The WHI trial reported increased risks of breast cancer, cardiovascular disease and VTE in participants using MHT. The Women’s Health Initiative (WHI) trial, first reported in 2002, 4 has had an ongoing impact on the perception of the risks of MHT among both clinicians and the general public, with many perceiving MHT as an unsafe treatment, especially with respect to breast cancer risk. Note that treated hypertension is not a contraindication.īenefits and risks of menopausal hormone therapy breast, endometrial and other hormone-dependent cancers (current or previous)Ĭonditions that are relative contraindications when transdermal MHT is preferred:.Contraindications to menopausal hormone therapyĬontraindications to menopausal hormone therapy (MHT): The most effective treatment for menopausal symptoms is MHT, and it can be offered to all symptomatic women who do not have contraindications (Box 1). 3įor women with symptoms, treatment options fall into three categories: MHT, non-hormonal prescription treatments and complementary therapies. Women aged under 50 years should be offered contraception for two years after the final menstrual period, and women aged 50 years and over should be offered contraception for one year after the final menstrual period, although the risk in the latter group is small. Women should be asked about contraceptive needs. Blood tests are appropriate in women under 45 years of age if early or premature menopause is suspected, and to exclude other causes of oligomenorrhoea or amenorrhoea. Measurement of follicle-stimulating hormone is not necessary for women at the normal age for menopause. This is also an opportune time to ensure that mammography, cervical screening and bowel cancer screening are up to date.Ī discussion about menopause provides an opportunity for health promotion: smoking cessation, healthy eating, exercise and minimising alcohol intake are all important. The consultation provides an opportunity to explore these concerns, along with a review of personal and family medical history, with emphasis on venous thromboembolism (VTE), cardiovascular disease and risk factors, cancer and osteoporosis. 2 Women may present with a range of symptoms and concerns. The clinical management of a women who is perimenopausal or menopausal necessitates a comprehensive assessment and a detailed discussion of treatment options, and this may require several consultations. These symptoms are often more pronounced in women with premature menopause or menopause due to surgery or other medical interventions. There is an increase in incidence of cardiovascular disease and osteoporosis after menopause.ĭuring the perimenopausal and postmenopausal years, women often have a variety of symptoms including vasomotor symptoms (hot flushes and night sweats), muscle and joint pains, sleep disturbance, mood changes and anxiety, and genitourinary symptoms. Menopause results in a number of physiological changes affecting the cardiovascular, musculoskeletal, urogenital and central nervous systems. Prior to the final period, women have a phase of fluctuating ovarian function and hormone levels known as perimenopause, which typically lasts several years. Women who have their final period between the ages of 40 and 45 years have early menopause, and those aged under 40 years have premature menopause, or premature ovarian insufficiency. 1 For Australian women, the average age at menopause is approximately 51 years, with a normal range of 45–55 years. Menopause is caused by cessation of ovulation and is defined as the final menstrual period. Women need clear information to make decisions that are appropriate for their circumstances. Choices relating to the timing and types of treatments are important to optimise benefit and minimise risk. Advances in the understanding of the evidence regarding the benefits and risks of MHT mean that clinicians can have the confidence to prescribe MHT safely to women with no contraindications, and adjust the type and delivery of MHT for those who do have relative contraindications. Although menopausal hormone therapy (MHT) is by far the most effective treatment for menopausal symptoms, there has been conflicting information about its safety. Both the clinician and patient face choices about hormonal and other treatments to address symptoms and long-term health. When women with symptoms present around the time of menopause, it provides an opportunity for clinicians to assess and promote health.
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