Chapter 11 – Menopause

Menopausal Hormone Therapy

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

Oestrogen 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 oestrogen receptor modulators

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Contraindications to systemic MHT (consider referral to menopause specialist):

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Side effects and adverse events of systemic MHT

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

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