Management of menopausal symptoms

Abstract

Menopause is the point at which oocytes are depleted and there is a marked drop in circulating estrogen and progesterone levels. Common symptoms associated with menopause and discussed in this review include vasomotor spasms, vulvovaginal atrophy, diminished bone strength, decreased libido, and neuropsychological changes. The biological etiologies of these symptoms stem from a deprivation of estrogen in the body. The core of menopausal symptom treatment has traditionally been hormone replacement to restore the underlying estrogen deficiency. In most cases, estrogen therapy is the most effective treatment of menopausal symptoms. However, hormone replacement, particularly systemic therapy, should be utilized with caution as it can increase risk of venous thromboembolic disease, breast cancer, and stroke. There are now alternative, non-hormonal options available to women who are unable to utilize hormone replacement or who do not want to assume its risks. Understanding the risks of both hormonal and non-hormonal treatment modalities is crucial for the provider who works with women who are transitioning into menopause or who are postmenopausal. This review will describe available treatments for commonly experienced symptoms of menopause.