Menopause is the cessation of menstruation; it typically occurs at around 51 years of age. The postmenopausal phase of life is linked to a variety of health conditions, including osteoporosis, cardiovascular disease and cognitive decline. Beyond symptom control, hormonal replacement therapy (HRT) reduces the incidence of chronic health conditions. Some unfounded concerns and misunderstanding about the risks of HRT contribute to a low uptake of HRT, currently around 10% of menopausal women. This article highlights the symptoms of menopause and treatment options available. As the majority of menopause management occurs in primary care, a good understanding of the risks and benefits is paramount when guiding patients to make informed decisions about the treatment options.
Get full access to this article
View all access options for this article.
References
1.
CanonicoMCarcaillonLPlu-BureauG, et al.(2016) Postmenopausal hormone therapy and risk of stroke: Impact of the route of estrogen administration and type of progestogen. Stroke47(7): 1734–1741. DOI: 10.1161/STROKEAHA.116.013052.
2.
CanonicoMFournierACarcaillonL, et al.(2010) Postmenopausal hormone therapy and risk of idiopathic venous thromboembolism: Results from the E3N cohort study. Arteriosclerosis, Thrombosis and Vascular Biology30(2): 340–345. DOI: 10.1161/ATVBAHA.109.196022.
3.
ChangSHKimCSLeeKS, et al.(2007) Premenopausal factors influencing premature ovarian failure and early menopause. Maturitas58(1): 19–30. DOI: 10.1016/j.maturitas.2007.04.001.
4.
ConstantineGDGrahamSClerinxC, et al.(2016) Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reproductive Health22(3): 112–122. DOI: 10.1177/2053369116632439.
5.
DennersteinLRandolphJTaffeJ, et al.(2002) Hormones, mood, sexuality, and the menopausal transition. Fertility and Sterility77(Supplement 4): S42–48. DOI: 10.1016/s0015-0282(02)03001-7.
FitzpatrickLAPaceCWiitaB (2000) Comparison of regimens containing oral micronized progesterone or medroxyprogesterone acetate on quality of life in postmenopausal women: A cross-sectional survey. Journal of Women’s Health & Gender-Based Medicine9(4): 381–387. DOI: 10.1089/15246090050020691.
8.
Formoso G, Perrone E, Maltoni S, et al. (2016) Short-term and long-term effects of tibolone in postmenopausal women. Cochrane Database of Systematic Reviews 10: art. no.: CD008536. DOI: 10.1002/14651858.CD008536.pub3.
9.
FournierABerrinoFClavel-ChapelonF (2008) Unequal risks for breast cancer associated with different hormone replacement therapies: Results from the E3N cohort study. Breast Cancer Research and Treatment107(1): 103–111. DOI: 10.1007/s10549-007-9523-x.
LuborskyJLMeyerPSowersMF, et al.(2003) Premature menopause in a multi-ethnic population study of the menopause transition. Human Reproduction18(1): 199–206. DOI: 10.1093/humrep/deg005.
12.
LyytinenHKDybaTYlikorkalaO, et al.(2010) A case-control study on hormone therapy as a risk factor for breast cancer in Finland: Intrauterine system carries a risk as well. International Journal of Cancer126(2): 483–489. DOI: 10.1093/humrep/deg005.
13.
Maclennan AH, Broadbent JL, Lester S, et al. (2004) Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database of Systematic Reviews 4: art. no.: CD002978. DOI: 10.1002/14651858.CD002978.pub2.
14.
Marjoribanks J, Farquhar C, Roberts H, et al. (2017) Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 1: art. no.: CD004143. DOI: 10.1002/14651858.CD004143.pub5.
15.
MukaTOliver-WilliamsCKunutsorS, et al.(2016) Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: A systematic review and meta-analysis. JAMA Cardiology1(7): 767–776. DOI: 10.1001/jamacardio.2016.2415.
NelsonHDVescoKKHaneyE, et al.(2006) Nonhormonal therapies for menopausal hot flashes: Systematic review and meta-analysis. JAMA295(17): 2057–2071. DOI: 10.1001/jama.295.17.2057.
NICE (2015b). Menopause: Diagnosis and management. Available at: www.nice.org.uk/guidance/ng23 (accessed 16 March 2021).
20.
PanayNStuddJ (1997) Progestogen intolerance and compliance with hormone replacement therapy in menopausal women. Human Reproduction Update3(2): 159–171. DOI: 10.1093/humupd/3.2.159.
21.
RahnDDCarberryCSansesTV, et al.(2014) Vaginal estrogen for genitourinary syndrome of menopause: A systematic review. Obstetrics and Gynecology124(6): 1147–1156. DOI: 10.1097/AOG.0000000000000526.
RossouwJEAndersonGLPrenticeRL, et al.(2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA288(3): 321–333. DOI: 10.1001/jama.288.3.321.
24.
SchierbeckLLRejnmarkLToftengCL, et al.(2012) Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: Randomised trial. BMJ345: e6409DOI: 10.1136/bmj.e6409.
25.
Somboonporn W, Davis S, Seif MW, et al. (2005) Testosterone for peri- and postmenopausal women. Cochrane Database of Systematic Reviews 4: art. no.: CD004509. DOI: 10.1002/14651858.CD004509.pub2.
26.
SternfeldBGuthrieKAEnsrudKE, et al.(2014) Efficacy of exercise for menopausal symptoms: A randomized controlled trial. Menopause21(4): 330–338. DOI: 10.1097/GME.0b013e31829e4089.
27.
SturdeeDWUlrichLGBarlowDH, et al.(2000) The endometrial response to sequential and continuous combined oestrogen-progestogen replacement therapy. British Journal of Obstetrics and Gynaecology107(11): 1392–1400. DOI: 10.1111/j.1471-0528.2000.tb11654.x.
28.
Van KasterenYMHundscheidRDSmitsAP, et al.(1999) Familial idiopathic premature ovarian failure: An overrated and underestimated genetic disease?Human Reproduction14(10): 2455–2459. DOI: 10.1093/humrep/14.10.2455.
29.
WeinerMGBarnhartKXieD, et al.(2008) Hormone therapy and coronary heart disease in young women. Menopause15(1): 86–93. DOI: 10.1097/gme.0b013e3180413e45.
