Vasomotor Symptoms of Menopause: Assessment and Treatment

Assessment

If the menopausal status is in doubt (eg, in a young woman with amenorrhea), testing for serum follicle–stimulating hormone (FSH) concentration may be helpful. A low value suggests hypothalamic amenorrhea, and an elevated value suggests premature ovarian failure. During the early years of normal menopause, however, FSH levels fluctuate widely, and a normal level gives little information for assessing menopausal status. 

For women at risk for osteoporosis, evaluation with dual energy x–ray absortiometry (DEXA) scan may be used to measure bone density. An initial examination at 65 is reasonable; earlier screening has been suggested for women who smoke or have family histories of early–onset fragility fractures.

Women with risk factors for coronary artery disease should be followed regularly and treated as necessary for prevention, including treatment for hypertension, hyperlipidemia, and other cardiovascular complications (see Cardiovascular section). This recommendation, and other screening recommendations (eg, for breast cancer and colon cancer) are related to a woman’s age and not to her menopausal status.

Treatment

Menopause is a normal part of life, and no treatment is typically required. Symptoms, when they occur, are usually tolerable and eventually pass. However, for women with particularly disturbing symptoms, the following considerations may be helpful.

• Hormone therapy is highly effective, but women considering this therapy should be counseled that it has been associated with an increased risk of heart disease, stroke, breast cancer, and endometrial cancer. Other effective treatments for hot flashes include some antidepressant medications (eg, paroxetine), clonidine, and gabapentin.
• Nutritional therapies may be useful (see Nutritional Considerations).
• Women should be counseled on adequate dietary or supplement intake of calcium and vitamin D.
• Exercise is important for stimulating bone formation and decreasing resorption, as well as for cardiovascular health.
• Antiresorptive medications can be considered for elderly patients with low bone–mineral density.