Menopause & Hormone Therapy

Definition

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity, typically occurring around age 50. Hormone therapy (HT) is the use of estrogen, with or without progesterone, to manage menopausal symptoms and reduce long-term health risks.

Epidemiology

• Average age of natural menopause: 51 years (range 45–55).
• Symptoms affect up to 75% of women during the menopausal transition.
• Early menopause (<40 years) occurs in ~1% of women.
• HT usage varies globally; more common in developed countries.

Etiology

• Natural menopause due to depletion of ovarian follicles.
• Premature or surgical menopause: oophorectomy, chemotherapy, or radiation.
• Hormone therapy: indicated for symptom management and prevention of osteoporosis in select women.
• Risk factors for severe menopausal symptoms: smoking, low BMI, nulliparity, early menopause.

Pathophysiology

• Declining ovarian estrogen and progesterone production.
• FSH and LH levels increase due to loss of negative feedback.
• Vasomotor symptoms due to hypothalamic thermoregulatory instability.
• Urogenital atrophy resulting from estrogen deficiency.
• Long-term estrogen deficiency increases risk of osteoporosis, cardiovascular disease, and cognitive changes.