Menopause

Abstract

During menopause women may present with vasomotor symptoms and/or symptoms of genitourinary syndrome of menopause. Women with genitourinary syndrome of menopause may be treated with low-dose vaginal oestrogen rather than systemic oestrogen. Transdermal administration of oestradiol should be considered the first-choice treatment in women with moderate to severe vasomotor symptoms who have risk factors precluding oral administration. Non-hysterectomised women require addition of a progestogen to minimise the risk of endometrial hyperplasia and endometrial cancer associated with unopposed oestrogen exposure. Micronised progesterone can minimise the metabolic impact and side-effects associated with progestogens. Menopausal hormone therapy is most effective when initiated within 10 years of the final menstrual period and before the age of 60. Use of menopausal hormone therapy for longer than 10 years needs an ongoing audit of benefits versus risks, but there is no clearly determined cessation date.