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Symptomatic Menopause-What Are the Safe and Effective Options?

Jerilynn C. Prior, BA, MD, FRCPC, Endocrinology and Metabolism, University of British Columbia; Centre for Menstrual Cycle and Ovulation Research; Vancouver Coastal Health Research Institute, Vancouver, BC.

Most menopausal women require no treatment. Despite controlled trial data showing risks from menopausal hormone treatment, three conditions benefit from ovarian hormone therapy: early menopause, severe vasomotor symptoms with osteoporosis, and sleep-disturbing night sweats. For early menopause, transdermal estradiol with full-dose oral micronized progesterone is needed until age 50. Severe hot flushes plus osteoporosis is treated for five years with estradiol and continuous progesterone. Severe night sweats disturbing sleep are effectively treated with daily full dose progesterone. Vaginal dryness despite lubricants and regular, gentle sex is treated with vaginal low, controlled-dose estradiol preparations or estriol cream.
Key words: early menopause, hot flushes, night sweats, vaginal dryness, ovarian hormone therapy, progesterone.