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Menopause and hormone therapy
Hormone therapy is the most effective treatment for hot flushes, and in a healthy woman below 60, or less than 10 years past menopause, benefit exceeds risk; a woman with a uterus must also receive a progestogen, and a transdermal patch raises the risk of thrombosis less.
Why it matters in the exam
Menopause is defined as 12 months without a period, at an average age of 51. Above age 45 with typical symptoms the diagnosis is clinical, without hormone tests. Exam questions ask who is suitable for hormone therapy, who is not (breast cancer, previous thrombosis or stroke, coronary disease, uninvestigated vaginal bleeding, active liver disease), and what the alternatives are. The WHI study taught that the risk depends on age and time since menopause, and that oestrogen alone (in a woman after hysterectomy) did not raise breast cancer, while the combination with a progestin raised it slightly after several years.
For women who cannot take hormones there are alternatives for hot flushes: an SSRI or SNRI (low-dose paroxetine, venlafaxine), gabapentin, and fezolinetant — an NK3 receptor blocker approved in 2023. Vaginal and urinary symptoms (the genitourinary syndrome) are treated with low-dose local oestrogen, which does not require a progestogen. A woman with premature ovarian insufficiency needs hormone therapy until roughly the usual age of menopause, for the sake of bones and heart. Hormone therapy is not given to prevent chronic disease such as heart disease or dementia.
Key points
- Menopause: 12 months without a period; average age 51.
- Hormone therapy: the most effective for hot flushes; preferably under 60 or within 10 years.
- Uterus present → add a progestogen; patch → less thrombosis.
- Alternatives: SSRI or SNRI, gabapentin, fezolinetant.
- Vaginal symptoms → local oestrogen without a progestogen.
Summary table
| Topic | Principle | Details | Exam notes |
|---|---|---|---|
| Diagnosis | 12 months without a period; average age 51 | Above age 45 — clinical | FSH only at a young age or when unclear |
| Systemic hormone therapy | The most effective treatment for hot flushes | Uterus present: oestrogen combined with a progestogen; after hysterectomy: oestrogen only | Preferably under age 60 or within 10 years of menopause |
| Contraindications | — | Breast cancer, previous thrombosis or stroke, coronary disease, uninvestigated bleeding, active liver disease | Transdermal patch — less thrombosis than a tablet |
| Non-hormonal alternatives | Hot flushes with a contraindication to hormones | SSRI or SNRI, gabapentin, fezolinetant | Low-dose paroxetine |
| Genitourinary syndrome | Dryness, painful intercourse, recurrent urinary infections | Low-dose local oestrogen | No progestogen needed |
| Premature ovarian insufficiency | Menopause before 40 | Hormone therapy until about age 51 | Protects bone and heart |
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Sources
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society, 2022 — Hormone therapy: benefits, risks, timing
- NICE guideline NG23, 2015, updated 2024 — Menopause: identification and management
- The 2023 Nonhormone Therapy Position Statement of The Menopause Society, 2023 — Vasomotor symptoms
- Berek and Novak's Gynecology, 16th edition (2019) — Menopause
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.