Journal
CLINICAL OBSTETRICS AND GYNECOLOGY
Volume 61, Issue 2, Pages 260-268Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/GRF.0000000000000358
Keywords
vasomotor symptoms; thrombosis; venous thromboembolism; hormone therapy; nonhormonal therapy; genitourinary syndrome of menopause
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- TherapeuticsMD
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For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. For treatment of the genitourinary syndrome of menopause, vaginal lubricants and moisturizers, low-dose vaginal estrogen, and intravaginal dehydroepiandrosterone are options.
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