Newswise — Hot flashes, night sweats and sleep disturbances are common symptoms of menopause that can affect health, quality of life and work productivity. A new review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.221438 recommends menopausal hormone therapy, historically known as hormone replacement therapy (HRT), as first-line treatment in people without risk factors.
Menopausal symptoms can start appearing up to 10 years before a person's last menstrual period and can persist for more than 10 years. These symptoms can have negative effects on individuals experiencing them.
Dr. Iliana Lega, along with coauthors, states that menopause and perimenopause can bring about troublesome symptoms and a decrease in quality of life. They emphasize that menopausal hormone therapy is considered the initial treatment option for vasomotor symptoms unless there are specific reasons to avoid it.
The review provides a comprehensive overview of the most recent evidence concerning the diagnosis and treatment of menopausal symptoms. It also discusses the potential risks and benefits associated with various therapies. The goal is to assist healthcare professionals and patients in effectively managing this condition.
The authors note that despite the availability of numerous treatments for menopausal symptoms, concerns about the risks associated with menopausal hormone therapy and a lack of awareness regarding treatment options often prevent patients from seeking or receiving appropriate treatment.
Benefits of menopausal hormone therapy include
- reduced hot flashes in as many as 90% of patients with moderate to severe symptoms;
- improved blood lipid levels and a possible reduced risk of diabetes; and
- fewer fragility fractures of the hip, spine and other bones.
What about the risks?
- Although previous evidence has shown an increased risk of breast cancer, the risk is much lower in people aged 50–59 years and in those who start menopausal hormone therapy in the first 10 years of menopause.
- Some studies show an increased risk of ischemic stroke in women older than 60 years who start therapy 10 years after the start of menopause, but the risk is low for those younger than 60.
For individuals who have risk factors or prefer not to undergo menopausal hormone therapy, nonhormonal therapies can be considered as alternatives. Certain medications, including selective serotonin reuptake inhibitors (SSRIs) and other nonhormonal options, have been found to be effective in alleviating menopausal symptoms.
The authors highlight that although there were initial concerns about a higher risk of cardiovascular events associated with menopausal hormone therapy based on the Women's Health Initiative trial, emerging evidence suggests a potential decrease in coronary artery disease among younger menopausal patients who begin menopausal hormone therapy before the age of 60 or within 10 years of menopause. This indicates that the timing of initiating menopausal hormone therapy may play a role in its cardiovascular effects.
The authors emphasize the significance of healthcare providers inquiring about symptoms both before and during menopause and engaging in discussions with patients regarding treatment options. This personalized approach takes into account individual preferences and potential risk factors when making decisions about managing menopausal symptoms.
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