OG32.1 | Menopause — Summary & Reflection

KEY TAKEAWAYS

Menopause is permanent cessation of menstruation after 12 months' amenorrhoea, average age 45–47 years in India (51 globally). Perimenopause features irregular cycles and fluctuating hormones; premature ovarian insufficiency (POI) is menopause before 40. The key hormonal changes are: inhibin B fall (earliest) → FSH rise → oestradiol fall → progesterone absence. Consequences of oestrogen deficiency: vasomotor (hot flushes, night sweats — hypothalamic KNDy neurone disruption), urogenital atrophy/GSM (progressive without treatment), osteoporosis (2–5% bone loss per year for 5 years, DEXA T-score ≤−2.5), and cardiovascular risk increase. HRT is first-line for moderate-to-severe symptoms: combined (oestrogen + progestogen) for women with uterus, oestrogen-only after hysterectomy; transdermal preferred; micronised progesterone preferred. Benefits: symptom relief (60–90%), bone protection, early cardiovascular protection. Absolute contraindications: hormone-sensitive cancer, undiagnosed vaginal bleeding, active VTE, severe liver disease. WHI risks apply to older women using oral CEE+MPA — modern HRT risk is substantially lower. Non-hormonal: SSRIs/SNRIs (vasomotor), topical oestrogen or lubricants (GSM), bisphosphonates + Ca/Vit D (osteoporosis).

REFLECT

Think about the woman in the opening case — what are the specific factors that make transdermal combined HRT the most appropriate choice for her? How would your counselling change if she had a history of ER-positive breast cancer treated 8 years ago? Reflect on the WHI trial's impact on prescribing: many women with disabling symptoms were denied effective treatment for 20 years based on a trial that enrolled a population unlike typical symptomatic perimenopausal women. How do you balance population-level risk data with individual patient benefit? What does shared decision-making look like in your menopause consultation?