Management of Menopausal Symptoms: A Review
Carolyn J Crandall1, Jaya M Mehta2,3, JoAnn E Manson4,5
1Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
JAMA
|February 7, 2023
Summary
Menopause treatments include hormone therapy and nonhormonal options for vasomotor and genitourinary symptoms. Estrogen therapy is effective but carries risks, while nonhormonal drugs offer alternatives for symptom relief.
Area of Science:
- Reproductive Endocrinology
- Women's Health
- Menopause Management
Background:
- Menopause, typically occurring between ages 45-56, affects over 50% of women with vasomotor and genitourinary symptoms.
- Vasomotor symptoms can persist for over 7 years, while genitourinary syndrome of menopause (GSM) is often chronic, significantly impacting quality of life.
Approach:
- Systemic estrogen therapy, alone or with progestogens, effectively reduces vasomotor symptoms by ~75%.
- Nonhormonal pharmacotherapies, including SSRIs and gabapentin, provide 40-65% symptom reduction for those not candidates for hormone therapy.
- Vaginal estrogen and other agents demonstrate significant subjective improvement in GSM symptoms.
Key Points:
- Conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) have been studied for cardiovascular and breast cancer risks, showing minimal excess events per 1000 person-years.
- Low-dose CEE plus bazedoxifene shows no increased breast cancer risk compared to placebo.
- Bioidentical estrogens offer transdermal treatment options for vasomotor symptoms.
Conclusions:
- Hormonal therapy, particularly estrogen, is the first-line treatment for bothersome menopausal vasomotor and GSM symptoms.
- Nonhormonal medications are effective alternatives for women unsuitable for hormone therapy.
- Hormone therapy is not recommended for cardiovascular disease prevention.
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