Vasomotor Symptoms as a Vital Sign: Cardiovascular, Metabolic, and Mental Health Risk in Menopause Care-Challenging Hormone Therapy Cases

Video Transcription

Video Summary

The presentation applies a treatment-selection algorithm to three menopause cases:

- <strong>Breast cancer survivor taking tamoxifen:</strong> For vasomotor symptoms (VMS), an NK3 receptor antagonist may be preferred because trials included patients receiving endocrine therapy. Venlafaxine can address both VMS and depression and is compatible with tamoxifen; avoid paroxetine and fluoxetine because they inhibit CYP2D6 and may reduce tamoxifen’s effectiveness. Escitalopram is another possible option. Consider mood, sexual side effects, medication interactions, and follow-up.

- <strong>Healthy 51-year-old with VMS, high fracture risk, and anxiety:</strong> Transdermal estrogen, with a progestogen if the uterus is intact, can address VMS and help prevent osteoporosis; progesterone may also support sleep. Hormone therapy is not a primary anxiety treatment, so reassess symptoms and refer for mental-health care if anxiety remains severe. The speaker also notes evidence associating SSRIs with lower bone density.

- <strong>Postmenopausal patient with prior unprovoked pulmonary embolism:</strong> Estrogen is inappropriate. Fezolinetant may suit her priorities of avoiding sedation and sexual side effects, but requires liver-function monitoring and careful interaction checks. Avoid coadministration with CYP1A2 inhibitors such as ciprofloxacin; reassess any new prescriptions.

Across cases, the speaker emphasizes individualized, shared decision-making, coordinated care, and planned follow-up.

Keywords

menopause treatment

vasomotor symptoms

tamoxifen

transdermal estrogen

pulmonary embolism

fezolinetant

shared decision-making