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Perspectives

Sex hormone prescribing in postmenopausal women: hormone replacement or hormone therapy and what are the alternatives?

Amanda J Vincent

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Abstract

A personalised approach to managing menopausal symptoms in women is needed in which the decision to use menopausal hormonal therapy, or alternatives, requires assessment and discussion of the woman’s individual risk and benefit profile with ongoing review.

Key Points

  • Oestrogen is the most effective therapy for menopausal symptoms, including vasomotor and genitourinary symptoms.
  • Many postmenopausal symptomatic women are not receiving treatment.
  • The main risk of oral oestrogen-containing menopausal hormone therapy in healthy women aged below 59 years or within 10 years of menopause is thromboembolism. Use of transdermal oestrogen minimises this risk.
  • Certain antidepressants and anticonvulsants and also clonidine are effective nonhormonal alternatives for management of vasomotor symptoms.
  • Limited evidence supports the use of acupuncture, yoga, soy isoflavones, cognitive behavioural therapy and stellate ganglion blockade for relief of vasomotor symptoms.
  • Hormone therapy should be instituted early and continued until the usual age of natural menopause in women with premature menopause (menopause at age under 40 years), unless contraindicated.

    Picture credit: © Steve Horrell/SPL.

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