Menopause and hormone therapy

Overview

Menopause is the permanent cessation of menstruation from loss of ovarian follicular activity, diagnosed clinically after 12 months of amenorrhoea without hormonal contraception. The years around it carry the heaviest symptom burden in a woman's primary-care life: vasomotor symptoms, disturbed sleep, mood change, and genitourinary atrophy that persists for decades.^[3]

The symptom burden is long, not transient. In SWAN, a multiethnic cohort of 3302 women followed with 13 visits over 17 years, frequent vasomotor symptoms lasted a median of 7.4 years in total and persisted a median of 4.5 years after the final menstrual period; women whose symptoms began before menopause had the longest course, beyond 11.8 years.^[15] Counselling should reflect those numbers, not the folklore of two bad years.

Hormone therapy sits at the centre of management because nothing else matches it: it remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause, and it prevents bone loss and fracture.^[17] The task in general practice is individualised prescribing with honest quantification of risk — which requires knowing what WHI actually measured.^[1]

References20ShowHide

1. [1]Manson JE, Chlebowski RT, Stefanick ML et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA, 2013.PMID 24084921
2. [2]Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 2002.PMID 12117397
3. [3]Sarri G, Davies M, Lumsden MA et al. Diagnosis and management of menopause: summary of NICE guidance. BMJ (Clinical research ed.), 2015.PMID 26563259
4. [4]Johnson KA, Martin N, Nappi RE et al. Efficacy and Safety of Fezolinetant in Moderate to Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. The Journal of clinical endocrinology and metabolism, 2023.PMID 36734148
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6. [6]Lee N, Lee Y, Kim G et al. Hepatic Adverse Event Signals of Fezolinetant in Real-World Use Based on Postmarketing Surveillance. Obstetrics and gynecology, 2026.PMID 42210869
7. [7]Rovinski D, Ramos RB, Fighera TM et al. Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis. Thrombosis research, 2018.PMID 29936403
8. [8]Scarabin PY Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric : the journal of the International Menopause Society, 2018.PMID 29570359
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10. [10]Fornili M, Perduca V, Fournier A et al. Association between menopausal hormone therapy, mammographic density and breast cancer risk: results from the E3N cohort study. Breast cancer research : BCR, 2021.PMID 33865453
11. [11]Fournier A, Berrino F, Clavel-Chapelon F Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast cancer research and treatment, 2008.PMID 17333341
12. [12]Fournier A, Berrino F, Riboli E et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. International journal of cancer, 2005.PMID 15551359
13. [13]Fournier A, Mesrine S, Dossus L et al. Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort. Breast cancer research and treatment, 2014.PMID 24781971
14. [14]Lundell C, Stergiopoulos N, Blomberg L et al. Breast and endometrial safety of micronised progesterone versus norethisterone acetate in menopausal hormone therapy (PROBES): study protocol of a double-blind randomised controlled trial. BMJ open, 2024.PMID 39448218
15. [15]Avis NE, Crawford SL, Greendale G et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA internal medicine, 2015.PMID 25686030
16. [16]Davis SR, Baber R, Panay N et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of clinical endocrinology and metabolism, 2019.PMID 31498871
17. [17]“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel The 2022 hormone therapy position statement of The North American Menopause Society. Menopause (New York, N.Y.), 2022.PMID 35797481
18. [18]Marjoribanks J, Farquhar C, Roberts H et al. Long-term hormone therapy for perimenopausal and postmenopausal women. The Cochrane database of systematic reviews, 2017.PMID 28093732
19. [19]Vincent AJ, Ee C Premature ovarian insufficiency diagnosis and management in general practice: A review based on the 2024 international guideline. Australian journal of general practice, 2026.PMID 41942077
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