Menopause is the cessation of menstrual periods for 1 year. The average age for menopause is 52.
- Estrogen:
- Estrogen relieves genitourinary atrophy, vasomotor instability, reduces hip and vertebral fractures, relieves hot flashes which decreases insomnia and fatigue, stabilizes mood changes, improves sexual function.
- Risks: cancer, especially when unopposed, CHD, bloating, headache, breast tenderness, increased blood clotting
- Women with a uterus should not take unopposed estrogen.
- Progesterone:
- Decreases risks of estrogen-induced bleeding and carcinoma.
- Risks: bloating, weight gain, irritability, and depression
- Long-term use (from 1 to 5 years) of hormone therapy is not recommended.
- Give the lowest dose for the shortest time.
- Try topical for vasomotor symptoms first. There isn’t much systemic absorption with topical.
- SERMs: ospemifene: contraindications similar to estrogen (but only works for vaginal symptoms). Add progestin if omen still has a uterus.
- SSRIs: Good for vasomotor symptoms in high-risk patients
- Conjugated estrogen and bazedoxifene: SERM plus estrogen, may be used with an intact uterus.
- Clonidine, gabapentin, and pregabalin are sometimes used for symptomatic relief.