Clinical Review

Managing the menopause

BMJ 2007; 334 doi: (Published 05 April 2007) Cite this as: BMJ 2007;334:736

This article has a correction. Please see:

  1. Helen Roberts, senior lecturer women's health
  1. Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, New Zealand
  1. h.roberts{at}

    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


    • 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 the increased risk of stroke, deep vein thrombosis, and gallbladder disease with both combined and oestrogen only therapy

    • Combined therapy is also associated with increases in risk of breast cancer and dementia (women aged >65)

    Sources and selection criteria

    This review is based on a search of Medline, the Cochrane Database of Systematic Reviews, and citation lists of relevant publications. The subject headings and key words used were “menopause”, “hormone replacement therapy”, “WHI”, “hot flushes”, “vaginal dryness”, “tibolone”, “testosterone”, and “complementary”.

    View this table:
    Table 1

     Grades of evidence for symptom relief at menopause

    What are the indications for hormone replacement therapy?

    Menopausal symptoms

    Indications for hormone replacement therapy are hot flushes, night sweats, and vaginal dryness (table 1).3 A Cochrane review of randomised trials showed a 75% reduction in flushes (18 fewer per week) with therapy compared with a 50% reduction with placebo.5

    Flushes can start while a woman is still having periods. Her perception of …

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