How to Treat: Menopause

+How to treat
In print

How to Treat: Menopause

By Susannah O'Sullivan

Menopause can be a challenging time of life for women, many of whom seek relief from distressing symptoms that affect their function and quality of life. In this article, Susannah O’Sullivan describes how to tailor treatment to each individual woman, while remembering to engage them in discussion of other midlife health considerations

This continuing medical education activity has been endorsed by the RNZCGP and has been approved for up to 1 CME credit for the General Practice Educa

1. Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am 2011;38(3):425–40.

2. Lawton BA, Rose SB, Cormack DM, et al. The menopause symptom profile of Maori and non-Maori women in New Zealand. Climacteric 2008;11(6):467–74.

3. Randolph JF Jr, Sowers M, Bondarenko I, et al. The relationship of longitudinal change in reproductive hormones and vasomotor symptoms during the menopausal transition. J Clin Endocrinol Metab 2005;90(11):6106–12.

4. Kravitz HM, Ganz PA, Bromberger J, et al. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause 2003;10(1):19–28.

5. Bromberger JT, Meyer PM, Kravitz HM, et al. Psychologic distress and natural menopause: a multiethnic community study. Am J Public Health 2001;91(9):1435–42.

6. Weber MT, Maki PM, McDermott MP. Cognition and mood in perimenopause: a systematic review and meta-analysis. J Steroid Biochem Mol Biol 2014;142:90–98.

7. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 2009;6(8):2133–42.

8. Avis NE, Stellato R, Crawford S, et al. Is there an association between menopause status and sexual functioning? Menopause 2000;7(5):297–309.

9. Sampselle CM, Harlow SD, Skurnick J, et al. Urinary incontinence predictors and life impact in ethnically diverse perimenopausal women. Obstet Gynecol 2002;100(6):1230­–38.

10. Szoeke CE, Cicuttini FM, Guthrie JR, et al. The relationship of reports of aches and joint pains to the menopausal transition: a longitudinal study. Climacteric 2008;11(1):55–62.

11. Davis SR, Castelo-Branco C, Chedraui P, et al. Understanding weight gain at menopause. Climacteric 2012;15(5):419–29.

12. Baber RJ, Panay N, Fenton A, et al. 2016 IMS recommendations on women's midlife health and menopause hormone therapy. Climacteric 2016;19(2):109–50.

13. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA 2013;310(13):1353–68.

14. Manson JE, Kaunitz AM. Menopause management--getting clinical care back on track. N Engl J Med 2016;374(9):803–06.

15. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause 2017;24(7):728–53

16. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015;100(11):3975–4011.

17. Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab 2019;104(5):1595–622.

18. Eisen A, Lubinski J, Gronwald J, et al. Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers. J Natl Cancer Inst 2008;100(19):1361–67.

19. Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2015(3):CD002229.

20. Olie V, Plu-Bureau G, Conard J, et al. Hormone therapy and recurrence of venous thromboembolism among postmenopausal women. Menopause 2011;18(5):488–93.

21. Straczek C, Oger E, Yon de Jonage-Canonico MB, et al. Prothrombotic mutations, hormone therapy, and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration. Circulation 2005;112(22):3495–500.

22. Ugras SK, Layeequr Rahman R. Hormone replacement therapy after breast cancer: Yes, No or maybe? Mol Cell Endocrinol 2021;525:111180.

23. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2007;116(7):e148–304.

24. Beck KL, Anderson MC, Kirk JK. Transdermal estrogens in the changing landscape of hormone replacement therapy. Postgrad Med 2017;129(6):632–36.

25. Lobo RA. Hormone-replacement therapy: current thinking. Nat Rev Endocrinol 2017;13(4):220–31.

26. Formoso G, Perrone E, Maltoni S, et al. Short-term and long-term effects of tibolone in postmenopausal women. Cochrane Database Syst Rev 2016;10:CD008536.

27. Palacios S, Mejia Rios A. Bazedoxifene/conjugated estrogens combination for the treatment of the vasomotor symptoms associated with menopause and for prevention of osteoporosis in postmenopausal women. Drugs Today (Barc) 2015;51(2):107–16.

28. Avis NE, Crawford SL, Greendale G, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015;175(4):531–39.

29. Ockene JK, Barad DH, Cochrane BB, et al. Symptom experience after discontinuing use of estrogen plus progestin. JAMA 2005;294(2):183–93.

30. Stuenkel CA. Managing menopausal vasomotor symptoms in older women. Maturitas 2021;143:36–40.

31. Shifren JL, Crandall CJ, Manson JE. Menopausal hormone therapy. JAMA 2019;321(24):2458–59.

32. Manson JE, Bassuk SS, Kaunitz AM, et al. The Women's Health Initiative trials of menopausal hormone therapy: lessons learned. Menopause 2020;27(8):918–28.

33. Hirschberg AL, Bitzer J, Cano A, et al. Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide. Maturitas 2021;148:55–61.

34. Handley AP, Williams M. The efficacy and tolerability of SSRI/SNRIs in the treatment of vasomotor symptoms in menopausal women: a systematic review. J Am Assoc Nurse Pract 2015;27(1):54–61.

35. Loprinzi CL, Sloan J, Stearns V, et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 2009;27(17):2831–37.

36. Shan D, Zou L, Liu X, et al. Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;222(6):564–79.e12.

37. Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA 2006;295(17):2057–71.

38. Othman AH, Zaky AH. Management of hot flushes in breast cancer survivors: comparison between stellate ganglion block and pregabalin. Pain Med 2014;15(3):410–17.

39. Comhaire FH, Depypere HT. Hormones, herbal preparations and nutriceuticals for a better life after the menopause: part II. Climacteric 2015;18(3):364–71.

40. Oseni T, Patel R, Pyle J, et al. Selective estrogen receptor modulators and phytoestrogens. Planta Med 2008;74(13):1656–65.

41. L'Hermite M. Custom-compounded bioidentical hormone therapy: why so popular despite potential harm? The case against routine use. Climacteric 2017;20(3):205–11.

42. Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, et al. Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? Osteoporos Int 2020;31(12):2271–86.

43. El Khoudary SR, Aggarwal B, Beckie TM, et al. Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: A scientific statement from the American Heart Association. Circulation 2020;142(25):e506­–32.

44. Thurston RC, Karvonen-Gutierrez CA, Derby CA, et al. Menopause versus chronologic aging: their roles in women's health. Menopause 2018;25(8):849–54.

45. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation 2019;139(10):e56–528.

46. Lobo RA, Pickar JH, Stevenson JC, et al. Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis 2016;254:282–90.