Hormonal therapy postmenopausal/perimenopausal

Farquhar CM, Marjoribanks J, Lethaby A, et al. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2005 CD004143... 

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. Perimenopause is the period immediately prior to the menopause and the first year after menopause. Indications of postmenopausal hormone therapy include the short-term treatment of menopausal symptoms (i.e., hot flushes, night sweats, and urogenital atrophy). 

The major indication for estrogen-containing hormone therapy is the relief of menopausal symptoms, and the benefits of short-term perimenopausal and postmenopausal hormone therapy for the relief of severe menopausal symptoms outweigh the risks in many women. 

Evaluation of each individual woman is essential in determining the appropriateness of perimenopausal and postmenopausal hormone therapy, and collaboration between a woman and her primary care provider in the decision-making process is essential. The benefits and risks of hormone therapy should be reassessed annually. 

The initial visit of a perimenopausal or postmenopausal woman is the most appropriate time to obtain a complete medical history, perform a physical examination, and educate the patient. Medical history should include determination of a personal or family history of thrombotic problems. The physical examination should include a complete cardiovascular examination, clinical assessment of thyroid status, and breast and pelvic examinations. Papanicolaou cervical cytologic examination and screening mammography negative for malignancy are required before initiating hormone therapy. Thyroid function tests and lipoprotein lipid profile also should be performed at the discretion of the clinician. 

For PMDD, the first-line strategy is to augment serotonergic neurotransmission, and the second-line strategy is to induce an anovulatory state using different types of hormonal treatments. For the perimenopause syndrome, augmentation of 5-HT neurotransmission and hormone-replacement therapy are the most common treatment strategies. Clinical studies have reported that 17/3-estradiol replacement improves mood in perimenopausal and postmenopausal women with no or mild depression. In postmenopausal women, 17/3-estradiol therapy alone or in combination with antidepressants may be used to treat a major depressive episode. 

Lung cancer The precise role of hormone replacement therapy in the development of lung cancer has often been considered unclear. This has been evaluated in a prospective cohort of 36 588 perimenopausal and postmenopausal women aged 50-76 years in Washington State [15. After adjusting for smoking, age, and other potential confounders, there was an increased risk of incident lung cancer associated with... 

Extracted isoflavones may be consumed as dietary supplements, and are marketed for perimenopausal women and postmenopausal women (PMW) looking for an alternative to hormone replacement therapy. Many of these supplements contain isoflavones from red elover rather than soybeans, and are supplied in daily doses of 50-200 mg/d (Setch-ell et al 2001 Howes and Howes 2002 Nurmi et al 2002 Tice et al 2003 Chua et al 2004 Delmonte and Rader 2006), although actual content upon analysis often differs to that stated on the label (Setehell et al 2001 Howes and Howes 2002 Nurmi et al. 2002 Tice et al. 2003 Chua et al 2004 Krenn and Potsch 2006). 

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