Hormone therapy -- where are we now?

BACKGROUND: Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity. The characteristic symptoms of a fall in oestrogen are vasomotor and urogenital atrophy symptoms; with symptoms reported by up to 85% of women over a mean duration of 5.2 years. Long term consequences of menopause include osteoporosis and cardiovascular disease. Menopause management is highly controversial and can be confusing for both clinicians and their women patients.
OBJECTIVE: To explore menopausal management options including comprehensive evaluation; lifestyle modification for symptom relief and risk prevention; hormone therapy or nonhormonal alternatives for symptom relief; prevention and treatment of long term risks; and education and psychological support and therapy. DISCUSSION: Use of hormone therapy involves consideration of the woman's risk-benefit profile. We attempt to clarify this complex topic and focus on the impact of hormone therapy in women aged 50-59 years, including the benefits of relief of hot flushes and urogenital atrophy symptoms and the prevention of fractures and diabetes; and the risks, including venothrombotic episodes, stroke, cholecystitis and breast cancer (with combined oestrogen and progestogen only). Nonhormonal options are also explored.