Menopause

Question 1

What are the effects of hormone replacement therapy in older women?

Answer 1

• The Women’s Health Initiative study in 2002 demonstrated increased risk of stroke, thromboembolism, heart disease and breast cancer in women exposed to combined HRT.
• Combined HRT increases breast cancer risk when taken for 5 years or more.
• Oestrogen-only HRT is thought to not increase risk of breast cancer. Risk of cardiac events is highest in the first year.
• Timing of initiation seems to be important. Starting around the time of menopause mitigates the risks of thromboembolism and heart disease.
• In general, HRT should not be commenced in older women who are long past menopause.
• Transdermal may be somewhat safer than oral.

Question 2

Define menopause.

Answer 2

• Menopause is the cessation of menstrual periods (amenorrhoea) for six months in a woman over 40 years of age.
• Average age of onset is 51 years old.