BMJ  2007;334:736-741 (7 April), doi:10.1136/bmj.39153.522535.BE

Clinical Review

Managing the menopause

Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, New Zealand

The first 150 words of the full text of this article appear below.

The transition into the menopause usually begins with elongation of cycle length, the term postmenopausal being used after one year with no periods.¹ Most women experience menopause between 40 and 58 years of age.¹ No menopausal symptom is universal.^w1 In Western society the commonest symptoms are hot flushes, night sweats, vaginal dryness, and sleep disturbance.² Many women manage the menopause by themselves, with only about 10% seeking help from healthcare providers.² Hormone replacement therapy is the most effective treatment for symptoms (table 1)³ and although opinions are still polarised advice on its use has changed after the women's health initiative studies.⁴

SUMMARY POINTS Hormone replacement therapy remains an appropriate treatment for women with moderate to severe menopausal symptoms Hormone replacement therapy should not be used for the prevention of chronic disease Treatment should be at the lowest dose for the shortest time necessary to control symptoms Women should be advised of . . . [Full text of this article]

Sources and selection criteria

What are the indications for hormone replacement therapy?

Menopausal symptoms
Prevention of chronic disease

What should women do about bone?

What needs to be done before starting therapy?

How is hormone replacement given?

What are the bleeding patterns with hormone replacement therapy and how should irregular patterns be investigated?

What advice can be given about stopping therapy?

Are there other treatments that can help menopausal symptoms?

What are the treatments for women with previous breast cancer?

Testosterone replacement

What does the future hold?

ADDITIONAL EDUCATIONAL RESOURCES
Useful websites
Other cochrane reviews of menopausal and older women

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