Test B12 and homocysteine annually.
Probiotic (Targeted Strains)Postmenopausal microbiome shifts toward less diversity and more pro-inflammatory species. Specific strains (Lactobacillus reuteri, L. acidophilus, Bifidobacterium lactis) have been studied for bone density, vaginal health and mood support.Multi-strain 10 to 50 billion CFU/dayEmpty stomach or with small mealEat fermented foods for synergy. Look for refrigerated or shelf-stable third-party-tested brands.

Collagen is not recommended here. Trials report modest skin and joint outcomes, and the evidence for bone density is thin.7

What to Expect

What to Expect Over Time

Hot flashes usually ease over years while bone and heart risks continue, so symptom care and long-term protection run together.

Treatment and supportive care, together
First Weeks

Simple steps cost nothing to try: avoiding caffeine, alcohol and spicy food, dressing in layers and slow breathing when a flash begins12. In trials, hot flashes also fell by more than half on placebo, so a remedy only counts as working if it beats placebo11.

Months 1 to 3

In placebo-controlled trials lasting at least 3 months, hormone therapy cut hot flashes by 75% compared with placebo11. In one trial of a plant-based diet with daily soybeans, half of those who finished reported no moderate-to-severe hot flashes by 12 weeks8.

Months 3 to 12

Bone loss speeds up after menopause12, which is why resistance training, protein, calcium and vitamin D matter now. Hormone therapy, if you use it, is reviewed and used no longer than necessary12.

Long Term

Among women with frequent hot flashes, symptoms last a median of 7.4 years in total2. Vaginal and urinary symptoms tend to persist, and vaginal estrogen treats them. A bone density test is advised by 65, sooner with risk factors12.

When to Seek Care

Tell your clinician about any vaginal bleeding or spotting after 12 months without a period, even a small amount, because it can be caused by cancer or another serious problem12. Get frequent palpitations checked, and stop black cohosh and seek care for yellowing skin or eyes, dark urine or right upper abdominal pain.

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Next Steps

Postmenopause Can Be Your Strongest Decades

The next 30+ years of your life can be marked by vitality, strength and clarity, or by accelerated decline. The interventions that shape that trajectory are within your reach: protein, resistance training, sleep, social connection and targeted nutrition.

Explore Perimenopause โ†’ Explore Osteoporosis →

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.9 This page is nutrition education, not medical advice, and it does not replace your doctor. Black cohosh carries a liver-safety warning and should be discussed with a clinician before use. If you are considering or taking hormone therapy, that decision belongs with your prescriber; nothing here replaces it.

