Menopausal Symptoms and Management

Introduction to Menopausal Symptoms

The decline in circulating estrogen levels during menopause contributes to accelerated bone loss and increased levels of low-density lipoproteins, causing various symptoms that significantly affect the quality of life of women 1

Other symptoms of menopause include vaginal dryness, urogenital discomfort, pruritus, dyspareunia, urinary infections, urinary urgency, sexual dysfunction, sleep disturbances, mood changes, depression, cognitive dysfunction, arthralgias/myalgias, and fatigue 2, 3

For women with an intact uterus, the combination of estrogen and progestin is recommended 3
For women without a uterus, estrogen alone can be used 3
The American College of Obstetricians and Gynecologists and other guideline societies recommend that hormone therapy be used with the lowest effective dose and for the shortest duration consistent with treatment goals, although this specific recommendation is not cited here, the general principle is supported by 3

Decisions to initiate or continue hormone therapy for menopausal symptoms should be made based on discussions between the woman and her physician 1
Women should be informed that there are some risks (such as the risk of venous thromboembolism, coronary heart disease, and stroke) within the first 1-2 years of therapy, while other risks (such as the risk of breast cancer) seem to increase with long-term hormone therapy 1
Hormone therapy is contraindicated in women with a history of hormone-related cancers, abnormal vaginal bleeding, recent pregnancy, or active liver disease 3