Practice Pearls Podcast: Menopause

Abnormal uterine bleeding (AUB) is a common clinical problem for both peri- and postmenopausal women. Endometrial cancer must be considered since AUB is the usual presenting symptom, but most abnormal bleeding is benign, with cancer occurring 1-14% of women with AUB.

For women who began hormone therapy near the menopause transition and have persistent symptoms, there is no general rule for stopping hormone therapy at age 65. When cessation of hormone therapy is needed or desired, it can be challenging, as symptoms may recur and other health considerations (such as osteoporosis prevention) arise. The first part of this episode discusses hormone therapy cessation. The second part focuses on the Genitourinary Syndrome of Menopause (GSM), a new term for the symptoms of vaginal dryness, dyspareunia, dysuria, and recurrent UTI which are associated with estrogen loss. GSM tends to worsen as time passes after the menopause transition, but there are several safe and effective treatments.

Many women suffer from menopausal symptoms but are not candidates for hormone therapy. This episode reviews the evidence regarding nonhormonal treatment options as alternatives to hormone therapy for vasomotor symptoms.

Prescribing hormone therapy can seem tricky with so many options to consider. In this episode, we discuss the history of hormone therapy and what you need to know to support shared decision-making with your patients in prescribing hormone therapy.

Hormone therapy adds risks and benefits to women’s long-term health. The Women’s Health Initiative (WHI) and the Early vs Late Intervention Trial with Estradiol (ELITE trial) have shaped our knowledge about the “timing hypothesis” and the impact of hormone therapy on disease risk. This episode covers our current knowledge about the benefits and risks of hormone therapy.

Our understanding of that landmark trial, the Women’s Health Initiative (WHI), continues to evolve. Data from younger women in the WHI, in addition to findings from the ELITE trial, suggest a favorable benefit/risk balance when menopausal hormone therapy is started within 10 years of the menopause transition or at age ≤ 60 years. As a result, the clinical guidelines for menopausal hormone therapy have changed. In addition, the SWAN study has provided us with a deeper understanding of women’s experiences during the menopause transition.