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Menopausal Hormone Therapy

Educational Objective
To understand that hormone therapy is most effective at managing menopausal vasomotor symptoms
1 Credit CME

Hormone therapy is the most effective treatment for managing menopausal vasomotor symptoms. Hot flashes and night sweats affect approximately 70% of midlife women and may persist for a decade or longer.1 Bothersome vasomotor symptoms have a significant adverse effect on sleep, daily functioning, and quality of life. Cognitive and mood symptoms often accompany disruptive hot flashes. Although lifestyle changes and nonhormonal options are available, women with frequent, severe vasomotor symptoms may greatly benefit from hormone therapy.2

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Article Information

Corresponding Author: Jan L. Shifren, MD, Midlife Women’s Health Center, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St, Yawkey 10A, Boston, MA 02114 (jshifren@mgh.harvard.edu).

Published Online: May 30, 2019. doi:10.1001/jama.2019.5346

Conflict of Interest Disclosures: Dr Shifren reported receiving personal fees from the New England Research Institute for research consulting. Dr Manson reported receiving grants from the National Institutes of Health.

References
1.
Avis  NE, Crawford  SL, Greendale  G,  et al.  Duration of menopausal vasomotor symptoms over the menopause transition.  JAMA Intern Med. 2015;175(4):531-539.PubMedGoogle ScholarCrossref
2.
The NAMS 2017 Hormone Therapy Position Statement Advisory Panel.  The 2017 hormone therapy position statement of The North American Menopause Society.  Menopause. 2017;24(7):728-753.PubMedGoogle ScholarCrossref
3.
Shifren  JL.  Genitourinary syndrome of menopause.  Clin Obstet Gynecol. 2018;61(3):508-516.PubMedGoogle Scholar
4.
Kaunitz  AM, Manson  JE.  Management of menopausal symptoms.  Obstet Gynecol. 2015;126(4):859-876.PubMedGoogle ScholarCrossref
5.
Manson  JE, Ames  JM, Shapiro  M,  et al.  Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making.  Menopause. 2015;22(3):247-253.PubMedGoogle ScholarCrossref
6.
Manson  JE, Chlebowski  RT, Stefanick  ML,  et al.  Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials.  JAMA. 2013;310(13):1353-1368.PubMedGoogle ScholarCrossref
7.
Vinogradova  Y, Coupland  C, Hippisley-Cox  J.  Use of hormone replacement therapy and risk of venous thromboembolism.  BMJ. 2019;364:k4810.PubMedGoogle ScholarCrossref
8.
Manson  JE, Aragaki  AK, Rossouw  JE,  et al; WHI Investigators.  Menopausal hormone therapy and long-term all-cause and cause-specific mortality.  JAMA. 2017;318(10):927-938.PubMedGoogle ScholarCrossref
9.
Rivera  CM, Grossardt  BR, Rhodes  DJ,  et al.  Increased cardiovascular mortality after early bilateral oophorectomy.  Menopause. 2009;16(1):15-23.PubMedGoogle ScholarCrossref
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