This article presents an insightful discussion on the paradigm shift in post-reproductive health, highlighting the importance of personalised menopausal hormone therapy.
In recent years, discussions surrounding menopause have increased, with countries like the UK, Australia, and the US at the forefront of this evolving discourse. A paradigm shift is underway, marking what can be aptly termed the ‘menopause revolution’.
Beyond the common hot flushes, menopause encompasses a spectrum of health issues impacting bones, mental health, sexual well-being, and cardiovascular health. Regrettably, millions of women have forgone treatment due to lingering fears instilled by the Women's Health Initiative (WHI) study. It is imperative for healthcare professionals to reassess and accurately address female patients, prescribing menopausal hormone therapy (MHT) judiciously where there are no contraindications.
THE GLOBAL PRIORITY OF POST-REPRODUCTIVE HEALTH
Post-reproductive health has become a global priority, recognising menopause as a phase when women continue to play pivotal roles in family and society. Comprehensive counselling on the benefits and risks of MHT, coupled with lifestyle education, is indispensable. The type and duration of MHT should be meticulously tailored based on individual patient history, menopausal age, physical characteristics, and current health status to ensure that the benefits consistently outweigh the risks. Regular reassessment of health conditions is particularly crucial for menopausal women, especially those on MHT.
EMPOWERING HEALTHCARE PRACTITIONERS
Healthcare practitioners play a pivotal role in safeguarding the health and lives of mid-life women. Increasing awareness of menopausal symptoms, offering diverse healthcare options, including MHT, and advocating for healthy lifestyle changes are imperative. The impact of modifications made before or during the menopausal transition is profound, even for women of advanced age.
TAILORED MHT FOR OPTIMAL BENEFITS
For women experiencing menopausal symptoms, particularly vasomotor and urogenital symptoms, and in the absence of contraindications, MHT stands as the primary treatment option. However, the prescription of MHT should be highly personalised, considering factors such as chronological and menopausal age, physical characteristics, and current health status. Initiating MHT at the onset of symptoms and maintaining it as long as the risk–benefit ratio remains favourable maximises its efficacy.
SEXUAL FUNCTION AND THROMBOTIC RISK
In early postmenopause, the choice between transdermal oestradiol-based treatment and oral conjugated equine oestrogens (CEE) can significantly impact overall female sexual function. Transdermal oestradiol-based treatment proves more effective, while transdermal testosterone treatment can address hypoactive sexual desire disorder, albeit with safety considerations. Notably, the type of progestogens associated with oestrogens plays a critical role in thrombotic risk. Micronised progesterone and dydrogesterone do not increase the risk, unlike norpregnanes (nomegestrol acetate and promegestone), norethisterone, and medroxyprogesterone acetate. For women with an increased baseline thrombotic risk, a preference for transdermal oestrogens, and, where indicated, micronised progesterone or dydrogesterone, is advisable.
CONCLUSION
The menopause revolution calls for a paradigm shift in the approach to women's health during this transitional phase.
By embracing personalised MHT, healthcare practitioners can not only alleviate bothersome symptoms but also contribute to the overall well-being and longevity of women.
Find out more here: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.15278
