Treating menopause - MHT and beyond

Every woman who lives past midlife will experience menopause, which, by definition, is complete cessation of ovarian function. This process might occur spontaneously (natural menopause) or be iatrogenic (secondary menopause), and can be further classified as 'early' if it occurs before the age of 45 years and 'premature' if it occurs before the age of 40 years. Globally, the mean age of natural menopause is 48.8 years, with remarkably little geographic variation. A woman's age at menopause influences health outcomes in later life. Early menopause is associated with a reduced risk of breast cancer, but increased risks of premature osteoporosis, cardiovascular disease and premature death. The cardinal symptoms of menopause, and adverse health sequelae, are due to loss of ovarian oestrogen production. Consequently, menopausal hormone therapy (MHT) that includes oestrogen or an oestrogenic compound ameliorates menopausal symptoms, while preventing menopause-associated bone loss and cardiometabolic changes. Importantly, comprehensive care of postmenopausal women involves lifestyle optimization (attention to nutrition and physical activity, reducing alcohol consumption and not smoking) and treating other established chronic disease risk factors. This Review offers a commentary specifically on the contemporary use of MHT and novel pharmaceutical alternatives to manage menopausal symptoms. Menopause affects roughly half of the global population, yet many affected people do not receive the treatment they need. This Review discusses currently available menopausal hormonal therapies and novel pharmaceutical alternatives to manage menopausal symptoms.

Automated summary

Menopause is a natural process that every woman will experience in midlife, characterized by the complete cessation of ovarian function. The age at which menopause occurs can influence a woman's health outcomes in later life. Early menopause is associated with reduced breast cancer risk but increased risks of osteoporosis, cardiovascular disease, and premature death. Symptoms of menopause are due to a loss of ovarian estrogen production, which can be alleviated by menopausal hormone therapy (MHT). Comprehensively caring for postmenopausal women involves optimizing lifestyle and treating other chronic disease risk factors. This review focuses on the use of MHT and novel pharmaceutical alternatives to manage menopausal symptoms.