Management of Menopausal Symptoms

Kaunitz, Andrew M.; Manson, JoAnn E.

doi:10.1097/aog.0000000000001058

Cited by 162 publications

(115 citation statements)

References 86 publications

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“…Disruptive and debilitating vasomotor symptoms are the main reason women seek medical care, usually from primary care or OB/GYN, because of menopausal transition [4]. Women with a history of smoking, obesity, depression, anxiety, or low socioeconomic status, are more likely to have vasomotor symptoms [4]. There is data to suggest vasomotor symptomatology has a genetic predilection, thus not all women encounter discomfort during the menopausal transition [14].…”

Section: Menopausal Transitionmentioning

confidence: 99%

“…Women in their 40's or younger, who experience surgical or early menopause, will require higher doses of hormones, which would be more physiologic. Low dose birth control may be a viable option for these younger women, even though they no longer require contraception [4]. Gynecologic consult may be needed to decide when to transition women from low dose contraception to hormone replacement.…”

Section: Hrt: Women With a Uterusmentioning

confidence: 99%

“…These symptoms often begin in menopausal transition, and can last up to 10 years. Disruptive and debilitating vasomotor symptoms are the main reason women seek medical care, usually from primary care or OB/GYN, because of menopausal transition [4]. Women with a history of smoking, obesity, depression, anxiety, or low socioeconomic status, are more likely to have vasomotor symptoms [4].…”

Section: Menopausal Transitionmentioning

confidence: 99%

“…There are many formulations of oral and transdermal estrogen/progestin combinations. If dosing progestins as separate from the estrogen, suggestions are Medroxyprogesterone Acetate 2.5 -5 mg nightly, Progesterone 100 -200 mg nightly, or the Levonogestrel intrauterine device [4].…”

Section: Hrt: Women With a Uterusmentioning

confidence: 99%

“…During menopausal transition, the period of a few years prior to the cessation of menses, both follicle stimulating hormone and estradiol levels drop significantly [3]. Women often seek care from their primary care provider or OB/GYN during this period because of disruptive and often debilitating vasomotor symptoms of menopausal transition [4]. Studies show that women with a history of hormonally associated psychopathology, e.g., peripartum depression or psychosis, or Premenstrual Dysphoric Disorder (PMDD), can be especially vulnerable to recurrent psychopathology during the menopausal transition [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Schizophrenia during Menopausal Transition

Crow¹,

Jasberg²

2016

Ment Health Fam Med

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Case 3Patient 3 is a 58 y/o woman with 2 months of delusional thinking. According to her family, she was disorganized and unsafe in the home. She called police due to paranoid delusions and requested admission for her safety. She declined medication. She felt that her family was plotting against her and that people were watching her through hospital windows. Her husband reported that when she was entering menopause, she had a very similar episode where she became delusional and paranoid, and acted on delusional content. She was treated at an outside hospital for depression at that time, and stabilized on citalopram. She then was stable without medication for 5 years, until two months prior to this presentation. The result of her hospitalization was civil commitment for psychiatric treatment and olanzapine therapy, which was effective. She declined a first episode workup, and did not offer a reproductive history. The patient was not pregnant nor on hormone replacement therapy.

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Section: Menopausal Transitionmentioning

confidence: 99%

Section: Hrt: Women With a Uterusmentioning

confidence: 99%

Section: Menopausal Transitionmentioning

confidence: 99%

Section: Hrt: Women With a Uterusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Schizophrenia during Menopausal Transition

Crow¹,

Jasberg²

2016

Ment Health Fam Med

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Menopausal Hormone Therapy

Shifren

Crandall

Manson

2019

JAMA

Self Cite

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Hormone therapy is the most effective treatment for managing menopausal vasomotor symptoms. Hot flashes and night sweats affect approximately 70% of midlife women and may persist for a decade or longer. 1 Bothersome vasomotor symptoms have a significant adverse effect on sleep, daily functioning, and quality of life. Cognitive and mood symptoms often accompany disruptive hot flashes. Although lifestyle changes and nonhormonal options are available, women with frequent, severe vasomotor symptoms may greatly benefit from hormone therapy. 2 Menopausal hormone therapy also has beneficial effects on bone mineral density and the urogenital tract, reducing fracture risk and managing atrophic changes and associated symptoms known as the genitourinary syndrome of menopause. In the absence of vasomotor symptoms, alternatives to systemic hormone therapy are recommended for managing fracture risk and genitourinary symptoms. Very low doses of estrogen placed directly in the vagina effectively manage the sexual and quality of life symptoms associated with the genitourinary syndrome of menopause with minimal systemic absorption and risk. 3 Many options are available for providing systemic menopausal hormone therapy for the management of vasomotor symptoms (Supplement). Women without a uterus should receive estrogen alone. Women with a uterus require progestogen in addition to estrogen to prevent endometrial hyperplasia. Menopausal hormone therapy typically raises the very low estrogen levels of women during menopause to physiologic levels seen during the reproductive years. Menopausal hormone therapy has a high degree of safety compared with contraceptive doses of hormones, which are supraphysiologic to suppress ovulation. A wide range of doses and formulations are available, and the lowest dose that can manage a woman's symptoms should be used. Maximum hot flash reduction is not seen until approximately 3 months of use, so women should be informed not to expect immediate symptom relief.The most commonly used formulations are the oral pill and transdermal patch, but other options (eg, transdermal gels, vaginal ring) also are available (Supplement). For women with a uterus, many formulations of estrogen-progestogen therapy combine both hormones for greater convenience and cost savings. Estrogen is provided daily, while the progestogen is provided daily (continuous combined) or cyclically for 12 to 14 days a month. Continuous combined regimens typically result in amenorrhea and are preferred by most women. "Breakthrough bleeding" may be a disruptive adverse effect of continuous combined regimens, especially for women early in the menopause transition. Cyclic regimens result in regular, predictable withdrawal bleeding.Transdermal estrogen therapy has many advantages compared with oral therapy, especially for women with obesity or cardiovascular disease risk factors. All estrogen patches contain estradiol (the natural hormone made by the ovaries during the reproductive years), are changed only once or twice weekly, and result i...

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Reproductive Organ Therapies

2023

Endocrinology

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Management of Menopausal Symptoms

Cited by 162 publications

References 86 publications

Schizophrenia during Menopausal Transition

Schizophrenia during Menopausal Transition

Menopausal Hormone Therapy

Reproductive Organ Therapies

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