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LEARNING OBJECTIVES

  1. Describe hormone changes through the menopause transition.

  2. Identify factors in a woman’s current and past medical history that need to be considered before starting hormone therapy.

  3. Compare and contrast nonpharmacologic and pharmacologic agents used for treating symptoms in perimenopause and menopause.

  4. Evaluate risks of hormonal and nonhormonal therapies used to treat menopausal symptoms.

  5. Educate women about perimenopause and menopause treatments.

INTRODUCTION

The menopausal transition is a sentinel event in a woman’s life and central to the health of aging women. By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide.1 In the United States (US), about 6000 women are currently reaching menopause age daily.2 In the western world, the average female life expectancy is just over 81 years. Most women will be living one-third of their lives or more after menopause. The combination of an increasing postmenopausal female demographic combined with an increased female lifespan represents a significant shift for health care delivery. Understanding the physical, emotional, cognitive, and sexual consequences of menopause is essential to the delivery of health care. Although some women will navigate the menopause transition without any bothersome symptoms, others will need significant health care attention. Menopause is associated with symptoms that range from mildly bothersome to extremely distressing, and accompanied by hormonal changes that adversely affect several nonreproductive systems (ie, heart, bone, and brain). As women live beyond menopause, health care providers must identify health issues and offer evidence based, safe, nonpharmacologic, and pharmacologic interventions that are personalized and comprehensive. Thus, health care providers need to understand the biology of menopause, its short- and long-term sequelae, and therapeutic options to optimize quality of life.

Patient Case (Part 1)

M.Z. is a 54-year-old woman in the obstetric gynecology clinic for evaluation and medication management by the clinic pharmacist.

Subjective Information

Chief Concern: “I would like to start hormones for my hot flushes. All my friends are on them and they say they feel wonderful.”

Present Illness History: She reports 10 hot flushes daily and wakes two to three times at night with night sweats, which can require changing the bed linens. She has noticed an increase in vaginal dryness and feels discomfort with intercourse. These symptoms have increased in the past year. She reports that her energy and enthusiasm for engaging in activities has diminished and has noted feeling sad two to three times a week for the past 6 months.

Medical History: Benign essential hypertension diagnosed 1 year ago and controlled.

Past Medical History: Reports mild depression in college that was managed with weekly cognitive behavioral therapy visits for 1 year. Denies any recurrence of symptoms until the past 6 months.

Social History: Lives with husband and their 25-year-old son. Works full-time as an Operations Director for a local health care system. Does not smoke and has minimal alcohol use. Exercises three times per week—45 to 60 ...

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