PW60: Update on Therapeutics for Perimenopause and Menopause

Everything we thought we knew about hormones has changed. Re-evaluation and long-term follow-up of the Women’s Health Initiative trials has led to new conclusions about the risks and benefits of menopausal hormone therapy. Estrogen use is actually associated with lower risk of breast cancer, and failing to use a progestogen alongside estrogen, regardless of whether the patient has a uterus or not, can increase risk of ovarian cancer. The conventional consensus on hormone prescribing has also been evolving in light of all of the new emerging knowledge. ACOG and the Menopause Society (formerly NAMS) endorse either vaginal estradiol or even topical estradiol to treat genitourinary syndrome of menopause or intractable hot flashes in breast cancer survivors after other non-hormonal therapies have failed (and with proper informed consent or weigh-in from their oncologists). Stopping hormones after age 60 or more than 10 years into menopause is no longer the recommended norm, as new large scale research has revealed more benefits than risks in this population.  

As menopause takes center stage in current discussions and media attention, a new medication has recently been approved to treat hot flashes. As well, there are herbal therapies that actually work that providers should be aware of.  With so many options to balance hormones and treat symptoms for our perimenopausal and postmenopausal patients, learn the safest and most effective delivery methods, formulations and dosing strategies along with laboratory methods to monitor therapeutic levels and safe metabolism and detoxification. Break free from the old misconceptions about hormones and be the provider your patients need to thrive during this time of transition.