Key Points : Menopause Management

• Lifestyle modification may assist menopausal symptom control, psychological symptomatology and cardiovascular and osteoporosis risk reduction.
• HRT is the most effective method for relieving hot flushes, urogenital symptoms, and sleeplessness. The lowest effective dose of HRT should be used for menopausal symptom relief for the shortest duration.
• A progestogen must be used with oestrogen therapy where a woman has a uterus
• Vaginal oestrogen is effective for isolated urogenital symptoms and is associated with minimal systemic absorption.
• Tibolone is an effective alternative to conventional HRT.
• Gabapentin, desvenlafaxine, venlafaxine, paroxetine and clonidine are non-hormonal alternatives for relieving vasomotor symptoms.
• Venous thromboembolism (VTE) is the main short term risk of HRT in women aged 50-59 years where HRT use doubles the baseline VTE risk.
• A small increase in the risk of breast cancer is seen after 5 years EPT use and 15 years ET .
• HRT should not be used for primary or secondary prevention of cardiovascular disease; however, short term use of HRT in healthy 50-59 year old postmenopausal women is not associated with an increase in cardiovascular risk.
• HRT should be initiated early in women with premature /early menopause and continued until age 50 years
• Current scientific evidence does not support the use of complementary/ alternative therapies in the management of menopausal symptoms.