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KEY CONCEPTS

KEY CONCEPTS

  • image The decision to use menopausal hormone therapy (MHT) and the type of formulation used must be individualized based on several factors, including personal preference, age, menopause onset, the severity of menopausal symptoms, and the risks of cardiovascular disease, breast cancer, osteoporotic fracture, and venous thromboembolic events (VTE).

  • image Menopausal hormone therapy is the most effective treatment option for alleviating moderate-to-severe vasomotor symptoms.

  • image Cardiovascular disease—including coronary artery disease, stroke, and peripheral vascular disease—is the leading cause of death among women, but MHT should not be used for reducing the risk of cardiovascular disease.

  • image The risk of breast cancer associated with MHT appears to be associated with the addition of progestogen therapy to estrogen. Use of estrogen alone does not increase the risk of breast cancer.

  • image Use of MHT at doses lower than those prescribed prior to the Women’s Health Initiative (WHI) study appears to be effective in reducing bone loss and managing menopausal symptoms.

  • image Use of transdermal MHT is preferred over oral preparations due to lower risk of thrombosis, and possibly stroke and coronary artery disease.

  • image Because of the increased risk of endometrial hyperplasia and endometrial cancer with estrogen monotherapy (ie, unopposed estrogen), use of systemic estrogen in women with an intact uterus must always be accompanied by progestogen or tissue-selective estrogen complex (estrogen-bazedoxifene) for endometrial protection.

  • image In women experiencing postmenopausal symptoms, initiation of systemic estrogen therapy should generally be limited to women younger than 60 years of age or within 10 years of menopause onset.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

What do you know about menopause? Before progressing in this lesson, create a list of all the information you currently know regarding menopause. It may be helpful to construct a “mind map,” a visual organization of the information to formulate connections between each item in your information list. When you have completed this task, identify needed information and consider how you might use this knowledge to improve a patient’s care.

INTRODUCTION

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. It is a natural life event, not a disease, as all women undergo menopause, and each experience it differently. Natural menopause occurs in stages including perimenopause (in the 5th decade), menopause, and postmenopause (1 year after menopause and beyond). Induced menopause can be experienced any time before natural menopause with bilateral oophorectomy (removal of both ovaries) or iatrogenic ablation of ovarian function (eg, chemotherapy, pelvic radiation). Symptoms of menopause can vary widely with induced menopause typically causing more severe symptoms. Due to the variability in duration, severity, and presence of menopausal symptoms among women, treatment should be individualized with treatment goals and decisions established in a shared decision-making process.

Epidemiology

The median age at the onset of menopause in the United States is 51 years, but can vary widely from 40 to 58 ...

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