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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 31. Menopausal, Perimenopausal, and Postmenopausal Hormone Therapy.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. The decision to use menopausal hormone therapy (MHT) and the type of formulation used must be individualized based on several factors, including the severity of menopausal symptoms and the risks of cardiovascular disease, breast cancer, osteoporotic fracture, and venous thromboembolic events (VTE).

  • Image not available. Menopausal hormone therapy is the most effective treatment option for alleviating moderate to severe vasomotor symptoms.

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

  • Image not available. 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 not available. In recently postmenopausal women who are at increased fracture risk, systemic estrogen therapy may be indicated for the prevention of osteoporotic fractures when alternate therapies are either contraindicated or cause excessive adverse effects.

  • Image not available. Menopausal hormone therapy appears to improve depressive symptoms in symptomatic menopausal women.

  • Image not available. Use of MHT at doses lower than those prescribed historically (ie, prior to the Women’s Health Initiative [WHI] study) appears to be effective in reducing bone loss and managing menopausal symptoms.

  • Image not available. 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 a progestogen or an estrogen agonist antagonist for endometrial protection.

  • Image not available. Premenopausal hormone therapy in young women with primary ovarian insufficiency (POI) differs markedly from MHT, and results of randomized trials conducted in menopausal women, including the WHI trial, cannot be extrapolated to premenopausal women with ovarian dysfunction.

MENOPAUSE AND MENOPAUSAL HORMONE THERAPY

All women undergo menopause, but every woman experiences 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

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. The median age at the onset of menopause in the United States is 51 years, but can vary widely from 40 to 58 years.1 An estimated 6,000 women in the United States reach menopause each day, and will spend approximately 40% of their lives in postmenopause....

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