How To Manage Menopausal Symptoms?

From the endocrine point of view, menopause is considered a deficiency state and estrogen replacement therapy as restoring the pre-menopausal endocrine milieu. The primary indications for menopausal HRT are climacteric symptoms and the prevention of osteoporosis. Menopausal therapy is however neither an elixir of eternal youth nor a panacea for the problems of postmenopausal women. It is not without risks and is neither tolerated nor required by all women.

It is well known that estrogen therapy is effective in 90% of women with hot flushes and is considered the gold standard treatment. Since low doses of estrogen are adequate to control even severe symptoms in the vast majority of women and effective in maintaining bone mass it is justifiable to use the lowest estrogen dose and for the shortest period whenever possible.

Postmenopausal therapy needs to be individualized. Decision about who should be treated, with what preparation and for how long depend on many factors, such as the woman's age, her past medical, family history, the indication for treatment and the potential risks and side effects in each individual case. It is now clear that the risks associated with HRT depend on the health profile of an individual woman.

For women with menapusal symptoms, making personal, informed decision about HRT can be challenging and often confusing. The initiation and duration of treatment are matters requiring careful judgement and monitoring. Short-term HRT is appropriate for those peri- and postmenopausal women, who have moderate to severe hot flushes and sweats. Women should be informed that there are some risks (eg, for venous thrombosis, coronary heart disease and stroke) within the first 1 to 2 years of therapy and these should be balanced against the severity of symptoms and expected benefit of treatment. Risk for breast cancer appears to increase with longer-term HRT (after four to five years), although earlier harm cannot be definitely excluded. Women's Health Initiative (WHI) trial provided information only on the effects of oral HRT consisting of Premarin and Provera. There is a possibility that other routes of administration might be safer, at least there is such evidence for transdermal estradiol in terms of risk of venous thrombosis.

Results from the WHI and similar trials cannot be extrapolated to women with premature menopause so there is no need at present to change current practice of prescribing HRT to these women.