Management of Menopause
Introduction to Menopause Management
- The American College of Obstetricians and Gynecologists recommends hormone replacement therapy (HRT) for menopausal women to prevent long-term health consequences of estrogen deficiency, with a typical regimen consisting of estrogen replacement therapy with progestin protection if the uterus is intact 1, 2
Treatment Recommendations
- Estrogen replacement therapy with progestin protection is indicated to manage symptoms and prevent long-term health consequences in menopausal women, according to the North American Menopause Society 2
- The preferred route of administration is transdermal estrogen due to avoidance of first-pass liver metabolism and lower risk of venous thromboembolism compared to oral formulations, as recommended by the European Menopause and Andropause Society 3
Duration of Therapy
- The National Comprehensive Cancer Network recommends continuing HRT until the average age of natural menopause (approximately 51 years), and then reassessing risks and benefits for continuation 1, 4
Monitoring
- The American Heart Association recommends monitoring for symptom control, side effects, and blood pressure in menopausal women on HRT, with clinical evaluation at 3-6 month intervals initially, then annually 2
- Annual mammography is recommended for women over 50 years, according to the American College of Radiology 3
Benefits of Treatment
- HRT provides relief of vasomotor symptoms, prevention of urogenital atrophy, maintenance of bone mineral density, and reduction of fracture risk, as stated by the Endocrine Society 2, 3
Risks and Contraindications
- Absolute contraindications for HRT include history of breast cancer, active venous thromboembolism, and active liver disease, according to the American College of Chest Physicians 3, 4
- Relative contraindications include history of venous thromboembolism, cardiovascular disease, and migraine with aura, as recommended by the American Headache Society 2, 3