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Menopause - Highlights

Description

An in-depth report on the treatment of menopause-related symptoms.

Alternative Names

Estrogen; Hormone replacement therapy

Highlights:

Menopause

Menopause is a natural process that occurs as a woman� ' s ovaries stop producing eggs, and production of the hormones estrogen and progesterone declines. (Menopause can also occur if a woman� ' s ovaries are surgically removed.) Menopause usually happens gradually between the ages of 45 - 55. During this transition time, called “perimenopause,” menstrual periods become more irregular and begin to taper off. When menstrual periods have completely stopped for 12 months, a woman is considered to have reached menopause. On average, women reach menopause around the age of 51, but menopause can occur at younger or older ages.

Perimenopausal Symptoms

During perimenopause, women may have various symptoms. Symptoms vary among women, and may range from mild to severe. Some women have no symptoms.

Hot flashes, an intense sudden build-up of body heat, are the most common symptom. Other symptoms can include heart pounding, mood changes, vaginal dryness, sleep disturbances, and thinning hair. These symptoms are caused by changes in estrogen and progesterone levels. After most women pass through menopause, many symptoms eventually subside and disappear.

Treatment

Menopause is a natural condition. It is not a disease that needs medical treatment. However, some women seek treatment for the relief of perimenopausal symptoms -- especially hot flashes. Hormone replacement therapy (HRT) is the most effective drug treatment for hot flashes, but long-term use (more than 5 - 7 years) can increase the risks of heart disease, stroke, blood clots in the lungs, breast cancer, ovarian cancer, and endometrial cancer. Therefore, doctors recommend that women who use HRT should take the lowest possible dose for the shortest possible time.

Other prescription drugs, such as antidepressants, are also sometimes used to manage hot flashes and mood changes. Although some women try herbal remedies for symptom management, little scientific evidence supports their effectiveness.

Menopause and Heart Health

When a woman reaches menopause, her risk for heart disease increases. It is important for postmenopausal women to follow preventive lifestyle modifications (healthy diet, exercise, not smoking) to ensure heart health.

Resources

www.menopause.org -- North American Menopause Society
www.acog.org -- American College of Obstetricians and Gynecologists
www.nia.nih.gov -- National Institute on Aging
www.nih.gov/PHTindex.htm -- National Institutes of Health -- Menopausal Hormone Therapy Information

References

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No. 420, November 2008: hormone therapy and heart disease. Obstet Gynecol. 2008 Nov;112(5):1189-92.

Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events. Am J Obstet Gynecol. 2008 Nov;199(5):455-66.

Beral V; Million Women Study Collaborators; Bull D, Green J, Reeves G. Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet. 2007 May 19;369(9574):1703-10.

Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 2009 Feb 5;360(6):573-87.

Col NF, Fairfield KM, Ewan-Whyte C, Miller H. In the clinic. Menopause. Ann Intern Med. 2009 Apr 7;150(7):ITC4-1-15.

Davis SR, Moreau M, Kroll R, Bouchard C, Panay N, Gass M, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008 Nov 6;359(19):2005-17.

Farquhar C, Marjoribanks J, Lethaby A, Suckling JA, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD004143.

Furness S, Roberts H, Marjoribanks J, Lethaby A, Hickey M, Farquhar C. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD000402.

Grodstein F, Manson JE, Stampfer MJ, Rexrode K. Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy. Arch Intern Med. 2008 Apr 28;168(8):861-6.

Haimov-Kochman R, Barak-Glantz E, Arbel R, Leefsma M, Brzezinski A, Milwidsky A, et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6.

Lethaby A, Hogervorst E, Richards M, Yesufu A, Yaffe K. Hormone replacement therapy for cognitive function in postmenopausal women. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003122.

Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007 Mar 20;115(11):1481-501.

Nelson HD. Menopause. Lancet. 2008 Mar 1;371(9614):760-70.

[No authors listed]. Herbal medicines for menopausal symptoms. Drug Ther Bull. 2009 Jan;47(1):2-6.

North American Menopause Society. Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society. Menopause. 2007 Mar-Apr;14(2):168-82.

North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007 May-Jun;14(3 Pt 1):355-69.

Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007 Apr 19;356(16):1670-4.

Reed SD, Newton KM, LaCroix AZ, Grothaus LC, Grieco VS, Ehrlich K. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause. 2008 Jan-Feb;15(1):51-8.

Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007 Apr 4;297(13):1465-77.

Tamimi RM, Hankinson SE, Chen WY, Rosner B, Colditz GA. Combined estrogen and testosterone use and risk of breast cancer in postmenopausal women. Arch Intern Med. 2006 Jul 24;166(14):1483-9.

Utian WH, Archer DF, Bachmann GA, Gallagher C, Grodstein F, Heiman JR, et al. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society. Menopause. 2008 Jul-Aug;15(4 Pt 1):584-602.

Wierman ME, Basson R, Davis SR, Khosla S, Miller KK, Rosner W, et al. Androgen therapy in women: an Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab. 2006 Oct;91(10):3697-710. Epub 2006 Oct 3.

Reviewed last on: 8/25/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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