Source: Kalantaridou SN, Dang DK,
Davis SR, Calis KA. Hormone Therapy in Women. In: DiPiro JT, Talbert
RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7994084.
Accessed June 8, 2012.
- Change of life
- Menopause is permanent cessation of menses after loss
of ovarian follicular activity.
- May be due to normal aging process, surgery (total abdominal
hysterectomy, bilateral oophorectomy), medications (e.g., chemotherapy),
or pelvic irradiation.
- Loss of ovarian follicular activity; postmenopausal ovaries
no longer primary site of estradiol or progesterone synthesis.
- As women age, follicle-stimulating hormone (FSH) rises and
ovarian inhibin declines. When ovarian function ceases, serum FSH
concentrations are >40 IU/L. Menopause characterized by:
- 10- to 15-fold increase in circulating FSH concentrations
compared with concentrations of FSH in follicular phase
- 4- to 5-fold increase in luteinizing hormone
- >90% decrease in circulating estradiol concentrations
- Median age at onset in United States: 51 years.
- Cigarette smokers experience menopause 2 years earlier than
- Women who have undergone hysterectomy more likely to have
- Vasomotor symptoms (e.g., hot flushes and night sweats)
- Vaginal dryness
- Urogenital atrophy
- Sleep disturbances
- Sexual dysfunction
- Impaired concentration and memory
- Dysfunctional uterine bleeding may occur during perimenopause.
- Complete medical history and physical examination.
- Menopause determined retrospectively after 12 consecutive
months of amenorrhea.
- Serum FSH levels exceed 40 IU/L when ovarian
function has ceased.
- Complete blood count (CBC)
- Relieve symptoms.
- Improve quality of life.
- Minimize adverse effects.
- Figure 1: Algorithm for pharmacotherapy of menopausal
- Vasomotor symptoms usually require hormone treatment for <5
- Consider tapering and stopping hormone therapy
after 2–3 years.
- Without treatment, hot flushes usually disappear within 1–2
- Vaginal dryness because of vaginal atrophy often requires
local or systemic estrogen therapy.
- Topical estrogen
cream, tablets, or vaginal ring
- Vaginal estrogen may be more effective and avoids high circulating
pharmacologic management of menopause symptoms. a Tibolone
is currently not approved for use in the United States. Reprinted
with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al.
Pharmacotherapy Handbook. 8th ed. New York: McGraw-Hill, 2012.
- Lifestyle modification, weight control, smoking cessation,
exercise, and a healthy diet may improve mild vasomotor and/or
- Hormone Therapy
effective therapy for relieving vasomotor symptoms; different routes
of systemic administration equally effective.
- No increased risk of breast cancer if treatment stopped within
- Table 1: Preparations suitable for replacement therapy
- Vaginal creams, tablets, and rings for treatment of vaginal
- Table 2: Lower doses may effectively control postmenopausal
- Adverse effects:
- Breast tenderness
- Heavy bleeding ...