An introductory summary to treatment options for Menopause

There is a lot of detail to look through about these topics, so here is a quick summary to provide an overall picture:

 

HRT is very effective at relieving vasomotor menopausal symptoms.

• transdermal preparations appear to be more effective than oral

Vaginal oestrogens are safe and effective for symptoms of postmenopausal vulvovaginal atrophy.

• there are some new second-line alternatives

Testosterone has some benefit on sexual function, with some risk of androgenic side effects and no long-term safety data.

Breast cancer is probably the most significant risk to consider. This is greater with:

• longer duration of treatment
• oral progesterone as a component of HRT
  • micronised progesterone may have lower breast cancer risk than other progestogens, though evidence is uncertain/controversial

Cardiovascular risk is now understood to be minimal:

• no increased risk with transdermal HRT
• very small stroke risk and moderate VTE risk with oral preparations

Reduced fracture risk is seen with current users of HRT, but this benefit fades on cessation of treatment.

Small effects on the incidence of endometrial and ovarian cancer are observed with HRT.

Regarding risk of dementia and all-cause mortality, the majority of evidence in the 2024 NICE review showed no significant difference between users and non-users of HRT, though this is still uncertain.