Chapter 11 – Menopause
CONTENTS
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Menopause: An introduction
- Normal physiological and endocrine changes at perimenopause and post menopause
- Menopausal symptoms
- The menopause consultation
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Menopausal Hormone Therapy (MHT)
- Systemic menopausal hormone therapy
- Women with an intact uterus
- After hysterectomy (with ovaries retained)
- Systemic MHT preparations and delivery systems
- Tibolone
- Selective estrogen receptor modulators
- Contraindications to systemic MHT including Tibolone and SERMs (consider referral to menopause specialist):
- Side effects and adverse events of systemic MHT
- Topical vaginal estrogen and genitourinary symptoms of menopause (vulvovaginal atrophy)
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Non-hormonal pharmacological treatments for menopausal vasomotor symptoms
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Alternative and herbal treatments
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Treating menopausal symptoms after breast cancer
- Premature ovarian insufficiency
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Other issues to consider
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- Low bone mass/ osteoporosis
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Cardiovascular disease
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Resources
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References
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Treating menopausal symptoms after breast cancer
Menopausal symptoms are common in women who are being treated for breast cancer. This may be because of chemotherapy causing ovarian failure, anti-oestrogen endocrine therapy, or because breast cancer is often diagnosed in the perimenopausal woman.
Treatment of these women is controversial, and the use of MHT has not been shown to be safe. Referral to a specialist clinic may be appropriate, or consideration of treatment with non-hormonal treatments such as SSRIs or clonidine.
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