Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Abstract

In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

Efficacy of Lactiplantibacillus plantarum PBS067, Bifidobacterium animalis subsp. lactis BL050, and Lacticaseibacillus rhamnosus LRH020 in the Amelioration of Vaginal Microbiota in Post-Menopausal Women: A Prospective Observational Clinical Trial

“…Menopause is a physiological phase in a woman's life corresponding to the end of menstrual cycles and the reduction of ovarian function, which leads to a drastic decrease in oestrogen and progesterone levels as well as bio-psychosocial changes [1,2]. The onset of menopause is typically observed in women between 45 and 55 years, with an average age of 51 [3,4].…”

“…The decrease In oestrogen can cause different disorders and symptoms, both neurovegetative (hot flushes, profuse sweating, palpitations, tachycardia, blood pressure fluctuations, sleep disturbances, vaginal dryness, and genital itching) and psycho-affective (irritability, unstable mood, fatigue, anxiety, demotivation, concentration and memory disturbances, and decreased sexual desire) [1]. Another consequence is the increase in the frequency of urinary tract disorders, as often happens in the transition to menopause [6].…”

Differences in menopausal quality of life, body appreciation, and body dissatisfaction between women at high and low risk of an eating disorder

“…First, the current investigation lacks consideration of hormone‐replacement therapy (HRT) in the examination of the association between menopausal quality of life and eating disorder risk. This exclusion is notable given that HRT is shown to be effective in relieving the adverse effects of menopausal symptoms for some women (e.g., hot flashes, genitourinary symptoms (Comparetto & Borruto, 2023 )) thus potentially preventing a deterioration in their quality of life. HRT could potentially reduce the likelihood of the development and exacerbation of eating and body image pathology.…”

“…This exclusion is notable given that HRT is shown to be effective in relieving the adverse effects of menopausal symptoms for some women (e.g., hot flashes, genitourinary symptoms (Comparetto & Borruto, 2023)) thus potentially preventing a deterioration in their quality of life. HRT could potentially reduce the likelihood of the develop-…”