Vasomotor Symptoms as a Vital Sign: Cardiovascular, Metabolic, and Mental Health Risk in Menopause Care-Panel and Q&A

Video Transcription

Video Summary

The panel discussed managing perimenopausal bleeding and endometrial hyperplasia, with several clinicians favoring the 52-mg levonorgestrel IUD for contraception, heavy bleeding, and endometrial protection. Other options include cyclic or continuous progesterone, vaginal progesterone, or progestins; treatment should reflect patients’ bleeding goals and pregnancy risk. They advised no fixed age or time limit for menopausal hormone therapy: reassess symptoms, health, and preferences, and taper if stopping. Cardiovascular and clotting risks require individualized assessment; prior heart attack or stroke and some histories of DVT may preclude treatment, while specialist consultation can help. The panel discussed liver monitoring for fezolinetant and evidence concerning its use with tamoxifen. For vaginal progesterone, speakers described using 200 mg and investigating abnormal bleeding rather than routinely performing endometrial surveillance. For underserved patients, they recommended verified, evidence-based resources, menopause-trained clinicians, and telehealth where available.

Keywords

perimenopausal bleeding

endometrial hyperplasia

levonorgestrel IUD

menopausal hormone therapy

fezolinetant

vaginal progesterone