Hot flashes, night sweats and sleep disturbances are common symptoms of menopause that can affect health, quality of life and work productivity. A new review published in CMAJ ( Canadian Medical Association Journal ) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221438 recommends menopausal hormone therapy, historically known as hormone replacement therapy (HRT), as first-line treatment in people without risk factors.
Menopausal symptoms may occur up to 10 years before the last menstrual period and can last more than 10 years, with negative effects for many people.
"Menopause and perimenopause can be associated with distressing symptoms and reduced quality of life," writes Dr. Iliana Lega, Women's College Hospital and the University of Toronto, Toronto, Ontario, with coauthors. "Menopausal hormone therapy is the first-line treatment for vasomotor symptoms in the absence of contraindications."
The review summarizes the latest evidence for diagnosing and treating menopausal symptoms as well as the risks and benefits of therapies to help clinicians and patients manage the condition.
"Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment," write the authors.
Benefits of menopausal hormone therapy include
What about the risks?
For people with risk factors or those who do not want to take menopausal hormone therapy, nonhormonal therapies, such as some selective serotonin reuptake inhibitors (SSRIs) and other medications, can help alleviate symptoms.
"Despite early concerns of an increased risk of cardiovascular events with menopausal hormone therapy after the Women's Health Initiative trial, increasing evidence shows a possible reduction in coronary artery disease with menopausal hormone therapy among younger menopausal patients, specifically those who start menopausal hormone therapy before age 60 years or within 10 years of menopause," write the authors.
They emphasize that it's important for clinicians to ask about symptoms before and during menopause and to discuss treatments with patients based on their personal preferences and potential risk factors.
Canadian Medical Association Journal
Literature review
People
A pragmatic approach to the management of menopause
15-May-2023