The Individualized Approach to Menopause Management

Brian W. Walsh
In: The Journal of Clinical Endocrinology & Metabolism · 1999 · vol. 84(6) , pp. 1900–1904 · doi:10.1210/jcem.84.6.5805 · PMID:10372684 · W2080609947
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Abstract

Most clinicians who care for women after the menopause are quite familiar with the benefits and risks of hormone replacement therapy (HRT) (1). They know that estrogen treatment relieves hot flashes, which can improve sleep, and that it reverses urogenital atrophy, to relieve dyspareunia. Clinicians are aware that estrogen treatment prevents postmenopausal bone loss, thereby reducing the risk of osteoporotic fractures. They know that estrogens have favorable effects on blood lipids and other cardiovascular risk factors (2), which can substantially lower the risk of cardiovascular disease, the leading cause of death for postmenopausal women. Fortunately, prescribing HRT to many women is relatively straightforward and highly effective. Many women will do quite well with the first standard hormone regimen they are given. For example, some women who have severe hot flashes get significant relief from HRT and are not troubled by side-effects. Not every case is this easy, however. Many women experience problems with HRT, resulting in a high discontinuation rate. Thus, large numbers of women will require an individualized approach to hormone treatment, posing a formidable challenge to the clinician. I have identified five common but challenging scenarios. Each case is entitled by the exact words I frequently hear in my practice. These words are followed by the strategies I use in management—some solutions are based on the results of well-designed clinical trials, others derive from personal experience.

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dyspareunia

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