May 2011


Hormone therapy

Where are we now?

Volume 40, No.5, May 2011 Pages 280-285

Helena J Teede

Amanda Vincent


Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. The characteristic symptoms of a fall in oestrogen are vasomotor and urogenital atrophy symptoms; with symptoms reported by up to 85% of women over a mean duration of 5.2 years. Long term consequences of menopause include osteoporosis and cardiovascular disease. Menopause management is highly controversial and can be confusing for both clinicians and their women patients.


To explore menopausal management options including comprehensive evaluation; lifestyle modification for symptom relief and risk prevention; hormone therapy or nonhormonal alternatives for symptom relief; prevention and treatment of long term risks; and education and psychological support and therapy.


Use of hormone therapy involves consideration of the woman’s risk-benefit profile. We attempt to clarify this complex topic and focus on the impact of hormone therapy in women aged 50–59 years, including the benefits of relief of hot flushes and urogenital atrophy symptoms and the prevention of fractures and diabetes; and the risks, including venothrombotic episodes, stroke, cholecystitis and breast cancer (with combined oestrogen and progestogen only). Nonhormonal options are also explored.

Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity and is diagnosed retrospectively following 12 months of amenorrhea in association with elevated gonadotrophins and oestrogen deficiency.1 Premature menopause occurs before the age of 40 years and early menopause before 45 years. Menopause can be spontaneous or can be induced by chemotherapy, radiotherapy or surgery. The time leading up to the menopause – the menopause transition – is characterised by declining ovarian follicle numbers, menstrual irregularity and hormonal changes including increasing follicle stimulating hormone, decreasing inhibin B and anti-mullerian hormone, and variable oestradiol levels.2 Testosterone levels decline during early to mid reproductive life with little change during the menopause transition.3 The average age of spontaneous natural-age menopause is 51 years, with the menopause transition commencing at 47.5 years. Risk factors associated with an earlier menopause include smoking, positive family history and pelvic surgery (including hysterectomy).4

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