Vasomotor Symptoms as a Vital Sign: Cardiovascular, Metabolic, and Mental Health Risk in Menopause Care-From Complaint to Prescription

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Video Summary

The lecture presents a shared-decision algorithm for menopause treatment: assess symptom burden and goals, evaluate hormone-therapy candidacy and individual risk, then choose and adjust therapy with follow-up. Hormone therapy generally has a favorable benefit–risk balance for eligible patients under 60 or within 10 years of menopause; route, dose, formulation, health profile, and preferences matter. Nonhormonal options include SSRIs/SNRIs, gabapentin, neurokinin-receptor antagonists, oxybutynin, cognitive behavioral therapy, and hypnosis; supplements lack consistent evidence. The speaker emphasizes monitoring and medication interactions, including avoiding paroxetine with tamoxifen. Genitourinary symptoms are chronic and progressive without treatment; options include low-dose vaginal estrogen and vaginal DHEA. Sexual health and low desire should also be discussed, with testosterone considered for postmenopausal hypoactive sexual desire disorder after other contributors are addressed. For hormone therapy, progesterone protects the endometrium when the uterus is present and may aid sleep. Treatment success depends on tailoring therapy and revisiting the plan.

Keywords

menopause treatment

hormone therapy

nonhormonal options

vaginal estrogen

testosterone therapy

shared decision-making