Chapter 11 – Menopause

Menopausal Hormone Therapy (MHT)

Systemic estrogen therapy is the most effective way of treating the vasomotor symptoms of menopause. Patients with an intact uterus should additionally always use a progestogen to protect the endometrium from hyperplasia and endometrial cancer.

Estrogen may also be administered topically to the genital tissues for genitourinary symptoms of menopause (vulvovaginal atrophy).

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Systemic menopausal hormone therapy

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Women with an intact uterus

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After hysterectomy (with ovaries retained)

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Systemic MHT preparations and delivery systems

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Tibolone

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Selective estrogen receptor modulators

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Contraindications to systemic MHT including Tibolone and SERMs (consider referral to menopause specialist):

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Side effects and adverse events of systemic MHT

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Topical vaginal estrogen and genitourinary symptoms of menopause (vulvovaginal atrophy)

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