hormones
Definition and Symptoms of Menopause
Menopause is defined as the final menstrual period, with symptoms affecting approximately 75% of individuals presumed female at birth.
- Menopause occurs at a median age of 51 years, with a normal range of 45 to 55 years.
- Perimenopause is a transitional stage lasting 4 to 8 years before menopause, characterized by irregular menstrual cycles.
- Symptoms include vasomotor symptoms (hot flushes, night sweats), urogenital symptoms (vaginal dryness, urinary tract infections, incontinence), psychological symptoms (anxiety, depression), and musculoskeletal symptoms.
- Symptoms can start during perimenopause and last an average of 7 to 10 years, with 28% experiencing moderate to severe symptoms.
Diagnosis of Menopause
Menopause diagnosis is primarily clinical, based on menstrual patterns, symptoms, and age. 
- Diagnosis typically does not require hormone concentration assessments for individuals over 45 years.
- Hormone tests (FSH and oestradiol) may be necessary for those with ambiguous menstrual histories or younger individuals with amenorrhea.
- Serum FSH and oestradiol should not be measured if oestrogenic-containing therapies have been used in the past 4 weeks.
Overview of Systemic MHT
Systemic MHT is indicated for treating menopausal symptoms and preventing osteoporosis.
- It includes estrogen-only MHT, combined MHT, and other forms like tibolone.
- Individualized assessment of benefits and harms is essential before starting therapy.
Contraindications, Benefits, and Harms of Systemic MHT
Contraindications must be assessed before initiating systemic MHT.