Menopause and Hormone Replacement

Excerpt

Menopause, defined as twelve months after a woman’s final menstrual period, is a natural event that marks the end of spontaneous ovulation and thus reproductive capabilities. In the Western world, the average age of menopause is 51 years.

During the time preceding and following the menopause, many women experience symptoms including hot flashes, vaginal irritation, trouble sleeping, fatigue, and weight gain. Each woman experiences perimenopause uniquely; although menopause symptoms may represent minor inconveniences for some women, other women find these symptoms more disruptive. This period of a women’s life also coincides with the time she is more likely to develop diseases associated with advancing age such as osteoporosis, cardiovascular disease, and cancer.

The clinical use of estrogens to treat menopausal symptoms was first evaluated in the late 1920s. By 1928, the first commercially available injectable estrogen was developed; and by 1942, the first oral formulation of estrogen was marketed. Over the years, data from clinical studies have refined the indications for hormone therapy. For example, estrogen remains the most effective therapy for hot flashes. However, it has also recently been established that estrogen is not appropriate to prevent chronic disease.

Thus, the challenges to clinicians and patients who consider prescribing and using hormone therapy are: whether to treat; with which agent (formulation, dose, delivery method); and for how long.