  1. Study of Women's Health Across the Nation (SWAN) and related epidemiology of the menopause transition, covering average age at final menstrual period and the proportion of women reporting vasomotor symptoms. PMC6784846. ↩ ↩
  2. Avis NE, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015. PMC4433164. Among women with frequent symptoms the median total duration was 7.4 years, persisting a median of 4.5 years after the final menstrual period. ↩ ↩
  3. Bone Health & Osteoporosis Foundation. What Women Need to Know. bonehealthandosteoporosis.org. Approximately one in two women over 50 will break a bone because of osteoporosis. ↩ ↩
  4. On efficacy: Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev, PubMed 22972105, whose authors concluded there is insufficient evidence to support the use of black cohosh for menopausal symptoms. Contrast with the meta-analysis restricted to isopropanolic extract: Castelo-Branco C, et al. Review and meta-analysis: isopropanolic black cohosh extract iCR for menopausal symptoms, an update on the evidence. Climacteric. 2021;24(2):109-⁠119. Full text, PubMed 33021111. Pooling 35 studies of that one extract, it found it better than placebo for menopausal symptoms; two of its authors work for the extract's manufacturer. On liver safety: LiverTox, NCBI Bookshelf and the NIH Office of Dietary Supplements fact sheet, ods.od.nih.gov, noting the US Pharmacopeia labeling recommendation. ↩
  5. Omega-⁠3 trials for vasomotor symptoms specifically are small and inconsistent; the cardiovascular and mood rationale is better supported than the hot-flash one. See NCCIH, ref. 9. ↩
  6. Creatine supplementation combined with resistance training in older adults increases lean mass and strength beyond training alone; effects depend on the training being done. See the Linus Pauling Institute and NCCIH entries, ref. 9. ↩
  7. Hydrolyzed collagen trials report modest skin and joint outcomes; bone density evidence is thinner and less consistent. ↩
  8. Barnard ND, et al. A dietary intervention for vasomotor symptoms of menopause: a randomised, controlled trial. Menopause. 2023. journals.lww.com. Moderate-to-severe vasomotor events fell about 88%; half of completers reported none by 12 weeks. ↩
  9. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  10. On who hormone therapy suits: the 2022 position statement of the North American Menopause Society concluded that for women younger than 60 or within 10 years of menopause onset, and without contraindications, the benefit-risk balance favors treating bothersome hot flashes and preventing bone loss, and that it is less favorable when therapy starts more than 10 years after menopause or after 60, PubMed 35797481. ↩
  11. On how much hormone therapy reduces hot flashes: a 2004 systematic review of 24 randomized placebo-controlled trials with 3,329 women found oral hormone therapy cut weekly hot flash frequency by 75% relative to placebo. Women on placebo also improved, by 57.7% from baseline, which is why any hot flash remedy needs a placebo comparison, PubMed 15495039. ↩
  12. On what menopause is and what to watch for: the US Office on Women's Health explains that after menopause the ovaries make very low levels of estrogen and progesterone, that changing hormone levels cause menopause symptoms, and that having less estrogen makes bone mass fall much more quickly than before. Surgery that removes both ovaries stops periods, makes hormone levels drop quickly and may cause strong symptoms right away; chemotherapy or pelvic radiation can stop periods for good or for a while; and women who smoke may reach menopause up to two years earlier and have more severe symptoms. For hot flashes it suggests avoiding triggers (such as spicy food, alcohol and caffeine), dressing in layers and taking slow, deep breaths when a flash starts; for hormone therapy it suggests the lowest dose for the shortest time needed. It advises seeing a clinician for any bleeding or spotting after a year without a period, because it could be caused by cancer or another serious problem, Office on Women's Health, menopause basics, early or premature menopause, symptoms and relief, treatment and menopause and your health. The US Preventive Services Task Force recommends screening for osteoporosis in all women 65 or older, and in younger postmenopausal women at increased risk, USPSTF, osteoporosis screening. ↩
  13. On primary ovarian insufficiency: in most women the cause is unknown; identified causes include genetic and chromosomal conditions such as Fragile X and Turner syndrome, and about one in five women with it has an autoimmune disease, most often thyroiditis, NICHD, What causes POI? ↩
  14. On hormones and bone after menopause: the US Office on Women's Health explains that after menopause the ovaries make very low levels of estrogen and progesterone, and that having less estrogen causes bone mass to be lost much more quickly than before, raising the risk of osteoporosis, Office on Women's Health, menopause basics and menopause and your health. ↩
  15. On vaginal and urinary symptoms after menopause: the 2020 position statement of the North American Menopause Society reports that the genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women, is likely underdiagnosed and undertreated, and can in most cases be effectively managed, and that there are insufficient data to confirm the safety of vaginal estrogen in women with breast cancer, so care should follow the recommendations of her oncologist, PubMed 32852449. ↩
  16. On hip fracture: a meta-analysis of cohort studies of older women and men found a 5 to 8 fold increased risk of death from any cause in the first 3 months after a hip fracture, with excess mortality persisting afterward, PubMed 20231569. ↩
  17. On heart disease in women: the CDC states that heart disease is the leading cause of death for women in the United States and can affect women at any age, CDC, women and heart disease. ↩
  18. On muscle loss with age: a review describes sarcopenia as the involuntary loss of muscle mass, strength and function with age, which impairs physical function and predisposes to disability, and notes that resistance and aerobic training can improve muscle growth and function, PubMed 15192443. ↩
  19. On vitamin D and fractures: in the VITAL trial of 25,871 US adults, women 55 and older and men 50 and older not selected for deficiency or low bone mass, 2,000 IU of vitamin D3 a day did not lower total, nonvertebral or hip fractures against placebo over a median 5.3 years, PubMed 35939577. ↩
  20. On magnesium for sleep and hot flashes: a meta-analysis of 3 trials in 151 older adults found magnesium shortened the time taken to fall asleep by about 17 minutes against placebo, with low to very low quality evidence, PubMed 33865376, and a placebo-controlled trial in 289 postmenopausal women with a history of breast cancer found magnesium oxide did not reduce hot flashes, PubMed 25423327. ↩
  21. On breast cancer hormone therapy and menopausal symptoms: the US National Cancer Institute explains that before menopause the ovaries are the main source of estrogen, that therapies suppressing ovarian function can sharply lower estrogen in premenopausal women, and that the most common side effects of hormone therapy for breast cancer are hot flashes, night sweats and loss of interest in sex, NCI, hormone therapy for breast cancer. ↩
  22. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
  23. On how long to take bisphosphonates: an American Society for Bone and Mineral Research task force suggests reassessing fracture risk after 5 years of a bisphosphonate by mouth or 3 years by infusion, considering continued treatment in women at high risk, and considering a drug holiday of 2 to 3 years for women not at high fracture risk, PubMed 26350171. ↩
  24. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. PubMed 30626577. In 80,396 women with a blood clot in a vein and 391,494 matched controls, oral hormone therapy was linked to a higher risk of clots (odds ratio 1.58), while transdermal preparations were not linked to any increase (0.93), making transdermal treatment the safest type for clot risk. ↩