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Last Updated: 2/5/2013  

Menopause and Hormone Therapy

Diagnosis
  • Ask women beginning at age 40 about menstrual changes and typical menopausal symptoms.

  • Diagnose menopause in women over age 45 who present with amenorrhea and other symptoms and understand that further testing is not generally needed.

  • Measure FSH levels to confirm menopause only if the diagnosis is unclear and confirm menopause in women with an FSH level >40 mIU/mL.

  • Perform a pregnancy test in sexually active women with amenorrhea and obtain additional laboratory tests to exclude other causes of menstrual dysfunction in patients without typical menopausal symptoms or in the presence of other symptoms.

Therapy
  • Advise lifestyle modifications in the treatment of hot flashes.

  • Recommend over-the-counter vaginal moisturizers or lubricants or topical estrogen to treat symptoms associated with vaginal atrophy.

  • Offer nonhormonal therapies such as gabapentin and SSRIs to relieve menopausal hot flashes.

  • Consider HT for the short-term (2 to 3 years) treatment of hot flashes in women who have not had adequate relief with nonhormonal treatments and treat with the lowest effective dose.

  • Recommend pelvic floor exercises and bladder retraining for the treatment of incontinence.

DOI: 10.7326/d293
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Nananda Col, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Michelle Cyr, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Margaret Miller, MD Women & Infants Hospital of Rhode Island
Providence, RI
has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Carol Wheeler, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Wendy Chen, MD, MPH has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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