Definition of Natural Menopause: No Menstrual Period for 12 Months. Average Age of Occurrence

Menopause

Definition of natural menopause: no menstrual period for 12 months. Average age of occurrence: 51-52 years.

Perimenopause:

 occurs around ages 42-52 years  irregular cycles: may be shorter or longer; heavier or lighter; missed periods  vasomotor symptoms: hot flashes, night sweats  urogenital and vaginal symptoms: dryness, itching, painful intercourse, increased bladder infections  FSH rises

Many women will have improvement in vasomotor symptoms within several months and most will resolve within 4-5 years. However, a substantial minority of women continue to have troublesome symptoms for years. Estrogen supplementation is clearly the gold standard therapy for the reduction of the vasomotor symptoms of menopause. The efficacy in reducing hot flashes is 80-100%. The Women's Health Initiative trial results have led to conclusion that hormone replacement therapy (HRT) has substantial risks and should definitely not be used for primary or secondary prevention of CHD in women. However, the absolute increased risks were small.

HRT indications by current labeling:

 treatment of moderate-severe vasomotor symptoms  treatment of moderate-severe vaginal atrophy (but consider topical instead for lower dose)  prevention of osteoporosis (not treatment) in women at significant risk

Due to the potential harms of HRT, many people are interested in non-hormonal treatment of hot flashes. Studies of treatment of vasomotor symptoms of menopause are complicated by the high rate of placebo effect (around 25%). Drugs that seem to be helpful:

 clonidine  alpha-methyldopa  antidepressants including venlafaxine, fluoxetine, paroxetine  gabapentin

Complementary therapies for hot flashes:

Phytoestrogens such as soy have not been shown to be better than placebo in randomized controlled trials. Black cohosh is a non-pharmaceutical treatment option that is touted by many. Evidence for its effectiveness is currently lacking as it only has a small number of small unblinded studies with poor methodology. There is also mixed evidence for Vitamin E. Evening primrose oil, ginseng, and wild yam cream have been proven to be ineffective. In summary, other options for treatment of vasomotor symptoms besides HRT:

 lower doses/shorter durations of use of HRT  topical treatment  other drugs as listed above (clonidine, alpha-methyldopa, antidepressants, gabapentin)  practical measures: paced respirations, dress in layers, and avoiding turtlenecks, down comforters, alcohol, spicy foods, and bright lights