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  • image The decision to use perimenopausal or postmenopausal hormone therapy must be individualized and based on several parameters, including menopausal symptoms, osteoporosis fracture risk, cardiovascular disease risk, breast cancer risk, and thromboembolic risk.
  • image Hormone therapy is the most effective treatment option for alleviating vasomotor and vaginal symptoms of menopause.
  • image Osteoporotic fracture prevention is an indication for use of systemic estrogen products when alternate therapies are contraindicated or cause adverse effects.
  • image Hormone therapy may improve depressive symptoms in symptomatic menopausal women.
  • image Cardiovascular disease, including coronary artery disease, stroke, and peripheral vascular disease, is the leading cause of death among women. Postmenopausal hormone therapy should not be used for reducing the risk of cardiovascular disease.
  • image Because of the increased risk of endometrial hyperplasia and endometrial cancer with estrogen monotherapy (i.e., unopposed estrogen), hormone therapy in women who have not undergone hysterectomy should include a progestogen in addition to the estrogen.
  • image Use of hormone therapy at doses lower than those prescribed historically (i.e., prior to the Women’s Health Initiative study) is effective in the management of menopausal symptoms.
  • image Results from randomized trials of hormone therapy in postmenopausal women cannot be extrapolated to premenopausal women with ovarian dysfunction. Women with primary ovarian insufficiency need exogenous sex steroids to compensate for decreased production by their ovaries.

On completion of the chapter, the reader will be able to:

  1. Describe the physiology of normal menopause.

  2. Identify the contraindications for hormone therapy.

  3. Assess the risks and benefits of short-term and long-term hormone therapy in women.

  4. Analyze the risks and benefits of individual hormonal regimens for the management of menopausal symptoms.

  5. List the factors that should guide selection of a specific hormone therapy regimen for an individual perimenopausal or postmenopausal woman.

  6. Describe alternative nonhormonal options for the management of menopausal symptoms.

  7. Based on patient-specific data, select an appropriate hormonal or nonhormonal treatment regimen for a postmenopausal woman with vasomotor symptoms.

  8. Recommend an appropriate duration of hormone therapy for the treatment of vasomotor symptoms.

  9. Select an appropriate hormone therapy regimen for the treatment of menopausal urogenital atrophy.

  10. List the benefits and risks of hormone therapy for osteoporosis prevention.

  11. Formulate a patient-specific monitoring plan for a perimenopausal or postmenopausal woman on a given hormonal regimen.

  12. Explain the pathophysiologic mechanisms underlying primary ovarian insufficiency.

  13. Describe the typical clinical features of women with primary and secondary amenorrhea.

  14. Recommend an appropriate hormone therapy regimen for girls with primary amenorrhea.

  15. Design an appropriate treatment plan for a woman with primary ovarian insufficiency.

  16. Propose an appropriate monitoring plan for a woman with primary ovarian insufficiency receiving long-term physiologic hormone replacement.


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. By definition, it is a physiologic event that occurs after 12 consecutive months of amenorrhea, so the time of the final menses is determined retrospectively. Women who have undergone hysterectomy must ...

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