Management of menopause: modern trends

Abstract

Climax is a 30-year-old staircase. Gynecologist should overcome her own hormophobia and understand the benefits and risks of menopausal hormone therapy (MHT) to help the patient cope with the menopausal symptoms. A very important earlier onset of MHT: started during menopause MHT reduces the cardiovascular risk by 20–50%, the hip fractures risk by 40%.

International Menopause Society recommendations on MHT (2016):

– MHT is the most effective and pathogenetic method for the vasomotor symptoms and urogenital atrophy treatment;

– drug dosage should be selected, gradually reducing to the minimum effective dose;

– it is selected individually for the patient;

– there are no reasons for limiting the mht duration;

– MHT risks and benefits differ for women in transition to menopause compared to older women;

– women on mht should be consulted at least once a year (endometrial ultrasound, pap smear, mammography, vascular condition assessment, coagulogram, lipid spectrum);

– progestogen adding as a continuous or cyclic regimen in women with uterus reduces the risk of endometrial neoplasia associated with estrogen therapy.

MHT also has a positive effect on various systems and organs: MHT is the only type of therapy with proven effectiveness in reducing fractures value in patients with osteopenia; MHT improvement cardiovascular risk profile due to its positive effect on vascular function, lipid levels, glucose metabolism; MHT reduces the incidence of newly diagnosed diabetes mellitus; does not affect weight gain.

Menopause management should be complex and include not only MHT, but also the treatment of major diseases, lifestyle changes (stop smoking, weight loss, reduction of alcohol consumption, reduction of emotional and psychological stress), diet rationalization, physical activity (aerobic exercise minimum 30–40 min/day), dynamic monitoring of woman’s condition.