Management of Menopausal Symptoms

Abstract

ImportanceMenopause, due to loss of ovarian follicular activity without another pathological or physiological cause, typically occurs between the ages of 45 years and 56 years. During the menopausal transition, approximately 50% to 75% of women have hot flashes, night sweats, or both (vasomotor symptoms) and more than 50% have genitourinary symptoms (genitourinary syndrome of menopause [GSM]).ObservationsVasomotor symptoms typically last more than 7 years and GSM is often chronic. Efficacious treatments for women with bothersome vasomotor symptoms or GSM symptoms include hormonal and nonhormonal options. Systemic estrogen alone or combined with a progestogen reduces the frequency of vasomotor symptoms by approximately 75%. Oral and transdermal estrogen have similar efficacy. Conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) were the only hormonal treatments for which clinical trials were designed to examine cardiovascular events, venous thromboembolism, and breast cancer risk. Compared with placebo, the increased risk of stroke and venous thromboembolism associated with CEE (with or without MPA) and breast cancer (with use of CEE plus MPA) is approximately 1 excess event/1000 person-years. Low-dose CEE plus bazedoxifene is not associated with increased risk of breast cancer (0.25%/year vs 0.23%/year with placebo). Bioidentical estrogens approved by the US Food and Drug Administration (with identical chemical structure to naturally produced estrogens, and often administered transdermally) also are available to treat vasomotor symptoms. For women who are not candidates for hormonal treatments, nonhormonal approaches such as citalopram, desvenlafaxine, escitalopram, gabapentin, paroxetine, and venlafaxine are available and are associated with a reduction in frequency of vasomotor symptoms by approximately 40% to 65%. Low-dose vaginal estrogen is associated with subjective improvement in GSM symptom severity by approximately 60% to 80%, with improvement in severity by 40% to 80% for vaginal prasterone, and with improvement in severity by 30% to 50% for oral ospemifene.Conclusions and RelevanceDuring the menopausal transition, approximately 50% to 75% of women have vasomotor symptoms and GSM symptoms. Hormonal therapy with estrogen is the first-line therapy for bothersome vasomotor symptoms and GSM symptoms, but nonhormonal medications (such as paroxetine and venlafaxine) also can be effective. Hormone therapy is not indicated for the prevention of cardiovascular disease.

The relationship between physical activity and the severity of menopausal symptoms: a cross-sectional study

“…Menopause is a period of life when the ovaries are depleted of oocytes and the cyclical activities of gonadotrophins, peptides, and steroids are lost[ 1 ]. The mean age of menopause is 51.4 years, but varies between populations from 49 to 52 years [ 2 ]. There are approximately 1.02 billion women over 50 years old around the world in 2021[ 3 ].…”

Announcing Expanded Content for Clinicians Through the Clinical Review and Education Section at JAMA Internal Medicine

“…We plan to cover a broad range of topics relevant to internal medicine, such as substance use disorders, obesity, and dementia. These reviews will follow a format similar to that of other JAMA Network journals; for example, a recently published review on the management of cirrhosis and another on treatment strategies for symptoms of menopause …”

“…These reviews will follow a format similar to that of other JAMA Network journals; for example, a recently published review on the management of cirrhosis 1 and another on treatment strategies for symptoms of menopause. 2 Clinical Insights are short (1000-1200 words) articles that provide a clinical overview of a focused topic of high…”

“…These reviews will follow a format similar to that of other JAMA Network journals; for example, a recently published review on the management of cirrhosis 1 and another on treatment strategies for symptoms of menopause. 2 Clinical Insights are short (1000-1200 words) articles that provide a clinical overview of a focused topic of high relevance to practicing clinicians. Modeled after JAMA Network Insights, they aim to provide evidence-based guidance for commonly encountered clinical scenarios or controversies where emerging evidence or nuanced decision-making affects medical care.…”

HRT for treating menopause: known unknowns

“…HRT can reduce the vasomotor symptoms of menopause (hot flushes, night sweats) by up to 80% 2. Only around 15% of women aged 45-69 in England are currently prescribed HRT, however 3.…”