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The menopause.

G A Greendale1, N P Lee, E R Arriola

  • 1Division of Geriatrics, School of Medicine, Center for Health Sciences, University of California, Los Angeles 90095-1687, USA.

Lancet (London, England)
|February 24, 1999
PubMed
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Menopause, the cessation of ovarian function, typically occurs around age 51. Hormone replacement therapy offers benefits for symptom relief and chronic disease prevention, but requires personalized decision-making.

Area of Science:

  • Reproductive endocrinology
  • Gerontology
  • Women's health

Background:

  • Menopause is defined as 12 months of amenorrhea due to permanent ovarian function cessation, with a mean age of 51.
  • The perimenopause, a transition period preceding menopause, involves changing ovarian function and symptom onset, like hot flashes.
  • The physiology and clinical aspects of the menopausal transition are not fully understood.

Purpose of the Study:

  • To review the evidence for associations between menopause and various symptoms and diseases.
  • To discuss hormone replacement therapy (HRT) for symptom relief and chronic disease prevention.
  • To highlight the importance of individualized HRT decisions based on benefits, risks, and patient preferences.

Main Methods:

  • Review of existing evidence on menopause-related symptoms and diseases.

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  • Analysis of hormone replacement therapy (HRT) indications, regimens, and complications.
  • Examination of observational data on HRT and all-cause mortality.

    • Main Results:

    • Observational studies suggest HRT use is associated with a 30-50% reduction in all-cause mortality in postmenopausal women.
    • HRT can be used for symptom management and chronic disease prevention, with varying doses and routes.
    • Unexpected vaginal bleeding during HRT may indicate endometrial hyperplasia, necessitating careful monitoring.

    Conclusions:

    • Postmenopausal hormone therapy is a complex intervention with both positive and negative health effects.
    • Individualized decision-making for HRT is crucial, involving a joint discussion between women and healthcare providers.
    • Patient preferences regarding health outcomes should guide the choice to use hormone replacement therapy.