Principles of management of premature and surgical menopause in women with initial reproductive health problems

Abstract

Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary menopausal syndrome and has been shown to prevent bone loss and destruction. This circumstance makes it possible to consider menopausal hormone therapy as the main method for the treatment of premature and surgical menopause. It is important to note that despite the similarity of the long-term consequences bilateral oophorectomy and premature fading in ovarian function differ significantly in the dynamics of the hormones concentration decrease. The risks of menopausal hormone therapy vary depending on the type, dose, duration of use, route of administration, timing of onset, and the use of estrogens and progestins. Treatment should be individualized by selecting the most appropriate formulation, dose, route of administration and duration of use, and also using the best data on maximizing benefits and minimizing possible risks with periodic reassessment of the benefits and risks of continuing or stopping the use of menopausal hormone therapy. Key recommendations of American Association of clinical endocrinologists and the American college of endocrinology (2017) are: for women with early menopause and primary ovarian failure, there are health risks that can include persistent vasomotor symptoms, bone loss, mood changes and an increased risk of cardiovascular diseases, dementia, stroke, Parkinson’s disease, ophthalmic disorders and overall mortality. The results of studies in older women do not apply to women with early menopause, and recent evidence suggests that such patients should use menopausal hormone therapy at least until the middle age of menopause. Transdermal oestrogen preparations are less likely to develop thrombotic risk and, possibly, the risk of developing stroke and coronary heart disease compared to oral oestrogens. If a progestagenic component is required, a more safest alternative is micronized progesterone.